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Old Age: What's Not to Enjoy?

What to Expect From the Free Medicare Wellness Visit

The Affordable Care Act (ACA), or Obamacare, includes several benefits for Medicare beneficiaries including a Welcome to Medicare Wellness Visit.

This is not a substitute for a more extensive physicial exam but a way for your physician to ask some questions about your health and work with you to develop or update a plan to prevent disease.

I was reminded of this recently when my internet friend, Chuck Nyren, published a report at his Huffington Post blog (where he describes himself as “Writer, Gadfly, Troublemaker”) about his first wellness visit.

It was a good reminder to me to tell you about it but on second thought, why reinvent the wheel, I thought. Besides, Chuck is a funnier guy than I am and he gave me permission to reprint his story titled Welcome to Your Welcome to Medicare Visit. Here's Chuck.

* * *

I didn’t ask if it was mandatory when this lady called, I just said, “Yeah, yeah, I’ll do it.” A free exam of some sort because you’re now sixty-five was what she wanted me to schedule. I did.

She said it wouldn’t be with my doctor but with a health care professional. I was only half listening. “And the best part is you can spend a whole hour with her! Not like with your Provider where you’re only allowed fifteen minutes.”

My egoism got the better of me. A whole hour talking about me, and if I’m not talking about me the other person is talking about me. That sounded great.

On my way to the appointment I tried to think of things to talk about. My arthritic knees had been overly achy lately but for the last few days had been fine. Other than that, I felt pretty good. It was weird going to the doctor when there was nothing wrong with you.

A nurse called my name. I was weighed, had pounded up a bit over the winter. I’ll lose it. Blood pressure was high a tad, lungs and heart sounded good. She shook out an octopus array of wires and I had a quick EKG. Heart = Fine. The nurse left and I spent a few minutes yanking off the stickies from crannies on my torso I never knew existed.

Marlene knocked and entered. “Welcome to your Welcome To Medicare Wellness Exam!”

“Thanks!” I said. I was chipper. She was chipper. We were chipper.

“Over the weekend I spent some time looking over your medical history,” she said.

“So that’s why my ears were burning!”

She readied herself to type. “Is there something wrong with your ears?”

“Ummm, no. A little wax, maybe.”

She typed something.

After documenting the faux affliction, we got to the real ones. I’d had some issues over the last few years, mostly one-offs like an episode of gout, shingles, a fainting spell (documented here on Huffington Post), some panic attacks years ago that still ambush me every so often.

The rest were namby-pamby boring stuff — none worthy of even a mention in a TV medical drama. A kidney stone fifteen years ago, psoriasis on and off. With every affliction mentioned, she typed and typed.

“It says you have cancer in your family.”

“Yes. Here and there.”

“Any family history of heart problems?”

“No.”

“Diabetes?”

“A brother and a grandmother. You probably see there that I took a bunch of blood tests a few months ago and everything was normal except my triglycerides were a bit high.”

We went through my medications. “Do you still take Cialis?”

“...Sure, when needed. Although I don’t really need it. If I take it it’s only a nick off the pill to counteract the very small, daily dose of Zoloft. If a hotsy-totsy night is planned, it just makes things a lot easier for, you know...everyone involved.”

She typed something.

There was talk about my thyroid. This was the first I’d heard of it. (A blood test was ordered, the next day it came back in the normal range.)

We said our goodbyes and I was out the door with a few pages of hard-copy in my hand. I imagined it read, You’re fine, go home.

I don’t remember exactly where I was when I actually looked at the first page — either outside the car and about to open the door or already in the driver’s seat. It’s all a blur now. Manually highlighted in blinding yellow was this list:

You Were Seen Today For
History of Adenomatous Polyp of Colon
Spondylosis Lumbosacral Region, unspecified spinal osteoarthritis complication
BMI 32.0-32.9, adult
Thyroid Mass of Unclear Etiology
Diverticulosis
Pre-Diabetes
Hypertriglyceridemia
Anxiety Disorder
Insomnia
ED (erectile dysfunction)
Essential Hypertension
Gout
Cerumen Impaction
Syncope
Risk for falls
History of Nephrolithiasis

I have no memory of driving home. I’m surprised I made it home at all because I’m obviously dying.

That was a week ago, and I’m still miraculously hanging on. I’m afraid to move, to breathe. If I do either, it’s done cautiously. Any wrong move might kick in one of my conditions, and I’ll kick.

I walk into the doctor’s office with bad knees. I walk out with a Death Sentence.

