The Useless, Almost Drive-Through, Nearly Touchless, Free But Expensive and Wasteful Physical Exam

There was a time when patients would see their personal physician only when they were sick. Then came preventive medicine and now many patients only see their doctor when they are well. When they are sick, the doctor has no openings and they are forced to go to walk-in care.

If a doctor has 1,500 – 2,000 patients and works 2,000 hours per year, more than half their time is probably spent on routine exams (for commercially insured patients) or Annual Wellness visits (for Medicare patients).

Commercially insured patients generally get a free physical, which is often cursory, and random bloodwork, often referred to as “routine”. The reimbursement for such visits is generous.

The US Public Health Service Taskforce on Prevention declared long ago that neither the exam nor the blood tests have any proven value from a prevention or early detection point of view. Choosing Wisely says the same thing.

The Medicare Wellness Visit is also called an exam, but the only thing that is more or less hands on is the mandatory blood pressure recording. Other than that, it is a talk visit. The first one of these includes a Mickey Mouse eye chart test, like the one at the Bureau of Motor Vehicles, and a baseline EKG, another test of no proven value. Every Wellness Visit pays more than a commercial insurance physical, but if you skip over offering frail 90 year olds testing for HIV, Hepatitis C or anything else on Medicare’s agenda, they might take their money back.

The cruel irony here is that sick people have deductibles and copays for their visits and testing. This can discourage patients from seeking care and getting new problems diagnosed in a timely manner.

According to The Motley Fool, a third of American families have trouble coming up with $400 to cover an emergency expense. And that’s an improvement compared to a few years ago. Yet, the typical annual deductible for commercially insured patients is several thousand dollars. So, many people hesitate to seek medical care they really would like to have.

Is that an ethical and sustainable way to provide health care coverage for hard working Americans?

It is time to consider a different copayment structure as a temporary way to humanize health care until we join the rest of the world in providing government financed universal basic health care for all:

– Provide free but voluntary mass screenings for proven things like blood pressure, blood sugar, cholesterol and mammograms.

– Cover a couple of doctor visits per year without cost for things each patient prioritizes. For some, that might be their hypertension or diabetes care, for others, their annual sinus infection or asthma/COPD flareups.

Like lawyers, we should at least be able to provide one or two free initial consultations. And, speaking of lawyers, the value of our time should not be restricted to face-to-face encounters.

But that’s a different pet peeve of mine.

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