Medicare Compliance & Reimbursement

Medicare benes not taking advantage of covered preventive services, screenings.

The day before economists Kenneth Thorpe and David Howard released their study on Medicare spending (see story on page 1), the Centers for Medicare & Medicaid Services (CMS) announced it would launch a new risk-reduction demonstration for Medicare beneficiaries. The agency hinted that proper preventive services were available through Medicare, but that benes simply were not taking advantage of them.

For example, only 45 percent of eligible benes had one claim for a colorectal cancer screening during 1998 through 2002, according to Medicare data. In the past two years, CMS has added many preventive services under Medicare, including the "Welcome to Medicare" exam, cardiovascular screening blood tests, diabetes screening, glaucoma screening for Hispanic Americans aged 65 and over and smoking cessation counseling, which "very few" Medicare benes have used, the agency says.

To get Medicare benes to utilize these preventive services, and thus lower Medicare spending on chronic diseases, CMS is taking a tip from corporate America. The Senior Risk Reduction Demonstration "will address multiple health risk factors that contribute to chronic diseases, including physical inactivity, obesity, smoking, depression, high blood pressure, high cholesterol, high blood sugar and underused Medicare preventive benefits," CMS says. "Taking a comprehensive approach to disease prevention and management has been shown to be cost effective in corporate settings," the agency adds.

Approximately 85,000 Medicare fee-for-service enrollees will be eligible to participate in the three-year demonstration, and CMS will select up to five disease-prevention, health-promotion and risk-reduction organizations for the test project.

"The Senior Risk Reduction Demonstration will help us determine whether more intensive support can help our beneficiaries stay well and prevent complications from chronic diseases," CMS administrator Mark McClellan said in an Aug. 21 statement. "This demonstration can support doctors and other health professionals by providing support in their efforts to help seniors make important changes, such as starting an exercise program and using recommended preventive care."

To view the demonstration solicitation, which went on display on the Federal Register, and for additional information, visit www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/Senior_Risk_Reduction_Solicitation.pdf.