My new take on medical visits: Fifteen minutes is much too long. Who knows what could happen during such an excruciating amount of time. From now on I want my appointments to be no more than thirty seconds, maybe less. They’d go something like this:

Doctor walks in. “What’s wrong?”

“Sore throat.”

“Open and say “Aahhh.”

“Aahhh.”

“I’ll write up a prescription and you can pick it up at the front desk. ‘Bye.”

“Later.”

The less I know, the healthier I’ll feel.

* * *

Ronni here again. I'm pretty well in sync with Chuck about how to deal with doctor's visits but there is a serious point to this too – that you should take advantage of these free wellness visits.

Anyone with Medicare Part B is eligible. It is free to almost everyone as long as your physician accepts assignment, and the Part B deductible does not apply although if the doctor orders tests not approved for the visit, you may owe a co-pay.

The Welcome to Medicare Visit can be done anytime during the first 12 months after you've joined the program. You do not need to have done the Welcome Visit to take advantage of the annual wellness visit.

There is more information about both visits – which are not the same thing as more extensive physical examinations – at medicare.gov.

UPDATE: A reminder for all medical/health posts. In the comments you may not recommend any specific kind healthcare, treatment, physician, medication, etc. or link to any website related to those areas or to any commercial product.


Comments

This is scary -- well-written and humorous, but downright disconcerting. So now, following Chuck's "free wellness checkup" compliments of Medicare, he has a laundry list of things he didn't know he had before, and probably really doesn't have now, but they are all on his medical history? This gives me no confidence in seeing a "health care professional," for such an "evaluation."

My body is the most important thing to me when it comes to applying the adage, "If it ain't broke, don't fix it," and I discovered a long time ago that the farther away I stay from most "medical professionals," the better I feel. Stories like Chuck's (and there are millions more like his out there) suggest why that is. So, no thank you, I won't be taking advantage of this hour long fall down the rabbit hole, but thank you for the entertainment this morning.

Chunk is a funny guy.

I had one of those wellness tests and it included a bunch of questions about safety in the home---throw rugs, shower chairs, etc.---as well as questions that were designed to find out if I was a depressed, lonely or active, happy senior citizen. I rather resented some of those questions and wondered what would happen if I didn't answer them "correctly."

My husband and I are very fortunate with our health insurance. Hubby has military retirement so we also have Tricare on top of my employer provided coverage and his medicare. Because of all this good coverage, the medical professionals are quite happy to order all sorts of tests and require 6 month checkups. I'm a reluctant patient and seldom go to the dr unless in pain. I have friends, though, with similar insurance coverage, who milk it for all its worth.

It sounds to me, (as someone who ran wellness classes in a community health centre for ten years) that the so-called 'wellness checkup' has nothing whatsoever to do with wellness! They have simply hijacked a term that was originally coined to describe a totally holistic attitude to health. Wellness includes important stuff like a healthy diet, three kinds of exercise (aerobic, strength and flexibility), lifestyle, state of mind, beliefs, attitudes and heaps more than that.

Most medical professionals (except for the more recently emerging practitioners of Integrative Medicine) are not trained in wellness at all. They are not about health. They are only about sickness . And their only response to sickness is pharmaceutical. Do you know how much time a medical student spends learning about nutrition? I have heard several doctors give the same answer. One day!!

I agree with Cathy Johnson, above. The farther away I stay from most "medical professionals," the better I feel.

I would add: take responsibility for your own health, learn how your body works and what it needs, eat real food, stay fit.

And if you want to know what wellness really is, read the book my friend John Travis first co-wrote with Regina Sara Ryan more than thirty years ago and which has recently gone into its third edition. It is called The Wellness Workbook.

I feel like I've reached that time where if I go to the doctor they're going to find something that needs fixing. It took a while for me to figure out that there are some things I could live with, or work on myself, and some things they need to deal with. I try to keep in mind what might be a complication only I have to deal with like pain from osteoarthritis, and what has the potential to complicate other people's lives, like a stroke from high blood pressure. I do feel like some of the treatments I've agreed to in the past complicated my life, but they motivated me to look for alternatives that work better for me. I have to live so I might as well do it the best for me.

Distressing to read that so many here seem to dismiss the importance of seeing a doctor (an MD). There are a lot of serious conditions and diseases that can and probably will overtake you as you age that you might not recognize right away. Not the least of these is cancer, which if not caught early can be fatal (and ladies, take it from one who knows, a screening mammogram won't necessarily see developing breast cancer).

The long list of conditions Ronni mentioned is undoubtedly the CPT terminology/code used universally by doctors and insurance companies. And it's a history, not necessarily a list of current problems.

