AAA screening benefit added to Medicare.
Although such screening is potentially life-saving, providing it during office visits will further strain the limited time available for prevention, Dr. Randall Card said.
"It's one of many preventive services that are covered by Medicare ... during this relatively short visit and that's a challenge physicians are running into," Dr. Card said, adding that Medicare pays for 30 minutes of physician time for the physical, which can require a physician to conduct or arrange for 15 or more screening services.
Nonetheless, he praised the new benefit, calling it a lifesaver for certain patients. "This benefit should help us identify patients who are at risk to have a catastrophic rupture of an abdominal aortic aneurysm, and the vast majority of those will result in death," said Dr. Card of Marquette (Mich.) General Hospital. "If we can treat them effectively before they rupture then we will be doing patients a service."
The Screening Abdominal Aortic Aneurysms Very Efficiently Act, signed into law in February by President Bush as part of the Deficit Reduction Act, provides for Medicare coverage of one-time abdominal aortic aneurysm (AAA) screening for males who have ever smoked and for males or females who have a family history of the disease. Coverage for the screening starts Jan. 1, 2007.
Some primary care physicians perform ultrasound in their offices, but few do vascular ultrasound, Dr. Card noted. Patients most likely will be referred to radiologists for testing and the physician will handle patient follow-up if there is an abnormality.
Ensuring that primary care physicians are aware of the benefit will take a concerted educational campaign, according to Dr. Robert Zwolak, Society for Vascular Surgery board member. Dr. Zwolak chaired the National Aneurysm Alliance, which fought for the new benefit.
Funding for educational campaigns and requirements for quality standards were stripped from the final bill to cut costs.
Screening proponents hope to expand the benefit in the coming years. The original legislation would have provided screening to Medicare beneficiaries with a family history of abdominal aortic aneurysm, as well as those who are at risk for cardiovascular disease or atherosclerotic vascular disease.
Supporters also hope over time to amass the data needed to argue for expansion of the benefit to other populations, including female smokers. "Some of us believe that they should be on that list as well, but we need more data to help that," Dr. Zwolak said. Last year, the U.S. Preventive Services Task Force recommended one-time screening for abdominal aortic aneurysm by ultrasonography in men aged 65-75 years who have ever smoked.
In arguing for its broad availability, Dr. Zwolak said that "there is a very effective treatment for the disease. If left untreated [it] has a very high mortality. There is a superb screening test that is inexpensive and accurate."
Medicare screening for and treatment of diagnosed abdominal aortic aneurysms is estimated to cost $200 million over 5 years and $1.3 billion over 10 years, according to the Congressional Budget Office. The CBO estimates that 58,000 beneficiaries will be screened the first year.
BY NELLIE BRISTOL
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|Title Annotation:||abdominal aortic aneurysm|
|Publication:||Internal Medicine News|
|Date:||Apr 1, 2006|
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