Download Welcome to Medicare - Exam Overview Transcript

Event ID: 2964611
Event Started: 6/8/2016 12:19:55 PM ET
Good afternoon, everyone. Welcome to the Quality Innovation Network Learning and Action
Network titled “Welcome to Medicare”. I will be the moderator for the webinar. On our agenda
today, you will see opening remarks, housekeeping, polling questions that we ask you to
participate in. We will have the feature presentation, more polling questions, and then follow up
with Q&A and closing remarks. In case you did not know, the Alliance is a five-year five state
initiative to ignite powerful and sustainable change in healthcare quality. Today we welcome
beneficiaries and providers alike from Alabama, Indiana, Kentucky, Mississippi, and Tennessee
as well as any other state that may be participating. We would like to thank each and every one
of you for taking the time to join us. We appreciate all you do to improve quality and to achieve
better outcomes in healthcare for the beneficiaries and providers that we serve. What we would
like you to learn today -- we'd like you to learn which preventive and training services Medicare
covers to keep your patients healthy and identify problems early when treatment is most
effective. Promote the referral of Medicare patients to screening for colorectal cancer during the
annual wellness visit. Before we begin, I’d like to run through a few housekeeping issues. All
phone lines have been placed on mute. We encourage you to use the chat feature which is located
at the right side or the top of your screen. The chat box will be monitored today. To enable full
screen you can click the two diagonal arrows just above the PowerPoint presentation. To disable
full-screen mode or to access the chat function, scroll to the top of your screen and access the
menu of items. If you would like your comment or participation answers to be private, you can
choose my name, Patty Brinkley instead of all participants. In addition to the chat box, we have a
separate Q&A function just below the chat function. This function will allow you to submit
questions to the panelist without being seen by all participants. The panelist may respond to all
participants with the answer. As we go through the presentation, make sure that you submit any
questions through the Q&A function. We will respond to you either in the Q&A box or on the
call. As noted earlier, we will have a polling question. This is the first one today.
This is an important one. We would really like to know who you are. Are you a Medicare
beneficiary or patient? A family member of a Medicare beneficiary? A healthcare professional,
healthcare provider, or other? Please select one of those.[ music ] Okay. Now we have our
answers. Thank you for that lovely music. It looks like we have some Medicare beneficiaries,
some caregivers, several healthcare providers. There are some others and a few of you did not
answer. Thank you for doing that. We will have other polling questions as we go along in the
presentation. With that, what I would like to do before we get started, I would like to introduce
our partner with the American Cancer Society, Carol Minor. She helped to pull this together and
arrange the webinar today. I am going to introduce Carol and then I will allow her to introduce
our speaker. Carol is currently a health care provider. She has worked primarily in prevention
and early detection education with health plans and state health providers associations. She has
several years of experience and has served as a state advocate committee. Carol serves as the
State Comprehensive Cancer coordination with specific interest in the colorectal committee in
order to help the state regulate the screening right in Tennessee. She works to engage community
partners for various levels of volunteering opportunity that support the American Cancer
Society's mission for research, advocacy, admission, and patient services. I thank you so much
for arranging the webinar. I will allow you to please introduce the speaker.
I'm really glad to be here so that we can continue that discussion. I am pleased to introduce our
feature speaker which is Dr. Kimberly Howerton. She is out of Jackson, Tennessee. She has
studied at the University of Tennessee – Health Sciences Center School of Medicine and she
went on to the St. Francis Family Medicine Residency program where she served as Chief
Resident. She is a member and the past president of the Tennessee Academy of Family
Physicians and is co-editor of the Tennessee Family Physician magazine. She is also on various
state advisory committees. I think the most important thing about her is that she practices patientcentered physician care. It is a combination of old-fashioned medicine and modern innovation.
She uses that to provide each patient with more time and attention to communicate with them
about their healthcare and their need. We have Dr. Howerton with us today and I am very
pleased to have her and to go through her presentation. I think you will be pleased as well.