My Welcome to Medicare exam was a good chance to get to know my new doctor, the one who'd just accepted me as a patient (I chose her based on a glowing recommendation from my son), and I welcomed the chance to spend some quality time with her. The exam included my first ever EKG, first ever bone scan, and first ever scan of my abdominal aorta -- all important benchmarks for future health care and information I'd never had on record before. Other testing brought up to date the information I'd accumulated from several different doctors over a number of years. The questions about home safety seemed unnecessary for Medicare to know but did give the doctor a chance to discuss possible risks I might have been unaware of. Especially important for someone who lives alone. (As it happened I was well aware, but some people might not be.)

Bottom line, it's a thorough medical exam ... for free. Given the cost of health care today, why wouldn't you jump at the opportunity?

Chuck is indeed a funny guy. However, I'm surprised that he dismisses shingles as being of little concern. For one thing, it's incredibly painful and disfiguring and may cause blindness in some cases. In addition, it's preventable. There's a one-time shingles vaccination which I had years ago.

I'm in complete agreement with Marian's comment about taking responsibility for your own health.

PiedType and others:
Re PiedType's "The long list of conditions Ronni mentioned..." I had hoped I was more clear at the top of this story. I republished a post that my friend Chuck Nyren had written at Huffington Post. I cannot take credit for this.

I think it's quite funny and we all have different attitudes toward our physicians and how often need or want to see them. He makes me laugh and unless something has gone drastically wrong, I'm with him on the short visit he describes at the end.

By now I think I know all the things wrong with my old body, but it can't hurt to keep up to date.

I have always believed that prevention is worth a pound of cure and that what you don't know CAN hurt you.

I did the wellness thing a couple of months "forgive me doctor it's been 15 years since my last..," All I needed was a little blood work to check my calcium levels but the triage nurse said the doctor had to see me before he would authorise the lab work. Then we played 20 questions and he saw that my cholesterol was a little high saw he added that to my lab work. A couple of days later doc's nurse called and said that I should stop taking the statin I was taking and switch to the new medication that was being called in to my local pharmacy. When I checked on the new meds online I discovered that might be marginally better than the drug I was taking and $1200 a year more expensive.
That's my last wellness visit.

About shingles... I knew pretty much nothing about it beyond the name and, "Ooh, I hear it's a bad thing. I hope I don't get it!" -- until one day four months ago I rolled a 1 on my saving throw (or my immune system finally threw up its metaphorical hands), and it was my turn.

Of course the symptoms started late on a Friday night when my family physician wasn't going to be available until Monday. It was a day and a half of googling before I realized what I had, and that I'd better get to an emergency room RIGHT NOW for a prescription for the anti-viral that could give me a better chance of minimizing long-term nerve damage, AKA post-herpetic neuralgia. I did, and the emergency room doc praised me for figuring it out right. By the time I filled the prescription at a 24-hour pharmacy and took the first capsule, I came in just under the wire for the 48-hour window of effectiveness.

If I'd figured it out a day earlier, the anti-viral would probably have helped more.

If I'd had the vaccine to boost my own immunity, I wouldn't have had to figure it out. The attack would never have happened.

Knowledge came too late to save me from a very nasty experience that's not over yet. To anyone reading this who hasn't been given the shingles vaccine: Madeleine's right. I had a bad attack, but it can be far worse. It's not worth risking. Ask your doctor!

There are a few contraindications. If you're one of the rare people who shouldn't receive the vaccine, your doctor will know. However, chances are they'll just say, "Oh, yes, we'd better attend to that!"


Good blog today - I had to visit a new doctor last Feb. after becoming fed up with the county clinic I had been visiting once a year for wellness check up. Had seen 2 female doctors who left the area, and, last, a nurse practitioner who made many mistakes in not reading my chart and not paying attention to what I told her.

I had met this new doc about 5 months prior when my husband had to see him for a bursa. Anyway I was grateful as I got an appt. the same day I phoned..... I had raging bronchitis after returning from a week in Hawaii. He was great, ordered a mammogram, and a Dexa scan and wrote RX for bronchitis medications I needed.

I paid close to $2oo. co-pay...when I finally got the invoice from Medicare I found out the bill was so high because he did a psychiatric evaluation on me!!! I guess that is OK as I was a new patient. The Medicare summary noted this visit constituted my annual Wellness visit so I will need to take the paperwork to show the new doc. He told me he'd see me in August for my Wellness visit but I do not want to pay for another one.

