Thursday, December 06, 2012

A Geezer Encounters Obamacare

Although some major provisions of the much-discussed Affordable Care Act don’t kick in for another year or more, a few things are in place now. I had my first encounter with Obamacare last month.

The pleasant lady on the phone said, “It’s time to schedule your Medicare wellness exam.”

“Is that a new name for my annual physical?” I asked.

“You’ll find it’s a little different,” she said, “and one nice difference is that it’s free. Medicare now is required to provide a yearly wellness assessment, so you won’t have any copay or other cost.”

I like free things. We agreed on a date and time very quickly.

The preliminary stuff conducted by our favorite nurse was same old, same old. She got my weight, pulse reading, and blood pressure recorded and settled me in to wait for our family doc. He has been conducting my annual physicals for the past four years. I’ve been pleased with his professionalism and genial manner. Usually, he spends 20 minutes to a half hour with me.

This time, our meeting was more than a little bit different. The doctor was with me for a solid hour. He ran through a lengthy checklist item-by-item, including questions regarding home safety and my mental state. I’ve been getting annual physicals for more than 20 years from highly competent doctors, but never was one nearly as extensive as the new Medicare exam, which is required by Obamacare.

When we finished the exam, my doctor handed me a copy of the form he filled out as he went. With it, I can tell precisely what my major office test readings were, the names of two additional tests he would arrange for me at a local hospital, and his recommendations for the future.

I know from earlier talks that my doctor has not been a fan of Obamacare. I tried tactfully to get a handle on his current opinion by asking him if the new requirements caused any big changes in his procedures. “Well,” he said, “there’s a whole new emphasis on prevention, and that’s a good thing.”

As one element of prevention for me, he scheduled a bone density test, something the new system recommends for people my age. My Medicare and Blue Cross insurances would have covered almost all the cost of the test in the past, but a $65 co-pay charge would have come out of my pocket. Obamacare requires that Medicare cover all the costs if the test results from an annual wellness exam. The co-pay was waived. We can always use an extra $65 around our place, and the free exam added another nice bonus to our modest household budget.

Obamacare also requires health providers to join the modern world by automating their systems to better track and share data. My doctor has been ahead of that game for some time. He conducts his physical exams with a lap-top computer up and running. However, getting exam results has been another matter. That often involved several phone calls and some minor delays, which could cause important misunderstandings.

This time, the results of my bone density test and the doc’s advice to make a little change in my lifestyle because of it appeared as an e-mail notice that the message was readily available to me on a secure site.

The message was clearly written and invited me to start a computer dialogue with the doctor if I had questions. I liked that a lot. In addition to pleasing patients, the quick, accurate communication probably will reduce some administrative costs at his clinic.

We are told that Obamacare does need some improvements, especially in the establishment of insurance pools by states. However, so far in my book it gets an AAA rating.


schmidleysscribblins, said...

Thanks for reporting on your recent experience with Obamacare. I too have had annual exams every year for many years with these physicians: GP, Dermatologist, Opthomologist, etc. My GP doesn't use anything that smacks of a computer, and I expect he will retire before he "gives in."

In 2013, I am seeing the fellow who does sigmoidoscopies and endoscopies. He said he would retire if Obamacare became law. I suppose he is still working as his nurse called me to schedule a follow-up.

As an alcohol and drug counselor, my husband David has been advocating preventive care for ages, as does my health insurance company (I too have BC/BS).

Good post and keep us posted. Dianne

PiedType said...

Your exam sounds a lot like the "Welcome to Medicare" exam I got when I first went into Medicare. It included the bone density test and also an abdominal aorta ultrasound scan (didn't know I had such a thing). I was surprised to hear questions about stairs in my home, whether I live alone, if I have pets, etc. It felt a little nosy at the time, but I can see the relevance.

The doctor and her group were already using electronic records, which impressed me. These days, why wouldn't you use computers? Detailed test results are mailed to me any time I ask and I get personal phone reports regardless. I think the only change after ACA kicked in was a brief chat about my weight, obesity, nutrition, etc., and a sheaf of (govt. required) printouts about it. A waste of time and paper, we both thought, since we talk about that anyway and the info is available online to anyone who looks for it.

I noticed one of my opthalmologists, who had been keeping paper records (I thought it so warm and quaint that this geeky hipster doctor jotted notes on paper) has been rolling over into electronic records. The other opth keeps computer records and has a system where I go online and enter all my own medical history for their reference and mine, but when I showed up for surgery I was told the system didn't really work and I had to fill out all the info again on paper forms. So it's going to take time. Neither opth is in the group practice my PCP is in, and at this time they cannot access her records or vice versa.

The goal, as I understand it, is for all doctors in the country to have access to the same records. With all the different computers and programs out there, that kind of standardization and integration is going to take a very long time, assuming it's even desirable; security will be a huge problem.

Dick Klade said...

Pied, I think what I got was the Welcome to Medicare exam, but because I started with Medicare before it existed, I'd never had one.

According to AARP Magazine, the comprehensive annual exam was made mandatory for all Medicare recipients when Obamacare went into effect.

I didn't get a batch of printouts during or after my exam, just a concise two-page summary, which appears to be a standard Medicare form.

Kay said...

Wow! That is very impressive. We get pretty good care at Tripler Army Hospital, but nothing like that. Wow!

Tom Sightings said...

I'm a supporter of the Affordable Care Act, and esp. its focus on preventive care. But you do realize, don't you, that while we all like "free things" they're not really free. It just means the costs are hidden.

Which is the problem I have with the ACA. It's good on access and prevention, and maybe some other things. But it doesn't address the cost of health care -- one reason my monthly premium increased 16% this year.

Dick Klade said...

Yes, Tom, I know there's no free lunch. However, I hope that a fairly small investment in more prevention will result in reduced insurance rates in the future.

My insurance cost also went up this year, but at a much lower rate than it has in recent years.

I think there are some cost-control measures in the ACA that haven't gone into effect as yet, but I'm not knowledgeable enough about the entire complex Act to be able to be confident about discussing them.

JHawk23 said...

My own background in the military and later the civilian part of government always emphasized the preventive benefits of an annual, or biennial) checkup.

In theory, costs of "free" checkups are easily absorbed by heading off diseases earlier, obviating more extreme and costly measures. And I've always believed that was true.

And yet... at my last such exam, I complained of some congestion in my upper respiratory system. I figured it was an allergy but the end result was a batch of expensive and probably unnecessary tests of my lung capacity, etc. It's those costs .. the costs of medicine conducted purely from fear of lawsuits .. that we really need to try to control.