Thank you for inviting me to be a part of this. Thank you for having me and I'm excited to be a
part of this discussion. Medicare patients are near and dear to my heart. I am growing closer and
closer to that age so it is even more important to me. Let's go ahead and get started. Let's review
our objectives. We are going to cover a significant amount of information in a short time. If you
have questions, please submit them and I will get back to you as soon as I can during the
presentation or during our question and answer period. I would like to make sure that everyone is
aware of the screening measures that Medicare covers. I want to look at the risk factors that we
can address that will affect our elderly and our seniors. At the end, I want to pull it together to
help our seniors with counseling, education, and use of the services provided by Medicare. In
2011, Medicare started offering an annual wellness visit. This is a true shifting of the focus a
Medicare. In 2011, they began this coverage and it was to encourage our seniors to be more
proactive in their healthcare and it really addresses prevention as the central part of healthcare. It
is designed so all patients can develop a game plan so they can stay healthy for the next 5 to 10
years. The great thing about this visit is it does not have a deductible. It does not have
coinsurance. It does not have a co-pay. This is a fully provided service for our beneficiary. It
comes 12 months after the Medicare beneficiary begins part B or 12 months after their first
Welcome to Medicare exam. The key point is that they do not have to have the Welcome to
Medicare exam to access this service. It just needs to be 12 months after they began coverage.
They can have this coverage 12 months after that, which is a great service. Before 2011, it was
unheard of. This is a great way for us to get our seniors into the office, look at their health needs,
and develop a plan. This does not have a deductible or coinsurance, but the physician or provider
can recommend certain services that may have a deductible or coinsurance. The great news is
that is discussed during the visit. There is time to sit down and talk about what the cost may be
and how to proceed. What does the patient really want? Like all things with Medicare, it is
clearly spelled out as to what we have to be doing during this visit, what our expectations are.
The first one is the health risk assessment and the history. We move into the physical exam and
the assessment which is what most people think of as their wellness visit. It ties it all together
with the counseling component. For all of the healthcare providers on the call -- you must have
all of these elements performed and documented before you can submit the claim for them. Make
sure that all of these elements are completed and documented. The first part we are going to talk
about is the health risk assessment. This really is a collection of the patient's self-reported
information. To help the patient get ready for the visit and the questions, when they call to
schedule the appointment, have your staff ask them to start gathering their medical records,
immunizations -- although we can find some of those on state immunization websites. Detailed
family history - give them some time to ask family members what is common in their family.
Have them sit down and list every medicine that they take. It may be a prescription medicine. It
may be over-the-counter. It may be a health supplement. They may not view the over-the-counter
medications or the supplements as important. If you or your staff mention this, they will see the
importance of it. Ask them to write down every healthcare provider that they have had within the
last seven years. Then you know the team that you are working with. After they have done all of
that, what we need them to do is complete a health risk assessment. This information can be
completed -- it usually takes 20 minutes for them to do it and it can be completed before the visit.
That is a critical piece. If they can do it before the visit it really streamlines all of the things that
happen when they get to the office. For some providers they can post it on the website so the
patient can link and download the information. You can mail them a paper copy of that is what
they prefer. If you have a patient that needs assistance with this, you can have them come to the
office a little bit earlier than their visit and sit down with a staff member and go through it. Have
the staff member ask the questions line by line and help them answer them if possible. As all
things with Medicare, we have a set list of what is really required of the health risk assessment -the minimum elements that we have to have. We have to have the demographic information, I
think all of us gather when we visit with the patient. We have to have their self-assessment of
their health status. It looks at their psycho-social and behavioral risks. It goes through and asks
them specific questions about their activity such as dressing, bathing, walking. It goes on to look
at what I called instrumental or the advanced ADLs. Who does their shopping and how do they
get their groceries? How do they clean their house? Who organizes the medicines for them? How
do they remember their medications? Who manages their money? Another piece I think is very
important -- and I bring it up in this part of the visit because it sets the stage for us to talk about
later in life. How are they driving? Have they had wrecks recently? The great thing about the
health risk assessment is that you can modify it. You to have the basic required elements but then
you can add items and questions that are specific for your patients and for your community.
