Medicare shortchanges initial doctor visit, SFVAMC ...( During an older patient's first visit t...)

Medicare shortchanges initial doctor visit, SFVAMC study says

During an older patient's first visit to the doctor, nearly 40 percent of the time spent is not reimbursed by Medicare, including evaluation of cognition and mood, and discussions of exercise, nutrition, and preventive services, according to a study from a San Francisco VA Medical Center researcher.

"With older patients you really can't ignore these services," said the study's lead author Elizabeth Landsverk, MD, geriatrician at the UCSF-affiliated SFVAMC. "For instance if you're not evaluating physical function and discussing the importance of exercise the patient may spend most of the day in the chair and lose the ability to walk well, and be at higher risk of falls."

"These preventive services are very important and if Medicare does not pay for them they are likely to be ignored," she added.

Landsverk examined how the time is spent during an elderly patient's initial visit to the doctor by tape-recording 21 such visits at Mt. Sinai Medical Center in New York. Reviewing the tapes, she logged the time in five-second increments, assigning each increment to one of 23 descriptive categories, such as history-taking, chatting, cognitive assessment, and so on.

She presented the results recently at the annual meeting of the American Geriatrics Society in Washington DC.

Although Medicare reimbursed for a majority of the doctor's time during an average visit, 37 percent of the time was not reimbursed. Medicare covers time spent on the physical exam, medical history, medication review, and planning of tests and treatments. However, it does not reimburse doctors for discussions of nutrition, exercise, preventive services, health education, or administrative tasks such as acquiring patient information from other sources and coordinating care, Landsverk said.

"These services can make a big difference in the health and functioning of older patients, and if Medicare isn't paying for them, and they are not performed, the pat
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Contact: Kevin Boyd
kboyd@pubaff.ucsf.edu
415-476-8429
University of California - San Francisco
5-Jun-2002

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