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new-logo25By author/contributor Marilyn M. Singleton, M.D., J.D.

 Marilyn M. Singleton, MD, JD, (San Francisco) is a board-certified anesthesiologist, professor and Association of American Physicians and Surgeons member (see bio at bottom of release)

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“In fact, the free wellness visit is mainly a lost opportunity to discover conditions unknown to the patient and for patients and doctors to enhance their special relationship. It is, however, an opportunity for the government to collect data about the patient.”

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A friend went in for his Medicare free “wellness visit,” compliments of the Affordable Care Act (ACA). He assumed it was like a doctor’s annual check-up. After all, when he took his dog to the vet for a wellness visit, little Sparky was examined and tested for worms. So my friend made the mistake of asking the doctor to listen to his heart and lungs – just because that is what we expect physicians will do. Then he got a bill. Neither my friend nor his physician realized that if the patient was actually touched during the free wellness visit, it ceased to be free.

Medicare’s annual free wellness visit includes a review of medical and family history; making a list of current “providers” and prescriptions; measuring height, weight, body mass index, and blood pressure; and giving the patient a schedule and/or referrals for appropriate preventive services. The visit is “free”—the doctor must take “assignment” (be paid by Medicare, not by the patient) and waive the usual 20 percent “copayment.” The Medicare Part B deductible does not apply.

Physicians and a host of others, including “health educators,” can furnish the visit. Indeed, the California legislature is considering authorizing pharmacists and optometrists to serve as primary care providers. It is likely, since we are struggling with a shortage of physicians, that most offices have nursing assistants furnish the free wellness visit. Or if a physician in a smaller office with fewer personnel chooses to conduct the interview, he is relegated to the role of a scribe.

What patients need is an annual visit to be examined by a physician. They need a visit in which the physician can detect that new asymptomatic heart murmur or discover cancerous or pre-cancerous skin lesions. The Medicare Handbook makes it clear: Medicare does not cover routine physical examinations (average cost, $80 to $200).

Yet Medicare is willing to pay $155.89 for the free wellness visit. Perhaps a better investment would be a physical examination that would allow the patient and the doctor—not an office worker—to connect with one another. We all know the value of human contact for engendering trust in a relationship. Twenty minutes with the physician behind the computer doing data entry is not how most patients expect to spend their precious time during a medical visit. More

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