Medicare has a template for the annual visit. It is in the appendix. The CDC has a sample form.
My favorite is actually the website HowsYourHealth.org. I have no financial interest in it at all.
It is an amazing tool and there is a lot of reasons I like it. First and foremost, it is free. It is free
for the patient. It is free for healthcare professionals to use. If you are healthcare professional and
you want to use this and you are going to modify it, they ask that you consider voluntarily
supporting it but it is not required. The second reason I love the tool is it is completely and
totally private. The patient does not have to reveal their name. There is no personal data that is
collected. They can ask and answer every question anonymously. If they want to share the
information with their provider, they can put their name on it and print it and send it to the
provider, however they want to share that. They make that choice to put their name on it. There
is no advertising. It is free and private. It is critical pieces in my mind. It is very sensitive to help
literacy. The questions are simply written. Every question has a picture with it. Sometimes when
you look at the website you say it is not a professional looking website. It is very specific for all
patients. It is very easy for patients to use. As you get through the website you will see it is well
organized. There is a lot of thought behind it even though it looks very simple. The other thing I
like about HowsYourHealth.org is it addresses -- this is the key required element. It addresses
health confidence. How well does the patient think they will be able to handle their care? It also
asks how does the patient view the health care they are receiving? In my mind, I can offer any
information that an office can provide. If it does not fit the needs of the patient, it is really not
useful. It drills down and gets to the heart of the whole visit. How does that patient view that
visit? Did I meet that patient's needs? If the patient decides to give that information to me, they
can do it anonymously. It really allows the dialogue for the improved care. Finally,
HowsYourHealth generates a summary at the end that talks about the risk, goals, action items. It
links them to websites that can help them improve their health care. It puts them in contact with
other people if they choose to improve their health. It is a phenomenal website that I think from a
patient perspective meets a lot of the needs. It is free. It has no bias at all. It is very important in
my mind on that. Some other required elements of the initial part of this visit are things that we
think of with a visit -- the family history. What types of illnesses run in your family? What did
your parents have? What about your brothers and sisters and children? What is your personal
past medical history? What are your surgeries? Just the standard things we think of when we fill
out the forms at the doctor’s office. The things that are unique about this is it addresses
depression. When I was doing review on depression in the elderly, I was shocked to find that 7%
to 36% of seniors suffer from either major depression or a mood disorder. Even more
importantly, that is linked to poor health outcomes and a shorter life expectancy. This is a critical
piece for us to address during our visit. If they have dementia, the risk of depression goes up by
50%. It is disheartening to know that our seniors are suffering from a mood disorder. Another
thing you can do to recognize it is there is a scale called the geriatric depression scale. There are
some simple questions. They are yes or no. As long as the senior has a health literacy to read the
questions, it is a very good tool to identify depression. That directs the rest of the care for them.
Some other simple questions. Do often feel sad or depressed? It is just as effective for screening
for depression. Simple things that we can do to make major improvements in a senior’s outcome,
health, and life. The other element that you need is the assessment of functional ability and
safety. We have to look at how well they can do their cooking and cleaning. Do they have risk at
home for falls – steps, rugs? Can they hear? If we are thinking about something as simple as fire
safety, they have to be able to hear their smoke detectors that go off. That is the unique piece of
information that we gathered. I think it has a major impact on our seniors. After we finish
gathering that information, the next part of our exam is the standard thing, the physical exam,
height, weight, blood pressure, listening to heart and lungs. The difference on this one is we sit
down and look at their cognitive ability. We can ask family members if they are with them. What
usually happens is the family member comes in for their own visit and tells me all of the things
about mom and dad that they are worried about. Mom and Dad come in and then we start talking
about those things and I can ask specific questions they get to the heart of the concerns. Also
during the visit, I include the time to get up and go test. We have them sit in a chair and ask them
to get up and walk 10 feet and then come back. If they can do that in less than 12 seconds, that is
an excellent indicator of their health. If it takes more than 12 seconds, they have a high risk of
falling and also it increases the risk of death within the next 12 months. That is a quick little
piece of the physical exam that has a lot of impact in the end for the patient. The final step of our
annual wellness visit is the counseling. I think that this is the tying together of all the things that
we have done that day. I sit down with a patient and look over everything that we have talked
about during the day, everything found on exam. We sit down and develop a written plan for the
future. What do they need? What are their screening measures they need to be done? What are
the risk factors? How do we address that? If you have an electronic health record, you can
actually build a template that is specific for the patient and actually develop a timeline. That way
when the patient checks, your medical assistant or nurse can go in and ask the questions. Do they
need their colon cancer screening? The nurse can ask that question. This is really the summation
of everything that takes place during the visit. It sets up the plan for the next 5 to 10 years.
