Welcome to Medicare

Initial Preventive Physical Examination (IPPE)

A new benefit under the Medicare Modernization Act

Effective date 1-1-05, changes for 2009

Eligibility:    Any Medicare beneficiary who enrolls in Medicare on or after January 1, 2005

Time limits:    Eligible for benefit in the first twelve months of enrollment in Medicare program (twelve months effective 1-1-09.  Previously was six months)

Benefit:    The Welcome to Medicare visit is not a typical preventive medicine service.  It is mostly a screening history, with referral to covered screening tests.

Who may perform the service:

    MD, DO, NP, PA, CNS (not Certified Nurse Midwife)

Other benefits:    Diabetes and cardiovascular screening available to all new and existing beneficiaries within certain diagnosis and screening criteria.  Screening for AAA when recommended at the IPPE visit, and meeting the criteria for needing screening.

"Welcome to Medicare"--7 Components of the Initial Preventive Physical Examination

1.  History.

•    Past medical history, surgical history, including experience with illnesses, hospital stays, operations, injuries, allergies and treatment

•    Current medications and supplements including calcium and vitamins

•    Family history including a review of medical events in the patient's family, including diseases that may be hereditary or place the individual at risk social history, alcohol, drug and tobacco use, physical activities and diet)

•    Social history including history of alcohol, tobacco and illicit drug use, diet and physical activities

2.    Review of patient's potential for depression using a screening tool recognized by national standards.   See these web sites for screening tools: http://www.aafp.org/afp/20020915/1001.html

          http://mail.med.upenn.edu/~abeck/scales.html

         http://www.stanford.edu/%7Eyesavage/GDS.html

3.   Review of patient's functional ability and level of safety using screening tool recognized by national standards.  Must include hearing impairment, activities of daily living, falls risk and home safety.  See these websites for information:

http://www.nidcd.nih.gov/health/hearing/10ways.asp

http://www.homemods.org/library/hthelp/audit.html

http://www.fallprevention.ri.gov/Module3/sld006.htm

http://www.fpnotebook.com/GER2.html

4.  Physical exam that includes height, weight, BP, calculation of BMI and screening for visual acuity and other exam components deemed appropriate by MD or NPP.  

5.  Performance and interpretation of an EKG is optional, starting Jan 1, 2009.

6. Education, counseling and referral, as appropriate, based on the results of the first five elements

7. With the patient’s permission, discussion of end of life planning.

8. A written plan (which may be in the form of a checklist) given to the patient at the visit which refers them to Medicare covered preventive medicine services.