Physicians grappling with mixed messages about preventive care

More than three years after the Affordable Care Act required new health plans to cover most preventive care without coinsurance, practices are still struggling to bill patients appropriately, USA Today reported.

Just as FiercePracticeManagement reported back in 2011, practices are not only erroneously charging patients copays for physicals and preventive screenings, but also failing to communicate well about the fact that copays are owed when additional services are provided during a preventive visit.

"Doctors' offices and staff aren't really educated about what is covered," Monica Lindeen, Montana's insurance commissioner and state auditor and vice president of the National Association of Insurance Commissioners, told USA Today. "They don't know what they need to bill for and what they don't."

The objective of the law is to remove financial barriers to preventive care so that patients will catch problems, such as high cholesterol and skin cancer, in early stages before they become more costly and serious to treat. "It's a positive," noted Juliet Mavromatis, M.D., who runs a primary care practice in Atlanta and who writes for The Health Care Blog, in the USA Today article. "It gets people in the office, particularly people worried about money. It removes a barrier to people being able to check in at least once a year."

Paradoxically, however, recent Choosing Wisely guidelines released by the Society of General Internal Medicine recommend against routine physicals for asymptomatic adults.

Danielle Ofri, M.D., physician author and associate professor at New York University School of Medicine, took on the contradiction in an opinion piece for the New York Times, writing: "This runs counter to a basic pillar in medicine that doctors and patients remain strongly attached to: the annual checkup. This is our chance to do screening tests and vaccinations and to discuss a healthy lifestyle. Anecdotally, we all can cite examples of checkups that uncovered serious illness."

Ofri concluded by explaining that despite scientific evidence suggesting that annual visits may cause more harm (i.e., overdiagnosis, overtreatment) than good, she still recommends them to patients.

Despite the mixed messages physicians are fielding about delivering cost-effective, appropriate care, doctors should know that the Choosing Wisely lists are recommendations that do not negate the law. Preventive care is still covered at no cost to patients. How much care to provide to patients and when is up to physicians' clinical decision-making.

To learn more:
- read the article from USA Today
- see the column from the New York Times