Feds push worth of ounce of prevention


Medicare Part D has gone a long way toward closing an important gap in healthcare coverage by providing a prescription drug benefit to enrollees. Now several government agencies are aiming to close the gap between the availability and use of covered preventive services among persons with Medicare. The goal is to do more to help beneficiaries manage their medical care rather than just paying the bills.

In 1981, pneumococcal pneumonia vaccine became the first preventive service covered under Medicare. Immunization against hepatitis B was added in 1984, the PAP test was added in 1990, and the screening mammogram soon followed in 1991. Further expansions included flu shots in 1995 and, in 1998, diabetes self-management training, bone mass measurements, pelvic exams, and colorectal cancer screenings became covered services. More recent additions to the list of preventive services include screening for prostate cancer (2000) and glaucoma (2002) along with medical nutrition therapy for diabetes and renal disease patients.

The Medicare Modernization Act (MMA) further expanded eligibility for preventive services. It provided for a onetime physical when persons first enroll in Medicare, also known as the "Welcome to Medicare" exam. In addition MMA added cardiovascular screening blood tests, diabetes screening tests, and smoking-cessation programs.

Members of Congress have been supportive of expanding preventive services. Legislative proposals have been introduced that would make such services even more accessible by extending the period for Welcome to Medicare physicals from six months to one year and eliminating the coinsurance for mammography and colorectal cancer screening tests.

Starting in 2007 Medicare will cover ultrasound screening for abdominal aortic aneurysms for certain patients. CMS envisions working with community organizations as it did to promote enrollment in Part D to increase the awareness and use of both the enrollment examination and the continued use of preventive services.

AHRQ is contributing to the outreach effort by supporting the development of guidelines for preventive services and their dissemination to primary care providers. AHRQ sponsors the U.S. Preventive Services Task Force, a panel of private-sector experts in primary care and prevention. The task force bases its recommendations on a rigorous assessment of the scientific evidence in support of the efficacy and cost-effectiveness of these services. The 2006 guidelines include 53 new or revised recommendations, including screenings for obesity, HIV, mental health and substance abuse, and metabolic disorders, as well as diet and behavioral counseling.

AHRQ has partnered with the United Health Foundation in distributing 400,000 copies of the Guide to Clinical Preventive Services, 2006, to clinicians nationwide. A copy of the guide can be obtained at http://www.ahrq.gov/clinic/pocketgd.htm or requested from the agency. AHRQ also devised a wall chart, the Adult Preventive Care Timeline, which summarizes who needs preventive services and when. The chart can be accessed and printed at http://www.ahrq.gov/ppip/timelinead.pdf.

To promote greater use of preventive services, AHRQ developed the Electronic Preventive Services Selector (ePSS) as an aid for primary care providers. To use the ePSS, a clinician inputs the patient's age, gender, and specified behavioral risk factors such as smoking, and the software program generates an individualized health report that can be printed and given to the patient.

The ePSS software matches patient characteristics against 110 recommendations covering 59 separate preventive service topics, including screenings, immunizations, and patient education. Many of these preventive services are already being offered by practitioners in pharmacy settings and the ePSS reports also may be appropriate for distribution in pharmacy settings. The ePSS software will work on both Palm and Windows operating systems and may be downloaded for free at http://www.ePSS.ahrq.gov/.

THE AUTHOR is associate professor, Department of Pharmacy Health Care Administration, University of Florida College of Pharmacy.

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