Medicare requires that this is a written plan. Make sure the patient has a copy of it and there is a
copy in your health records. That way both of you can go and reference it and make it easy. We
have a polling question. Are you aware of the services that are available and billable for Part B?
If you could all give us your answers. Make sure that you hit the submit button. Excellent. I like
to hear that this many of our participants are aware of these. That is much different than the
general population. We will go through these pretty quickly. I want to mention them. They are
on the CMS website if you want to go back and look at them. Some key points that I think we
don’t think of often is alcohol misuse, screening and counseling, body mass measurements,
cardiovascular screening, colorectal cancer screening, tobacco use, Depression, diabetes,
diabetes self-management, glaucoma, hepatitis C, recommended vaccines – flu, pneumococcal,
HepB. The other things we can get covered is intensive behavior therapy and obesity which I
think is critical to our promotion of health as opposed to just the treatment of the disease. There
is medical nutrition therapy. There is ultrasound screening for abdominal aneurysms for select
populations. Mammograms, Pap smears. I want to highlight that Medicare covers screening for
sexually transmitted infections. This may make some people pause and think why is that a
Medicare provided service? One thing to think about, our seniors often will come back into the
dating world after they lose their spouse. They will come back into a world that is very different
from the world they were in right before they got married. This is always an interesting
discussion that I have with my patients. They are usually shocked about the things that they need
to worry about at this point in their lives. Medicare actually covers the screenings in the
discussion. We have another polling question. Is your practice currently encouraging people to
get an annual wellness visit? That is encouraging. We have a significant number of practices
that are encouraging. That is very encouraging to hear. I appreciate that. As Ben Franklin said, an
ounce of prevention is worth a pound of cure. We’d like to focus on two elements or two areas of
Medicare covered services that really can make a significant impact on our seniors. It can lead to
early detection and decreased morbidity and mortality. In America, the two most common causes
of death are cancer and heart disease. We will spend a few minutes talking about these. The first
one is colon cancer. This is our second leading cancer cause of death in America. About 135,000
of us are diagnosed with colorectal cancer each year. It is quite unfortunate -- quite sad to hear
that. Even more unfortunate is that one in three adults that are actually eligible for screening does
not get tested. Even more alarming are the patients that are underserved. Our Hispanic
population, American Indians, rural populations, patients with less education and less income.
These people -- we are not reaching them and they are not getting screened for a preventable
cause of death. This is something that quite a few health care leaders have noticed and have
taken note of. We have the national colorectal cancer round table. They have come up with the
80% by 2018 initiative. The goal of this initiative is to screen 80% of eligible adults 50+ and
older by 2018. The website you can see is an excellent resource for education for providers. It
provides public health announcements. It really lays out the roadmap to spread this word, to get
this information out to patients and to really make an impact and to increase public awareness.
