The yearly physical that isn’t

I realize that most of my readers are below Medicare age, but as goes Medicare, so goes the nation, so pay attention my friends.

Nearly all healthcare plans now include so-called preventative care, including some sort of yearly check-in visit. Medicare’s version of this is the “Annual Wellness Visit”. Most patients think this means they are getting a complete physical, and often they do, but this isn’t going to continue.

Medicare’s Annual Wellness Visit has a very limited set of requirements, including screening for depression and dementia, making a list of all the doctors someone is seeing, and calculating their body mass index. It’s really a brief visit, and doesn’t pay all that well.

Despite this, many of us have been including a more traditional physical. This adds on considerable uncompensated time to the visit. A time will come when AWVs are brief visits done by assistants, and the patient will have to come in for a physical on another day (which will not be covered at 100%, as the AWV is). I suspect many patients won’t like this.

The same may happen with non-Medicare plans. Doctors’ offices may have patients come in for a brief prevention visit with a physicians’ assistant, fill out any health screening forms, and make them come back at another time for a real physical.

It’s all better than being un-insured, but don’t be surprised when your doctor tells you that your yearly physical isn’t your yearly physical.

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  1. I have never had a “physical”. Is there anything particularly good or essential about it, like some useful tests, or is it just a case of effectively forcing someone to see a doctor for a bit so they can reveal potential problems that they just neglect to see a doctor about? E.g., “why yes, I have been shitting blood for the last six months and just never got around to telling anyone”. (I imagine that is a big issue when healthcare is private in contrast to Nazi-Communist NHS over here because of the financial implications of even a 10 minute consultation)

  2. There is no clear evidence that a yearly physical has significant benefit, but insurance companies have found that if they shove people to the doctor once in a while for basic screening they actually save money.l

    And yes, I often get the “by the way blood’s pouring out of me” thing at physicals.

    While physicals may not have been shown to have a ton of benefit, there is no other system-wide screening system for such big players as hypertension and diabetes. It’s a useful tool.

    One of the big problems in my field, where people tend to have lots of medical problems, is that a yearly long visit is very, very useful, but not covered by insurance as such, making patients pissed off to get a bill because they THINK it is a covered yearly physical.

  3. Reblogged this on Pre-Med Panda and commented:
    Been seeing this change around the office of the doc I shadowed and I noticed that it is giving the doc much more things to jot down in their charts.

  4. Zelda

     /  March 31, 2014

    Twenty years ago I told my husband he needed a routine physical, that we should both have one since we were both approaching 40. We both had lots of tests. On the way out of the office, I nudged my husband and asked him, “Did you tell the doctor about all the foam in your urine?” The doctor happened to be standing in the hallway and overheard my question. He grabbed my husband by the arm, took both of us into a private room, and began an hour long session of asking questions. It turned out, after testing and a biopsy which was sent to the Mayo clinic, that my husband had an RPKD, Pauci Immune. He was treated with chemotherapy. Now, twenty years later, he needs a kidney transplant. All of the other people with this diagnosis in our area, diagnosed at the time my husband was, have passed away.

    This long story is to say: there are big and little signs of illness in your health that are a clear sign to your doctor that something is wrong. You would never guess.

    P.S. If nothing else, when my husband first found out he was ill, our son was seven years old. Now he is 27. Twenty years of having a father is an important difference in life.

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