Pressure is building for more preventive care

Medicare urged to expand test coverage

Pressure is building on Congress to increase the number and scope of preventive care tests and services covered by Medicare. How ever, that effort is being complicated by competing cost considerations, such as Medicare paying for a drug prescriptions and catastrophic and long-term care measures, experts say.

The prestigious Institute of Medicine (IOM) in Washington, DC, for instance, has called for Congress to expand Medicare coverage to include such preventive services such as medically necessary dental care, skin cancer screening, nutrition therapy, routine care in clinical trials, and elimination of the three-year limit on immunosuppressive drugs for transplant recipients.

The IOM also is seeking the eight screening services recommended by the U.S. Preventive Services Task Force for people older than 64. Those services include blood pressure testing, height and weight checks, and screenings for vision and hearing impairments and problem drinking.

Currently, Medicare covers flu, pneumonia, and hepatitis B shots; mammograms; Pap smears; pelvic exams; colorectal screenings; diabetes self-management; bone mass measurements; and prostate screening tests.

The Health Care Financing Administration already funds a demonstration project for up to 1,800 Medicare beneficiaries with coronary heart disease to enroll in a program for reversing heart disease created by Dean Ornish, MD, who is founder and president of the nonprofit Preventive Medicine Research Institute in Sausalito, CA.

The project’s goal is to determine whether a lifestyle modification program — a low-fat, low-cholesterol diet and moderate exercise — is a safe and effective alternative to bypass surgery and angioplasty.

Legislation sponsored by U.S. Sens. Bob Graham (D-FL) and James Jeffords (R-VT) adds eight new preventive screening and counseling benefits to Medicare’s list. Those include hypertension, glaucoma, vision, hearing, cholesterol and osteoporosis, smoking cessation counseling, and hormone replacement therapy.

While it’s hard to argue with the idea of preventive medicine, some critics say it is fiscally unsound to add more items to Medicare’s coverage when many of the items on the current list of approved preventive services are being underutilized.

"The basic problem is that the Medicare benefit package, as it is now designed, does not distinguish between effective and ineffective services," says John Wennberg, MD, of Dartmouth College in Hanover, NH.

Before adding more preventive benefits, "the entire benefit package needs to be re-examined using the criteria of evidence-based medicine," Wennberg says.