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Benefits of Preventative Health Care

October 21, 2013

In 1736 Benjamin Franklin said “An ounce of prevention is worth a pound of cure.” Even though he Franklin was talking about fire prevention, we KNOW our founding fathers understood the concept. Why then, more than 200 years later, do the leaders of our country not seem to understand this concept? I am speaking specifically about healthcare. More specifically why was this concept not translated into the health insurance for our nation’s elderly; Medicare?

Under the Social Security Act of 1965 Medicare the federal government asserted Medicare would cover all reasonable and necessary health services. So what is reasonable and necessary? The Feds define that too! It means “no Medicare payment shall be made for items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the function­ing of a malformed body member.”   Wait. What? Illness? Injury? Malformed Body Member? What happened to that ounce of prevention the Ben mentioned? Medicare pays for medical services once our senior citizens get ill, injured or malformed. We don’t pay to keep them well?!

I know, I know, Medicare has expanded coverage for preventive services over the last 20 years but still an Annual Physical Exam is not a covered Medicare benefit as are many other screening services. Medicare covers cancer screening, diabetes screening,
alcohol misuse screening, screening for abdominal aortic aneurysms, cardiovascular screening etc. Each of these screen for a disease as an exclusive component…as if the disease were the patient not the patient. I think we need a holistic approach but Medicare won’t pay for it. Or will they?

FQHCs are in a very unique position. Medicare pays for Primary Preventive Services. Yes,  in an FQHC not only will Medicare cover those previously expanded screening services it will cover medical social services, nutrition assessment, preventive health education, well child care, voluntary family planning services, physical exam targeted to risk and many more. This is exciting and wonderful for a Medicare beneficiary. We should expand our Medicare outreach. It is good for us and good for the patient.

The Medicare Benefits Policy Manual for FQHCs has it all spelled out. Take advantage of the one instance in which Mr. Franklin’s advice was actually heeded for Medicare.

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