Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How Medicare ruined the annual physical

Hans Duvefelt, MD
Physician
November 14, 2015
Share
Tweet
Share

Twenty years ago, I changed the name and focus of the annual physical I offered my patients. I designed a new form on my laptop with Geoworks, my favorite DOS-based (pre-Windows) desktop publishing program, and rolled out my “annual health review.”

I explained to patients that many of the things we used to do in routine physicals every year had proven to be of little value, but there were more and more screening and preventive services we simply needed to talk about. It was also a time to do a thorough review of systems, and to update the family history.

When patients started talking about sore knees, allergies or frequent urination, I would try to gently steer the conversation by saying something like “those are things we can look into sometime, but today I’d like to focus on the big health issues that could kill you.”

This approach was generally well accepted, and my homemade form made documentation quick and efficient. As the years went by, and as guidelines changed, some things disappeared from my routine. For example, screening or baseline EKGs were proven to be of little value, and I also stopped doing visual screenings on adults, because I wanted them to go to an eye doctor to get their intraocular pressure checked. My own Schiotz tonometer had become a veritable museum piece as it is so much more awkward for patients than modern tonometers.

I never did have a set of routine blood tests for a routine physical. Even when PSA testing for prostate cancer screening was de rigueur, I reasoned, “This is America, and nobody has to do anything; who am I to boss people around by requiring that they have certain tests?” Ordering blood test was something I always did with the patient’s informed consent. Even with cholesterol, I always had plenty of patients who felt they had a healthy lifestyle and simply didn’t want to know what their cholesterol was.

I talked with patients about diet, alcohol, seat belts and all kinds of lifestyle issues. But I didn’t screen for things we essentially cannot treat, like early dementia. In our annual conversations, I usually got a good sense of who was high-tech in terms of wanting “everything done” in case of a cardiorespiratory arrest, but I admit I wasn’t quite systematic in collecting advance directives.

Of course, my annual health review was not covered by Medicare, since it was perhaps technically a physical. But Medicare did pay for long visits where three or four chronic health conditions, even stable ones, were reviewed, so sometimes it was possible to add the Annual at no charge to a chronic care visit.

The other doctors in my practice used the same form, but I know each one carried a slightly different conversation with their patients. This visit was in the hands of my colleagues a reflection of each one’s style and of their patients’ preference. Dr. A ordered a few more blood tests, Dr. B recommended vitamins and supplements, and Dr. C promoted exercise with more passion than I did, and so on. These differences caused patients to gravitate to the one doctor among us that resonated most with their own ideas. This was personalized health care before patient-centeredness became formalized and formulaic.

All of us were pretty comfortable with our combined physical and health review visits.

Fast forward twenty years.

Today, under the new world order, doctors are mandated to perform annual wellness visits on their Medicare patients, but not according to their own best efforts or their patients stated preference — one item missed or omitted out of deference to conflicting guidelines or common sense, like the kindergarten-style visual exam for new Medicare beneficiaries in their first six months of coverage, and no payment is collected. And similarly, check a few basic things like lung or heart sounds, the presence of leg edema or skin cancer, and the free insurance benefit is forfeited.

What was a naturally evolved focused physical combined with an individualized health risk assessment has been replaced by a tightly scripted no-touch session that leaves many doctors and most patients confused and bemused.

This new “annual” feels like an administratively reinvented wheel, downright square and not rolling very well at all, at least on the roads where I travel.

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.

ADVERTISEMENT

Prev

Why medical scribes are the ultimate answer to our health IT woes

November 14, 2015 Kevin 125
…
Next

Technology in health care requires context

November 15, 2015 Kevin 2
…

Tagged as: Primary Care

Post navigation

< Previous Post
Why medical scribes are the ultimate answer to our health IT woes
Next Post >
Technology in health care requires context

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Hans Duvefelt, MD

  • The art of asking where it hurts

    Hans Duvefelt, MD
  • Thinking like a plumber when adjusting medications

    Hans Duvefelt, MD
  • The American food conspiracy

    Hans Duvefelt, MD

Related Posts

  • Why this physician supports Medicare for all

    Thad Salmon, MD
  • A physician contemplates Medicare blended rates

    Ira Nash, MD
  • A physician suggests how to improve Medicare

    Niran S. Al-Agba, MD
  • Instead of Medicare for all, how about Medicare for more?

    Brian C. Joondeph, MD
  • Expensive Medicare patients aren’t who you think

    Peter Ubel, MD
  • The conservative appeal of Medicare for all

    Peter Ubel, MD

More in Physician

  • Love on life support: a powerful reminder from the ICU

    Syed Ahmad Moosa, MD
  • Why we fear being forgotten more than death itself

    Patrick Hudson, MD
  • From basketball to bedside: Finding connection through March Madness

    Caitlin J. McCarthy, MD
  • The invisible weight carried by Black female physicians

    Trisza Leann Ray, DO
  • A female doctor’s day: exhaustion, sacrifice, and a single moment of joy

    Dr. Damane Zehra
  • The hidden cost of malpractice: Why doctors are losing control

    Howard Smith, MD
  • Most Popular

  • Past Week

    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Do Jewish students face rising bias in holistic admissions?

      Anonymous | Education
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • Why true listening is crucial for future health care professionals [PODCAST]

      The Podcast by KevinMD | Podcast
    • Love on life support: a powerful reminder from the ICU

      Syed Ahmad Moosa, MD | Physician
    • Surviving kidney disease and reforming patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Antimicrobial resistance: a public health crisis that needs your voice [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Do Jewish students face rising bias in holistic admissions?

      Anonymous | Education
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • Why true listening is crucial for future health care professionals [PODCAST]

      The Podcast by KevinMD | Podcast
    • Love on life support: a powerful reminder from the ICU

      Syed Ahmad Moosa, MD | Physician
    • Surviving kidney disease and reforming patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Antimicrobial resistance: a public health crisis that needs your voice [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

How Medicare ruined the annual physical
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...