MEDICARE REIMBURSEMENT FOR PREVENTIVE CARE - CHANGES IN PERFORMANCE OF SERVICES, QUALITY-OF-LIFE, AND HEALTH-CARE COSTS

A randomized, controlled trial was conducted to assess the effects of a financial and office systems intervention to increase preventive car e in physicians' offices for patients aged 65 years or older. A total of 1,914 patients from 10 primary-care medical practices in central No rth Carolina were randomized within practices to an intervention and a usual-care control group. The intervention consisted of full Medicare reimbursement to physicians for preventive care and health promotion packages (thus making these services free for patients), regular promp ting of physicians to routinely schedule preventive care visits, a new office system in which nurses carried out many preventive procedures, and a form for charting preventive care. The performance of screening tests dramatically increased in the intervention group relative to co ntrol (P < 0.001), but there was evidence of lack of follow-up of abno rmal findings by physicians. At the 2-year follow-up, there were minim al differences between intervention and control groups in health-relat ed quality-of-life indicators. Relative to the $294 per patient 3-year cost to Medicare for waivered services, the intervention was reimburs ed-cost neutral or slightly cost reducing ($190 over 3 years) for Medi care. It is concluded that adding reimbursement for preventive service s for Medicare-even with the office systems changes made in this study -will not by itself lead to effective implementation of preventive ser vices in community medical practices. To enhance patient benefit from preventive services, greater attention needs to be focused on an organ ized approach to patient follow-up.