"Typically Medicare reimburses more for doing things to the patient, such as a procedure or addressing a disease like heart failure. As a physician you can get more money from Medicare for cleaning out earwax or removing harmless skin growths than you can for spending 40 minutes evaluating the patient and figuring out how to keep them healthy," Landsverk said.

Future studies should address whether time spent on certain non-covered services actually translates into healthier patients, better outcomes or cost savings, she said.

Patients are likely to get better overall care through payment plans such as On Lok or a vertically integrated HMO like Kaiser Permanente, which try to offset future costs to the plan by preventing the patients decline. However, even good plans like Kaisers need more funding, she said.

Even though Medicare does not cover expenses for geriatric services that benefit many patients, some doctors can still take advantage the system, by doing less to help the patient and billing for more, Landsverk said.

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Contact: Kevin Boyd
kboyd@pubaff.ucsf.edu
415-476-8429
University of California - San Francisco
5-Jun-2002