Medicare Annual Preventive Care Visits: Use Increased Among Fee-For-Service Patients, But Many Do Not Participate

Abstract

Under the Affordable Care Act (ACA), Medicare coverage expanded in 2011 to fully cover annual preventive care visits. We assessed the impact of coverage expansion, using 2007-13 data from primary care patients of Medicare-eligible age at the Palo Alto Medical Foundation (204,388 patient-years), which serves people in four counties near San Francisco, California. We compared trends in preventive visits and recommended preventive services among Medicare fee-for-service and Medicare health maintenance organization (HMO) patients as well as non-Medicare patients ages 65-75 who were covered by private fee-for-service and private HMO plans. Among Medicare fee-for-service patients, the annual use of preventive visits rose from 1.4 percent before the implementation of the ACA to 27.5 percent afterward. This increase was significantly larger than was seen for patients in the other insurance groups. Nevertheless, rates of annual preventive care visit use among Medicare fee-for-service patients remained 10-20 percentage points lower than was the case for people with private coverage (43-44 percent) or those in a Medicare HMO (53 percent). ACA policy changes led to increased preventive service use by Medicare fee-for-service beneficiaries, which suggests that Medicare coverage expansion is an effective way to increase seniors' use of preventive services.

Colorectal Cancer Screening in the Era of the Affordable Care Act

“…Chung and colleagues evaluated Medicare beneficiaries in a large multispecialty practice and found that colorectal cancer screening rates had declined slightly, though perhaps less than expected, among Medicare fee-for-service beneficiaries. 20 A series of reports published by the Department of Health and Human Services concluded that the absolute number of Medicare beneficiaries using preventive services has increased. 21,22 Most recently, Fedewa et al examined colorectal cancer screening use before and after passage of the ACA and found a modest increase in use, particularly among the poor and elderly.…”

Data Management for Applications of Patient Reported Outcomes

“…We did not fully assess HRA implementation including how characteristics of the care delivery setting affect data management capacity [35]. As CMS provides financial incentives for the annual wellness visit, our findings reflect PRO implementation in response to external incentives rather than internal needs [36]. We focused on data collection and use and did not examine clinician attitudes towards using these PROs at the point of care or patients’ perceptions of response burden or usefulness.…”

Association between Continuity of Care and Health-Related Quality of Life

“…41 However, assessing and acting on patient-reported information may not change individual or population-level scores of the measures themselves. 27,34,42,43 Thus it may be the process of PRO assessment and clinical action that reflects high-quality care and not necessarily the change in PRO score. This interpretation of PRO use is consistent with calls for "reimagining" quality assessment to focus on measuring important processes, with less emphasis on outcomes.…”