Whereas, the Medicare Modernization Act of 2003 provides coverage for new preventive services which includes a “Welcome to Medicare Visit” (WMV), a one time preventive exam which is reimbursable under Medicare Part B if it is provided within 6 months of enrollment; and (1)

Whereas, the WMV and additional preventive service screenings provided to Medicare beneficiaries effective January 2005 as well as other Medicare preventive service benefits hold great promise as a coordinated, systematic means for assessing health risks and initiating timely and appropriate interventions; and (2)

Whereas, the Government Accountability Office reports issued over the past three years have consistently found that Medicare preventive services largely go underutilized; and (6,7,8)

Whereas, the new preventive services appeared to have gained little attention from the media and consumers; and

Whereas, the lack of planned resources devoted to the promotion of these critical new benefits virtually guarantees continued underutilization of many of these much needed preventive health care services; and

Whereas, the disparities in health care are especially evident in preventive care; and (4,5)

Whereas, AMA Policy H-425.984: Preventive Medicine Services calls for the AMA to “continue to develop appropriate consumer-oriented vehicles to educate the public about clinical preventive services and their benefits;” and

Whereas, physicians unaware of the new Medicare benefits may not know how to be properly reimbursed; therefore be it

RESOLVED, That the AMA work with relevant stakeholders including appropriate national medical specialty societies, state and county medical societies, relevant federal agencies (e.g., CMS, AHRQ, CDC, HRSA, NIH), the American Health Quality Association, and the coalition Partnership for Prevention to actively promote to consumers the Welcome to Medicare Visit and other Medicare-covered preventive services (Directive to Take Action); and be it further

RESOLVED, That the AMA focus on underserved populations in the Welcome to Medicare Visit and other Medicare preventive services campaigns; and be it further

RESOLVED, That the AMA in partnership with other stakeholders develop and disseminate resources to assist physicians in efficiently implementing the Welcome to Medicare Visit and other Medicare preventive services as part of an overall prevention approach (Directive to Take Action); and be it further

RESOLVED, That the AMA actively educate physicians about evidence-based preventive measures and how to incorporate these measures into their daily practice (Directive to Take Action).

References:

1. CMS Legislative Summary.  Summary of H.R.1 Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Public Law 108-173.  April 2004

2. Woolf S, Coffield A.  The “Welcome to Medicare” visit: a Chance to raise the Profile of Prevention among Older Adults.  BMJ Feb 2005; 330:E337-E338

3. Mokdad A, Marks J,. Stroup D, Gerberding, J. Actual Causes of Death in the United States, 2000. JAMA, March 10, 2004; 291: 1238 - 1245.

4. Kelley E, Moy E, Stryer D, Burstin H, Clancy C.  The national healthcare quality and disparities reports: an overview.  Medical Care. Mar 2005; 43(3 Suppl):I3-8.

5. CDC. Access to Health-Care and Preventive Services Among Hispanics and Non-Hispanics—United States, 2001-2002.  JAMA, November 17, 2004; 292: 2331 - 2333.

6. GAO-04-1004T.  Medicare Preventive Services. Sept, 2004

7. GAO-03-958. Medicare:  Most Beneficiaries Receive Some but not all Preventive Services.  Sept. 2003

8. GAO-02-422.  Medicare:  Beneficiary Use of Clinical Preventive Services. Sept. 2002

9. Card, Randall. How to Conduct a “Welcome to Medicare” Visit. Family Practice Management. April 2005 

Fiscal Note:

Relevant AMA Policy:

H-165.880 Coverage for Certain Types of Well Care Examinations by Health Insurers

H-165.890 Medicare Transformation

H-425.987 Preventive Medicine Services

H-425.986 Healthy People 2000 - Challenges in Preventive Medicine

H-425.984 Clinical Preventive Services

H-425.997 Preventive Services