Doctors Offer Advice In Navigating Maze Of Medicare ‘Physical’

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For Medicare patients, getting a “physical” requires running a paperwork maze — mostly because it is not an actual physical.

“It’s a planning session,” Dr. Jennifer Dumbolton told the audience at a recent Lunch & Learn program at the Payson Regional Medical Center’s Senior Circle.

The Medicare physical is more properly called “Welcome to Medicare” preventive visit, which might help avoid some of the confusion. But the government being what it is ...

The goals of the visit are health promotion, disease prevention and detection, according to Jan Parsons, Senior Circle advisor.

New patients can schedule the welcome visit for free within the first 12 months the individual becomes eligible for Medicare.

The patient must complete an extensive questionnaire in advance of the visit, Dumbolton said. It requests lots of personal information, some of which patients may find intrusive and insulting. For instance, they are asked if they can take care of their own hygiene and dress themselves.

“The visit allows the doctor to make a plan with the patient for their future health care and maintenance,” said Dr. Amalia Pineres, who was a co-presenter of the program with Dumbolton.

Outlined on the medicare.gov Web site, the visit includes a review of the individual’s medical and social history related to their health and education; counseling about preventive services, including certain screenings, shots and referrals for other care if needed. It also includes height, weight and blood pressure measurements; a calculation of body mass index; a simple vision test; a review of the potential risk for depression and the individual’s level of safety; an offer to talk about creating advance directives; and a written plan for which screenings, shots and other preventive services that may be needed and details about the coverage by Medicare for screenings, shots and the other services.

Dumbolton explained the advance directives include such things as an end of life plan, which can be discussed only with the patient’s consent; health care proxies; living wills; and after-death issues.

“It takes a half hour or more to get through (the Welcome to Medicare visit),” Pineres said.

To make the process more efficient, the patients get the questionnaire before their actual appointment with the doctor. The Medicare Web site advises patients to bring medical records, including immunization records, family health history, prescription and over-the-counter drugs, vitamins and supplements and how often they are taken and why.

After completing the visit, patients get a checklist of information about the free screenings and preventive services.

Those who have been eligible for Medicare for more than a year have a similar planning service available through the yearly “wellness” visits.

At this visit, the doctor will develop or update the individual’s personalized prevention help plan to prevent diseases and disability based on their current health and risk factors. Naturally there is paperwork involved, the individual must fill out a Health Risk Assessment for the visit.

The visit will include a review of medical and family history; developing or updating a list of current care providers and prescriptions; height, weight, blood pressure and other routine measurements; tests for detection of any cognitive impairment; personalized health advice; a list of risk factors and treatment options; and a screening schedule.

The “Wellness” visit is also free, however, if additional tests or services are part of it and are not covered under preventive benefits, the individual may have to pay co-insurance and the Medicare Part B deductible may apply.

Dumbolton and Pineres talked about some of the screening tests:

• Colonoscopy: Starting at age 50, perform every 10 years unless

health issues require more often.

• Lipids: Every 5 years, without risk factors.

• Bone density: Every 2 years.

• Diabetes: At least annually.

• Glaucoma: Annually with risk factors.

• Mammograms: Annually after age 40.

• PSA, annually.

• Pap, every two years or annually if at high risk.

• HIV: Annually or more often if at high risk.

• Immunizations: flu shot, annually; pneumonia, every 5 years; a DTP

shot for diphtheria, tetanus and pertussis in older adults

recommended.

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