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Life Health > Health Insurance > Health Insurance

The Catch: Medicare to Pay for Wellness Chats

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Primary care doctors who treat traditional Medicare patients are getting a small break: They can get paid for one office visit with each Medicare patient per year during which the only test that must be administered is a blood pressure test.

But, to qualify for the payment, from the Centers for Medicare & Medicaid Services (CMS), doctors must do what they can to counsel the patients to avoid cardiovascular disease.

CMS is putting the heart disease counseling session benefit in the package of preventive services added to Medicare by the Patient Protection and Affordable Care Act of 2010 (PPACA).

CMS wants the primary care providers who conduct the sessions to screen adults ages 18 years and older for high blood pressure and engage in “intensive behavioral counseling” to persuade patients to eat better and avoid dietary choices that contribute to high blood pressure, high cholesterol, and, potentially, debilitating chronic diseases.

For men ages 45 to 79 and women ages 55 to 79 who are good candidates for using aspirin as a preventive measure, the providers are supposed to recommend use of aspirin.

For the provider to be paid for the session, the Medicare patient must be “competent and alert at the time that counseling is provided” and the advice must be provided “in a primary care setting.”

“Emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation facilities and hospices are not considered primary care settings under this definition,” officials say in a CMS cardiovascular disease counseling coverage decision summary.


For consumers, one of the goals of digital health information privacy rules is keeping information about medical care they pay for out of pocket out of the hands of insurance companies.

Deven McGraw, director of the health privacy project at the Center for Democracy and Technology, Washington, talked about that concern today in Washington during a health information privacy hearing organized by the privacy subcommittee at the Senate Judiciary Committee.

In 2006, 80% of Americans who participated in a survey about online health information said they were worried about identity theft and fraud, and 77% said they were very concerned about their medical information being used for marketing purposes.

Another 56% said they were afraid of employers having access to their health information, and “55% were concerned about insurers gaining access to this information,” McGraw said, according to a written version of his testimony posted on the committee website.

Congress recently has added to the health data privacy laws in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 by letting patients prohibit the sharing of personal health information with insurers when the patient pays out-of-pocket for care, McGraw said.

Another witness, Loretta Lynch, the U.S. attorney for the Eastern District of New York, testified that some already have made criminal use of stolen personal insurance data.

“In September 2009, an Indianapolis defendant was sentenced to three years in prison for stealing insurance records of over 900,000 individuals,” Lynch testified. “The records included personally identifiable information, confidential medical information, and confidential email communications. The defendant had threatened to publish this personal information and confidential medical data on the Internet, unless each victim insurance company paid him $1,000 per week for four years.”


Independence Blue Cross, Philadelphia, has promoted Elizabeth A.W. Williams to the new position of senior vice president and chief communications officer.

Williams now oversees communications and brand strategy, advertising, media, public relations, communications planning, creative services, sponsorships, and events.

Williams previously was a vice president for corporate and public affairs.

She has a bachelor’s degree in political science from Smith College and a master’s degree in journalism from Northwestern University.

She is a member of the Strategic Communications Advisory Group at the Blue Cross and Blue Shield Association, Chicago.


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