I've heard that the shingles vaccine is only approximately (?) 50% effective but I still got mine when it was covered by Medicare, and I have not had shingles.

After having a great female doctor for 15 years who went into teaching and administration full time it has been discouraging to find how difficult it is here in Ventura County, California to get a good M.D. I liked the male doctor so will continue with him, however I prefer a woman doctor. Oh well, at 76 I not longer have to get a pap test so I will hope for the best.

I don't want to bear bad news, but I must report that I got a mild case of shingles about a year after getting the vaccine. It was unpleasant but nothing compared to what it can be. So, please do get the vaccination; just don't feel misled if you get a minor case later. Be glad that you did the right thing!

Hate to chime in again, but for Pete's sake, if you haven't gotten the shingles vaccine yet, get it!! I had one outbreak, caught just inside the 48-hour window. Still was miserable for several weeks. A year later, there was another much milder outbreak. When the vaccine finally became available, you can bet I was the first in line -- even before Medicare decided to cover it. It was several hundred dollars then, but I knew I'd gladly pay that and more for relief if I got shingles again.

Ronni, I realized too late that the list was not yours. I should never write anything until I've had my morning coffee. Mea culpa.

I should probably add that having had a shingles attack from which he has fully recovered is indeed no big deal. He's right to list it as a one-off incident that doesn't matter any more. In fact, it's almost a plus. Studies show it improves his odds against a second attack.

And, yes, the shingles vaccine only improves your odds, too; it's not a guarantee. Still worth it. I hear there's a new shingles vaccine in development which is testing out to be much more effective, especially in the elderly, but it's not on the market yet and won't be for a while.

On topic... I'm here in Canada, so I can't speak to these wellness visits. However, even though we have a very responsive health care system, and I am lucky enough to live in a city with excellent services, now that I'm of an age to be talking to doctors more, I too have noticed the tendency to want to prescribe a pill for every little thing that you mention to them.

I appreciate this, don't get me wrong. Sometimes a pill is necessary, even life-saving. All the same, I've realized that I have to understand all the factors. I have to know possible side effects, so I can watch for them. I have to pay attention to the trade-offs, because my sense of what matters most is not going to be the same as theirs, and once in a while I am going to have to speak up and say no, I don't want that. Luckily most of the doctors I've seen here do respect this.

Enjoyed Nyren's humor, but my experience with annual wellness exams dictated by the Affordable Care Act for Medicare recipients was quite the opposite. I'd had acceptable annual physicals from doctors I trusted for many years, but the first "wellness" exam was far superior to any others. It was thorough, with everything well-defined, and with an easily understandable report for me. The whole thing was more professional than any exam system I'd experienced previously.

Obviously from the comments here, there are different strokes for different folks in the sometimes baffling field of medical care in the U.S.

Thanks to Ronni for featuring my HuffPo piece – and thanks for all the comments. I’ll comment on a few:

The exam didn’t really bother me. Afterwards, when first seeing the cover page list of afflictions, I rolled my eyes and snickered. This wasn’t a “Wellness Exam” but an “Unwellness Exam.” I knew I could come up with a humorous take on it. So, don’t take my take too seriously.

“…the CPT terminology/code used universally by doctors and insurance companies. And it's a history, not necessarily a list of current problems.”

That’s probably true, but one thing I did not make up: the title of the list on the cover page. It read You Were Seen Today For, implying that these were all current conditions - not past, not future. Of course, I knew better.

“I'm surprised that he dismisses shingles as being of little concern”

Not sure I dismissed it, just categorized it as a ‘one-off’. I didn’t get the vaccination (a mistake) and the chances of a second bout are low (famous last words). I have read that a new vaccination is in the pipeline and is 98% effective. My humorous take on shingles:

http://www.huffingtonpost.com/chuck-nyren/binging-shingles_b_4826468.html

Ronni sums up everything:

… This is not a substitute for a more extensive physical exam but a way for your physician to ask some questions about your health …

... we all have different attitudes toward our physicians and how often (we) need or want to see them …

What this really is a way for the MD to get extra income from Medicare. This visit was initially slow to catch on but the Govt pushed the use of the extra cpt codes until the MDs found a way around it and scheduled the appointment s. However in my case a Medicare Nurse met with the paitient. If any complaints from the patientj another appointment was scheduled to see the MD. Extra income by using the new codes. Medicare Waste

I agree with Michael. A Medicare waste. My Dr. had the nerve to tell me he gets a good grade from Medicare for doing them. So I am supposed to do this for who? I refused it and will never do a wellness exam.

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