The resources that this website has -- you can see that we have their emblem. Now you know
what this means. If we can get the word out to the general population, we hope that we can get
80% of all people screened by 2018 and that would mean 277,000 fewer people would be
diagnosed with colorectal cancer and we would save approximately 200,000 lives by 2018. That
is a staggering number. It is just with simple awareness -- awareness for patients, for the public,
and also awareness for providers. I think a lot of times there is so much that we have to talk
about that we do not focus on some of the actionable items. The other part of it in addition to
making the public aware, we need to talk about that colonoscopy is not the only way to screen. It
is the gold standard. It is tried and true. It is what everybody thinks about for screening for colon
cancer. But we all know that people are not eager to go through the prep. Some people cannot do
the prep. Some patients -- especially diabetics have a difficult time doing the prep for the
colonoscopy. We need to be able to offer them other options. The slides talk about what
Medicare covers and how often it is covered. It is for your reference. When we talk about other
options, some of the things we have that we can do to screen for colon cancer -- we can do high
quality fecal occult blood testing yearly. We can do a yearly testing. These are easy to do for
patients. They collect these at home. We don't do the digital rectal exam. It is collected at home
and brought in. That is done every year. We can do DNA testing every three years. This is very
easy for patients. They collect at home and they don't have to do the prep. They don't have to
have dietary restrictions. It provides reassurance for the next three years if they are at normal risk
for colon cancer. This is not for our high risk population. In the end, studies have shown that the
number of lives saved by these options is almost the same as the colonoscopy. That news will
make a lot of patients much more likely to have their screenings. This is easier to convince a
patient to do than a colonoscopy, although I always start with a colonoscopy. When I see that
they will not do it and I have patients to say they absolute will not do a colonoscopy, I can drop
back with this method for them. It is a great way to screen for them. With the Roundtable -- the
leaders of the Roundtable said the best screening is the one that gets done. We just need to offer
our patients more options. They need to know that they have more options to screen for colon
cancer. Our next cancer screening I will talk about today -- and this is a recently added service –
is screening for lung cancer. If they are patients that are 55 to 77 years old, they smoked, had at
least a 30 pack year history and have currently smoking or quit within the last 15 years, they
qualify for a low dose screening for lung cancer. I sit down with my patients and talk to them
about what this means -- what would they want if they were diagnosed with lung cancer. How
would they want to proceed? What are the other health risks? What are the risks of repeated
CTs? We have that discussion. If the patient wants the screening, we proceed. The other thing
that I use is to talk about cessation. Probably one of the number one things we can do in our
office to promote health is to help people stop smoking. I tell my patients there is no pressure.
Every visit I ask them if they are ready to quit. I've done this for years and years and years and
got the answers no, not yet. As late as 15 years into a patient relationship, I had someone tell me
they are ready. As soon as they tell me they are ready, we move into counseling. Medicare
covers that. We get to cessation attempts per year. Each attempt can have four visits – can be a
group visit, it can be an individual visit. Medicare will cover up to eight sessions in an entire
year. It is part of the preventive services we can provide for our services. The last cancer
screening I will mention today briefly is cervical cancer screening. Medicare has listed what is
covered. It differs a little bit from that United States Preventive Task Force screening. It is
covered by Medicare. We need to make sure that we are providing the service and offering the
service to our patients. Let's move into the other aspect of screening and risk prevention -obesity. As we all know, we have an epidemic in America. So many of our adult and so many of
our children are obese now. This is a critical piece of healthcare that we can offer. If they have a
body mass of 30 or greater, it can be 1 on 1, can be group. I personally found if it is a group visit
it has more success and patients like to talk with others. They do not like people to talk to them.
They like to talk to people who are going through the same challenges. I think group visits are
very effective for obesity behavioral therapy. Medicare covers weekly visits for the first month.
Then they cover visits every other month until month six. At month six we have to go back and
ask, have they lost three kilograms? If they have lost three kilograms, they can continue the visits
up for an entire year. Medicare does not require copayment, coinsurance. The deductible is
waived. It is provided to the patient at no extra charge. If they went out into the community, it
can be several hundred dollars a month to have this type of benefit if they use someone else.
Something that is often overlooked and is very helpful. Related to that is Medicare coverage for
diabetes screening. If somebody has risk factors or prediabetes they can be screened from
Medicare. There are different ways that you can screen. If they have prediabetes they can do it
twice a year. If they have risk factors, they can have it once a year. When they are diagnosed
with diabetes, they qualify for nutritional therapy and diabetes management training.
