One of the things I love about family medicine is that I get to care for people of all ages. I almost went into pediatrics, but the time I spend with older adults was too valuable to give up. Our elders have such great stories and knowledge to impart – it’s an honor to participate in their lives and share their experience.
Since I first realized in residency training that Medicare didn’t cover preventive care, I’ve been frustrated with trying to focus on maintaining the health of my patients instead of just responding to one health crisis after the next. I never understood how Medicare would pay for a patient’s heart attack but not cover a screening blood test to check cholesterol before the heart attack so we could have a chance to prevent it.
Focusing on the power of prevention, the Affordable Care Act included new preventive screening, vaccine, and Adult Wellness Visit coverage for Medicare beneficiaries. After struggling for years to balance the best preventive care I knew my Medicare patients deserved with the barriers of high co-pays, lack of coverage, and fixed incomes, these provisions have allowed me to better meet the needs of my Medicare patients.
For example, the Medicare Wellness visit is an opportunity to focus on functionality and activity – how is the person actually doing every day, rather than just what ailments are causing them trouble right now. We screen for depression and risk for falling. We objectively measure cognitive function and we discuss the end-of-life care that patients want or don’t want – if they want to discuss that – and often here in Oregon they do. We also review and discuss recommended vaccines or screening tests – and discuss when these tests are not indicated or beneficial. This is a very different sort of visit than normal because it’s focused on maintaining health – exactly what we want our health care system to focus on.
At the end of each Wellness visit, I’ve started asking if patients paid a co-pay. Usually they haven’t and are surprised one wasn’t collected.
But last week I had an 80 year-old patient in for his Wellness Visit who needed his co-pay refunded because it was accidentally collected when he came in. He was thrilled to get his money back. He grinned and said, “I think I’ll use it to go out to lunch with my sisters.” He meets his 2 older sisters every week for lunch.
Then when we were discussing vaccines I realized he’d had his zoster (shingles) vaccine in 2009 – prior to the Affordable Care Act.
“Boy, that was expensive - I still have the receipt.” He’s a really organized person. “It was $122! At the time I though WOW is this worth it? But I got it because I have friends who’ve had shingles and I don’t want it. Now you can get the vaccine for free? I guess I should of waited.”
As I wished him well on his way off to lunch, I recognized how much the conversation has changed. Although we are just a few steps down the road to where we need to be, we are making progress.
On our journey, we can learn from the advice my 80 year-old patient gives as his key to success, “you just gotta keep moving!”
Evan Saulino is a family physician. This post originally appeared on Progress Notes.
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