Peninsula Daily News column 2-17-11 "Medicare can help one be and stay well"

OK, it’s three days after Valentine’s Day and it’s pretty clear to me that I should attempt to redeem myself after last week’s column.

                For those of you who completely lost your minds last Thursday, or spent it in another time zone or experienced any other aberration that prevented you from catching last week’s effort, I essentially implied (well, OK, I said it “out loud”) that chocolate and other nutritional sins might actually have their place, particularly if you happen to be in the situation of caring for someone with dementia.

                While that seems pretty specific to me, some of you undoubtedly took that as a recommendation (if not a prescription) to go forth and consume vast quantities of BAD FOOD; so, since our February excuse for indulgence has passed, I’ll gloss-over the “excuse” that I may have provided by directing your attention to “wellness” and “prevention.”

                Look: You know as well as I do that the only way to avoid the astronomical costs of healthcare and the coma-inducing experience of health insurance that usually comes with it is to utilize either (or both!) as little as possible; thus, for those of us who have yet to achieve immortality, we’re forced to confront the daunting realities of wellness and prevention – In other words, don’t get seriously sick.

                Even Medicare has begun to figure this out.

                Now, it makes absolutely no difference to most of us whether this stuff has been available for a while or it’s a product of “health care reform;” the fact is, here we are and here it is and we might as well use Medicare (which is “health insurance”) to avoid having to use health insurance! (…or something like that) – Anyway, here we go.

                …and if you’d like to research all of this yourself, by all means, do so – Just go to: http://bit.ly/9hc89L and have a real nice day.

                The “Welcome to Medicare” physical exam has been available for a while, but a lot of us don’t seem to be real sharp about getting it done. Beginning January 1 of this very year, there is no longer a coinsurance or deductible payment required for it, so now we have even less of an excuse to avoid it: Not knowing what might be wrong will not make “what’s wrong” go away, in the same sense that “denial” is not a river in Egypt.

                Also beginning last January 1^st, we Medicare-types have access to an “annual wellness visit.” You do not need to get the “Welcome to Medicare” physical before getting the “annual wellness exam,” but if you do get it first, then you have to wait 12 months to get your first “wellness” exam – Your call, because doing SOMETHING beats-the-heck out of doing NOTHING.

                The initial Annual Wellness visit includes:

• Routine measurements (height, weight, bloodpressure, etc.).
• Medical and family history.
• Establishing a list of current medical providers, suppliers and medicines.
• Personal risk assessment.
• Review of functional ability and level of safety.
• Detection of any cognitive impairment.
• Screening for depression (very common for a lot of us!).
• Establishing a schedule for Medicare's screening and preventive services for the next five to ten years.
• Any other advice or referrals that come up.

So, besides getting on the front-end of anything that might be wrong (which often includes, NOTHING), you’re establishing a “baseline.” Subsequent Wellness visits will pretty much retrace the same steps, the idea being to see whether anything that might have changed is a “problem.”

I realize that this isn’t exciting stuff. If you’re looking for “exciting,” try spending your spare time in a hospital bed, trying to figure out whether you’re there under “inpatient” or “observation” – No? Then, this is looking a little better all the time.

Now, also beginning January 1^st (Yes, January 1^st was a busy day!), cost-sharing was eliminated for these Medicare-covered services, assuming that your doc “accepts assignment,” which means she/he agrees to accept what Medicare pays as payment-in-full:

• Abdominal aortic aneurysm screening;
• Bone mass measurement;
• Breast cancer screening/mammograms;
• Certain types of colorectal cancer screenings;
• Flu shots;
• Hepatitis B shots;
• Pap tests and pelvic exams;
• Pneumococcal shots;
• Prostate cancer screening;
• Smoking cessation;
• Medical nutrition therapy services (for those with diabetes or kidney disease, or who had a kidney transplant in the last 36 months.

You’ll probably pay 20% of the Medicare-approved amount for the doctor visit for these services:

• Cardiovascular screening tests;
• Diabetes screening tests;
• HIV screening tests.

Now, wasn’t that simple? Of course not! This is Medicare! But the fact remains that the game has changed and, for once, it’s swinging our way, meaning that prevention and wellness makes more sense than the high drama (and higher cost!) of heroic medical intervention.

No, you probably won’t live forever, and the fact is, most of us don’t want to – We just want to “live” until it’s time to do something else.

This is a way to help us do that.