Management training is 10 hours within the first year thereafter they get two hours a year to
refresh and go back and focus. I use this a lot in my diabetic patients. It really increases their
knowledge and their management of their disease. It is very helpful. The number one killer of
Americans is cardiovascular disease. Medicare covers intensive behavioral therapy for this. Once
a year we can sit down with our patients and we can talk about the risk factors and how to reduce
them. Every five years, we can screen the Medicare beneficiaries for hyperlipidemia or high
cholesterol. That is without the deductible or coinsurance. This means the patient does not have
to pay for testing. In this visit, it is very personalized. Medicare does not have a lot of goals of
what it should involve. I use that time to personalize it for that patient. We really drill down on
their needs, on their lifestyle and their choices, things we can and can’t do. It is furnished by
their primary care provider in the office. It is very simple coverage that we can offer our patients.
Some other things that are covered, and I would encourage everybody to do this. Every single
year I actually talk about in every visit with my seniors. It is covered every year. Glaucoma, if
they had diabetes. HIV, hepatitis C. Please make sure that our seniors are getting their flu
vaccines, pneumonia vaccines, both of them and their hepatitis C if needed. I know we have
covered a ton of information quickly. I want to leave you with a final thought that talks about the
resources. CMS has so much information. You can probably spend an entire day just going
through their website. The National Colorectal Cancer Roundtable has excellent resources for
public awareness and also things you can do in your own office. You can refer patients to that
website. The American Cancer Society has an enormous amount of information on their website.
Qsource also has this information on their website. I am also available at any time if you would
like to contact me. I will turn the presentation back over.
Thank you so much. I see that we have several questions in the chat. I think we have some time
for them. Don, would you like to read some of those questions?
There are a lot of great questions here. The first question comes from Amanda Childress. She
asked if you think CMS will change the Welcome to Medicare coverage from every 12 months
to per calendar year like the Medicare advantage plans? I think we're talking about the annual
wellness visit here.
Right now, I don't see any indication that they will. If there is anybody else on the call that might
have more insight, but from a provider standpoint, I don't see any indication that it is changing.
The next question is from Dan. He had been approached by a vendor and the vendor had said
they can do that HRAs over the phone before the patients came to the clinic and he was
wondering if it is okay for the assessment to be done by the vendor.
Does the vendor charge anything for this?
It does not say so in the question but I would assume so.
I would recommend that if any vendor is offering the service at a cost, I would not do that. I
would recommend using the information provided by a free service by either the physician or on
the web, such as HowsYourHealth.org. I would not pay for that service.
Okay. If it was free, would it be allowed to be done by vendor?
If it was free I would ask them to explore and talk to the provider to make sure this is a reputable
vendor and how they will use that information that patient provides. What is the privacy? How
will they protect the patient's privacy? Who are they going to share the information with? I am a
very private and frugal person. My answer to almost everything is privacy and low costs.
Those are great points. Thank you. Several more questions if we have time.
Okay.
The next one is from Melinda Childress. Asking about questionnaires for the behavioral risk
adjustment. What is the best questionnaire to use? She is asking about the PHQ9 or the CAGE
questionnaires.
Those are acceptable forms. When you look at the data, they are going to provide reliable data. I
generally recommend finding one you are most comfortable with and that fits that patient. Both
of those are allowed. If you go to HowsYourHealth and also the one that is provided by CMS,
they have behavioral risk factor questionnaires. The questions are built into them.
We have several more questions. There were a couple more questions about using the visits as a
good time to document the diagnosis codes, especially major depression that can get into risk
adjustment. It is not really a question but a comment. There was a question, is it best to address
the advanced care directive during the annual wellness visit or at a separate encounter since it is
now available?
