For one physician, health reform means more time with patients

WASHINGTON–If federal Medicare officials need a star for their new public service ads touting preventive care benefits for seniors, Dr. Rebecca Andrews, a clinic director at the UConn Health Center, would be perfect for the role.

Andrews, the Health Center’s associate medical director for general medicine, says her practice-among Medicare patients at least-has been transformed by federal health reform.

The biggest change? Many of her elderly Medicare patients used to only come to see her when they were sick–crammed into her schedule for a 15-minute appointment to deal with a cold, flu, or other urgent illness.

Now, because federal health reform allows Medicare patients to get free annual wellness visits, Andrews gets to spend 45 minutes with those patients when they are healthy–asking them about diet and exercise, persuading them to get colonoscopies or sign up for smoking cessation.

Before the free visits were available, Andrews said she would try to squeeze a few general questions in at the end of a 15-minute sick visit–asking, for example, whether the patient had gotten a seasonal flu vaccine or a mammogram–for fear they wouldn’t come in again until they were ill again.

Now, she can probe those issues in a different environment.

“It’s 45 minutes where you get to sit and talk to your patient,” Andrews said in a recent interview. “You review all their histories and medications, and then you ask them a long list of questions trying to catch anything you have missed. And you do a lot of healthy behavior sessions. You talk to them about vaccines, you talk to them about a colonoscopies.”

Under federal health reform, Medicare began covering annual wellness visits at the beginning of 2011 with no co-pays or other “cost-sharing” mechanisms. The government health insurance program for seniors also started providing other prevent services at no cost to seniors, such as screenings for prostate cancer and osteoporosis.

Proponents of the reform law say such provisions represent a significant shift in health care-with a greater emphasis on prevention-that is key to curbing spiraling health care costs.

Some patients in private plans may also now be eligible for free annual physicals and other preventive care. Under health reform, insurers are now required to cover recommended preventive services, without any co-pay or deductible, for new enrolles–individuals and families who signed up for a new health plan after Sept. 23, 2010.

Republicans in Congress have targeted the entire health law–including the new preventive care benefits–for repeal. House Republicans say Medicare is already on an unsustainable course, a major driver of the current annual deficits. They have proposed privatizing the program, by giving seniors subsidies to purchase insurance in the private market, which would save the federal government billions of dollars.

Democrats have seized on the GOP proposal and highlighted the impact on seniors. According to an analysis by the Congressional Budget Office, Medicare patients would see their out-of-pocket health care costs jump significantly under the GOP plan, and obviously the free preventive care would disappear.

Rep. Joe Courtney, D-2^nd District, recently held a town hall meeting on Medicare, with Andrews as his marquee speaker. He said her experience demonstrates that the free prevention care is “exactly the kind of delivery reform that we need.”

On Monday, the federal Centers for Medicare and Medicaid released a report showing that so far, more than 5 million Americans, about 20 percent of Medicare beneficiaries, have taken advantage of those free preventive services. CMS also launched a new public education campaign on Monday aimed at the other 80 percent of Medicare patients.

“You take your car in for a yearly smog check, change the battery in your kitchen’s smoke detector, and file your taxes,” Mayra Alvarez, public health policy director at the federal Department of Health and Human Services, wrote in a recent blog post. “But what about you?”

She noted that Americans currently use preventive health services “at about half the recommended rate,” often because they don’t have the co-pay needed for an office visit.

Andrews said making the check-ups free has made a world of difference for several patients in her practice. For instance, she persuaded one patient–a 51-year-old woman on Medicare because she’s disabled–to sign up for the new smoking cessation program, another new freebie under health reform.

“I was seeing her twice a month… and she quit successfully and was doing very well,” Andrews recalled.

During one of the appointments, though, the woman mentioned she’d seen some blood in her stool.  “At first she didn’t want to do anything,” Andrews said. “But she agreed to come in for the wellness physical exam. And I got to spend a significant amount of time–half the appointment-discussing why she needed to have a colonoscopy.”

Her patient resisted, then relented. As a result, she learned that she had colon cancer. But it was detected at a very early stage, so she only need surgery to remove the cancer–no chemotherapy or radiation.

Andrews said the cost of wellness check-up is about $400. The cost of not catching colon cancer early is astronomical. “It’s a better system for all and it can save money for everyone,” she said. “You save really big on the other end by catching these diseases early.”