Dr. Patricia Lindholm thought it was a great idea this year when Medicare announced it would cover free annual wellness visits for older people.
"OK, finally we're getting Medicare to cover preventive medicine, catch problems while they're smaller and more treatable," the Fergus Falls, Minn., family physician said.
Then she started conducting a few -- and quickly changed her mind.
What she thought would be a full physical exam turned out to be essentially a hands-off screening that was "pretty worthless for most of my patients -- a waste of their time and mine," she said.
Lindholm isn't just any family doc. She's president of the Minnesota Medical Association. And while there's no full revolt among doctors against the new Medicare benefit, other physicians share Lindholm's irritation.
The wellness screenings emerged as one of the signature benefits of the big federal health overhaul that Congress passed last year -- an effort to catch problems early, keep patients healthier and cut future Medicare costs.
Some doctors, however, are having second thoughts. To get paid by Medicare, a physician and nurse must complete 15 steps during a 30- to 45-minute exam, including brief screenings for dementia and depression, an eye exam, a medical history and personalized health advice. They must also check weight, height and blood pressure -- the only time the patient must be touched.
Although much-touted in letters to the 46 million aged or disabled people on Medicare, the wellness visits haven't caught fire with patients either. Since Jan. 1, about 780,000 patients have received the new service, Medicare officials say.
Last month, federal officials announced a nationwide campaign among doctors, patients and families of those on Medicare to increase awareness of the benefits under the new law. In addition to the free preventive visits, they include some free cancer screenings, immunizations and other tests and counseling.
Since 2005, Medicare has offered a separate and free "Welcome to Medicare" doctor visit for the 2 million new enrollees during their first year.
A beneficiary's first free wellness screening must come at least a year after the "welcome" visit, and subsequent screenings must be at least a year apart.
Several doctors in Twin Cities-area clinics have chafed at the restrictions. If doctors want to go beyond the Medicare agenda -- order tests or prescribe medication, for instance -- they must either ask the patient to return for a separate visit or split the bill between Medicare and the patient.
"That can be confusing for patients who think Medicare is paying for a comprehensive visit," said Suzanne Werner, manager at Allina Medical Specialties Clinic in St. Paul, Minn. "The doctor wants to treat the patient as an individual, with tests and treatment geared to that person," she said. "Sometimes that's hard to do."
Medicare officials say doctors misunderstand the value of the screening tool and say there is no plan to change the process.
"The elements of this visit are defined by statute and are meant to (focus) on prevention," said spokesman Donald McLeod. "The visit has been misperceived by a number of people due to the fact that Medicare has traditionally been focused on diagnosis and treatment of disease rather than its prevention."
The American Medical Association agrees the wellness visits can help, though it would like more flexibility.
Some doctors say mastering the "somewhat clunky" regulations is worthwhile.
"It's helping me do a good job of screening for health and safety issues," said Dr. Rod Christensen, a family-practice physician in Northfield, Minn., and chief medical officer for Allina's 45 clinics.
Last month, he and nurse Renee Estrem spent 45 minutes on a wellness visit with a long-term patient, Patty Warner, 69, of rural Northfield. But they did more than that. Warner had been treated earlier in the week at a hospital for a fast heart rhythm, a condition that in the past had sent her to the hospital emergency department. Christensen wanted to go over her health in more depth than the wellness visit would pay for.
"This is a perfect example of what we should do," he said afterward. "With all my Medicare patients, even those I think I know well, I want to assess their risk of falls, of driving problems, of abusive relationships. I want to know how they're doing overall."
In the end, Warner also received a new prescription to control blood pressure, a tetanus booster shot and a physical exam -- with the costs split off and billed to her Blue Cross Blue Shield Medicare plan.
"Doctors are too afraid to talk about costs, about what's covered by Medicare and what the patient or insurance may have to pay," Christensen said. "Our patients aren't stupid. If I bring it up, they don't have to wonder or worry."
Still, his clinic sends a brochure to patients before they come, noting what services might not be covered by a preventive visit.
While Christensen encourages the visits, in Fergus Falls, Lindholm is on the brink of forgoing them.
"I know my patients," she said. "If I'm doing my job, neither my patients nor I usually learn anything new from this."