Annual physicals not necessarily prescription for good health

Q:Why don't Medicare and other health-insurance plans cover annual physicals? I had to pay $200 for a physical last summer. It wasn't covered by either Medicare or my Medigap insurance.

Answer: Annual physicals, where the doctor checks your heart, lungs and general wellness and maybe orders a battery of tests even though there's nothing specifically wrong, used to be routine. Now, the folks footing the health-care bill don't necessarily agree that they improve health outcomes, so some insurers aren't paying for them.

Reports examining the value of annual physicals have not always been clear or consistent in their recommendations.

A federal advisory panel, the U.S. Preventive Services Task Force, frowns on one-size-fits-all annual exams that might, for instance, call for routine electrocardiograms in healthy adults.

Johns Hopkins University experts looked at the value of "periodic health examinations," described as more targeted preventive exams. Their findings, summed up in a 339-page report in 2006 for the federal Agency for Healthcare Research and Quality, said periodic exams were valuable to make sure people got recommended services such as mammograms.

While Medicare does not pay for a physical every year, it pays for quite a bit of regular preventive health care. That includes cholesterol and other blood lipid level screenings every five years, mammograms every 12 months, fecal occult blood tests every 12 months, flexible screening colonoscopy once every 24 months for folks at high risk, or once every 10 years for others.

Medicare also covers: annual flu shots, bone-density testing every 24 months for folks at risk for osteoporosis, up to two diabetes screenings a year for high-risk people, and an annual glaucoma screening for some risk groups.

New enrollees have 12 months to get the one-time "Welcome to Medicare" exam when they sign up for Part B. Patients pay 20 percent of the bill.

That exam sets a baseline, said Dr. Sallie S. Cook, chief medical officer for the Virginia Health Quality Center.

"There really is lack of evidence that a comprehensive physical exam and routine laboratory tests once a year are indicated," Cook said.

One local doctor who thinks annual exams should be paid for by Medicare said it would make sense to fold all the preventive services into an annual exam to make sure they get done.

Medicare, she added, undervalues the time and skill it takes to interpret results and counsel patients.

Contact Tammie Smith at (804) 649-6572 or .