Physicians treating Medicare beneficiaries often do not give them the full range of recommended preventive services, according to a new report by the General Accounting Office released to the public on Thursday.
In 2000, about 30% of beneficiaries did not receive a flu shot, and 37% had never been vaccinated against pneumonia, the GAO reports, citing federal statistics.
Furthermore, the report says many Medicare beneficiaries appear to be unaware that they may have conditions that preventive services are meant to detect.
A routine checkup where a doctor could deliver preventive services is not covered under fee-for-service Medicare, which enrolls about 84% of Medicare beneficiaries, the report says.
Medicare+Choice HMOs, on the other hand, generally offer a benefit for periodic checkups. Some of these plans are regarded as "particularly innovative" in assessing risk, providing screening services, and conducting prevention programs, the GAO says.
Surveying five Medicare+Choice plans serving 1.2 million Medicare beneficiaries in 15 states, the GAO finds some plans try to determine needed preventive services by paying for periodic preventive visits, sending out health risk questionnaires and making periodic assessments of medical claims and pharmacy data, the report says.
But the report says few of plans conducted "a systematic evaluation" of whether these approaches improved health outcomes or lowered healthcare costs And the few studies that exist are "limited in terms of how their findings might be generalized to Medicare beneficiaries."
The GAO suggests the following options for improving the provision of preventive services under fee-for-service Medicare, but warns they would raise costs:
- a one-time "Welcome to Medicare" examination for new beneficiaries
- a periodic examination benefit for all beneficiaries
- using non-physician providers to assess health risks and ensure the delivery of preventive services, an approach that CMS recently considered