Research from leading expert organizations confirm time and time again the importance and effectiveness of preventive screenings and exams. Yet why are practitioners still having difficulty meeting this relatively inexpensive need for their patients? One argument is that payers place too many obstacles in the way, over-incentivizing reactive care and making the provision of preventive services difficult for practitioners to provide. Another argument is that patients may not be aware they are eligible to receive such services, often at no cost to them, and do not ask about what such services are available. A final argument is that, as a society, we are so focused on taking care of our over-abundance of chronically ill people that practitioners simply lack the time to flip the healthcare paradigm to a preventive care model. It's probably reasonable to assume that all the above play some role in the underutilization of preventive services. The Centers for Disease Control and Prevention (CDC) supports this notion, citing a lack in implementation on the behalf of practitioners.
Want to learn more about providing and getting paid for preventive services? Check out our detailed guide!
The underutilization of preventive services is making it difficult to get a handle on the spiraling costs of chronic health conditions. With 90% of the United States' $3.5 trillion annual health expenditures spent on treating people with chronic and mental health conditions, chronic disease prevention and preventive services should be on the top of mind for practitioners and patients alike.
Understanding the Concept of Preventive Services
We mentioned "preventive services" several times above. In the event that this term is new or not very familiar to you, let's step back and answer the question you may have: What are preventive health services? Healthcare.gov provides a helpful preventive services definition: "Routine healthcare that includes screenings, checkups, and patient counseling to prevent illnesses, disease, or other health problems".
The various types of preventive health services are some of the most valuable resources in our healthcare arsenal and should be provided across the age spectrum. While our healthcare system seems to be good at providing preventive care to younger populations, elderly counterparts, and consequently some of our most vulnerable patients, are often overlooked or remain unaware that they should be receiving preventive screenings.
More specifically and within the realm of primary care, preventive services cater well to our senior patients. In addition, they are reimbursed well by Medicare. Based on guideline schedules, the subject of preventive screenings can be broached during any visit but are often best received by patients when they are participating in their Medicare annual wellness visit (AWV). The final step in completing the AWV is creating an action plan. This provides the perfect opportunity to identify and schedule preventive screenings and exams the patient is due for or will be due to receive prior to the patient's next annual wellness visit.
Per Medicare guidelines, practitioners should work with their Medicare patients to determine whether these patients should receive the preventive services and screenings listed below. Most of these services are reimbursable to the rendering practitioner and usually fully covered by Medicare with no out-of-pocket expense to the patient. They can be broken down as follows:
Assessments and Counseling
- Alcohol misuse screening — Medicare covers one screening annually and up to four brief, face-to-face counseling sessions per year.
- Depression screening — Covered once annually by Medicare.
- Obesity screening and counseling — Intensive behavioral therapy is covered for patients with a body mass index of 30 or more.
- Behavioral therapy for cardiovascular disease — A risk reduction visit is covered once annually by Medicare.
- Smoking and tobacco use cessation counseling — Medicare covers up to eight face-to-face visits every 12-month period.
- Low dose lung cancer screenings (LDCT) counseling to determine if LDCT imaging should be ordered.
Clinical Procedures and Imaging
- Abdominal aortic aneurysm screening — Covered by Medicare once in a lifetime.
- Bone mass measurements — Covered by Medicare for at-risk individuals once every 24 months.
- Lung cancer screening — A low-dose computed tomography (LDCT) scan is covered once every 12 months for patients meeting predefined criteria.
Laboratory Diagnostics
- Cardiovascular disease screening — Covered once every five years and includes tests for cholesterol, lipid, and triglyceride levels.
- Diabetes screening — Medicare covers up to two screenings per year for at-risk patients.
- Prostate cancer screening — All men over the age of 50 are covered once every 12 months.
Vaccinations
- Flu vaccine — Covered once each flu season.
- Pneumococcal shots — Medicare covers the initial vaccine, and the second shot is covered 11 months after the first vaccine is given.
- Hepatitis B shots — Patients with medium to high risk for Hepatitis B are covered.
Preventive Services Meaning: The Value of Preventive Services
The National Council on Aging reports that nearly 80% of older Americans have at least one chronic disease, and of those people, 77% are battling at least two chronic diseases. Ninety percent of Americans over the age of 55 are at risk for hypertension, leaving them very vulnerable to America's leading cause of death: heart disease. Chronic diseases are creating a huge strain on patients, siphoning away their quality of life, hard-earned money, and productivity.
Simply put, the provision of preventive services saves lives, but access to preventive care is still a major concern for many Americans. Income and education levels play a big role in whether patients receive preventive services. Of American adults aged 50 to 74 and making less than $25,000 annually, only half will receive a colorectal cancer screen. This figure is significant because treatment of colorectal cancer is not only difficult, but it can cost upwards of $50,000 to battle. Yet when caught in its earliest stages, it's very treatable and costs are considerably lower.
The same can be said about other chronic conditions such as heart disease, diabetes, and obesity. If practitioners can support more patients with preventive services and chronic conditions are caught early and mitigated effectively, the overall cost of treatment decreases tremendously and patients typically live healthier and happier lives.
While preventive services work to improve the health and wellness of patients, practitioners and their practices can reap the rewards of a proactive healthcare model as well. Medicare, as previously noted, and many other payers cover preventive exams at little to no cost to the patient, reducing barriers and allowing patients to be more proactive in their care. For practitioners, it's generally easy to perform preventive exams, such as Medicare's annual wellness visit, and these services often reimburse well, making them a low-hanging fruit on the revenue tree.
Promote Wellness Through the Provision of Preventive Services
Providing patients with preventive services and exams is a win-win for everyone. With the cost of healthcare spiraling out of reach for a growing number of Americans, it is vital that we shift our focus to the more cost-effective healthcare delivery model of promoting health and wellness with the use of preventive services and exams. Through such screenings and assessments, the health of our nation will improve, saving lives and dollars. Even payers, both government and private, are working hard towards incentivizing practitioners to deliver these services, making preventive exams and screenings sustainable and lucrative.
With improving and evolving technology, practices and practitioners that find it difficult to manage preventive services for their patients can identify readily available support tools, such as the technology solutions offered by Prevounce, to help facilitate and increase practice efficiency and productivity. Between the prospect of helping patients live longer and healthier lives and the increasingly generous reimbursements from payers, preventive services should be a core offering for every practice and practitioner.