Since it is available, you can include it. From a content standpoint, it is hard to put in there. I will
bring it up and ask the patient if they have an advanced directive. If they seem open to that
discussion at that moment, we will continue on with that line of discussion. If they don't, I bring
it up and make a note in my charts to come back and we talk about it at a separate visit. It’s very
personalized to that patient. It is a covered part of a wellness visit.
Thank you. We have a couple more.. What components do you feel are critical to have a provider
to do? How much longer does it take you to perform?
I think it is critical for us to perform the review. I think it is critical for us to do the exam. I
personally like to do the counseling part of it toward the summation. My office is slightly
skewed. My appointments are 30 minutes. I realize that is not a typical office. At that point you
could have your ancillary staff organize everything and then you have the final discussion with
that patient. Make sure if they have questions that they can contact you. Like I said, I realize my
office is somewhat skewed.
Okay. Thank you. A couple questions about the physical and then a couple about colorectal
cancer screening. The questions about the physical, does the Welcome to Medicare visit include
a complete physical? This is blood pressure, et cetera. The other question about the environment
is to talk about -- it is asking what is required for the physical exam components? What is
covered and what is the minimum are the two questions that we are trying to get at there.
Let me get back to the slide. There is very little that is required from the physical exam. Weight,
height, BMI, blood pressure. Very little is required. Very little. And then the cognitive
assessment. I will personally do a full physical exam but that is not required.
So the full physical can be included.
It can be. There is no additional reimbursement for the full physical. That is more of a
professional decision to complete the physical.
All right. Thank you. Then some questions about the colorectal cancer screening. One from a
group of Medicare beneficiaries in Kentucky. They are asking if Medicare covers a colonoscopy
routinely even though there is no cancer or history of cancer or does it cover the occult blood lab
work? The other comment on that was that some Medicare advantage and traditional Medicare
quality measures don't include the Cologuard DNA stool sample tests. If you have any thoughts
on which test would meet the quality benchmarks.
As far as quality is concerned, the Cologuard, the highly sensitive fecal occult blood test and the
colonoscopy, and flex sig, if done at the right intervals, are equal. The traditional standard
Medicare actually says on the website that they cover the Cologuard. I am unsure about the
Advantage plans and their coverage. Medicare's website says that Cologuard is a covered
service. Back to the original question, if there is no family history, no risk factors, should we be
doing the screening -- most definitely, yes. It is a screening measure. For the normal risk person,
it is highly recommended. Our survival rate is as high as 90% if it is detected early. Most of the
time it can detect an issue before it actually becomes colon cancer. Medicare covers that. It is
recommended. Highly recommended.
I think the question about the Cologuard DNA stool sample -- Melinda, if you could just type in
the comments to clarify if I'm wrong. When looking at the Medicare quality reporting program, it
does not get counted as meeting the guidelines, even though it is covered by Medicare as far as
payment. I will see if Melinda can add to that question.
While we are waiting, Dr. Howerton, what a great presentation and thank you so very much. If
you wouldn't mind to pass me back the ball, I will advance the slide a little. We have a slide
regarding on-demand learning. If you would like that, the presentations are recorded and
available on our website. I also think that in the chat function, the link to the slide was also
placed there. Don, did you get a follow-up on that yet?
No other questions. Melinda did state what I was saying was correct. There were issues with the
quality measures not using the DNA stool sample to qualify for the quality measure. That may be
something to consider on the provider side. Hopefully we get the quality measures updated. I
think it is the best outcome moving forward.
We have one more question from the chat. It is from Laura Haegen. Does the AAA screening
have to be ordered during the [ Indiscernible ] or is it covered one time?
I have ordered it at the annual visit and the patient has had it covered and paid for it. I would
suggest it during a regular visit.
Thank you.
Thank you so very much. We are almost at the end of our time. I really want to thank you and
Carol Minor, our representative from the American Cancer Society her in Tennessee and all of
our participants for joining the call. The staff is here to help. Please contact us if you have any
questions or comments at all. At the end, please stay on to complete the post event survey. Your
feedback is very important to us. This has been recorded it will be on the website that is on the
slide. The link to the slides were placed in the Q&A. We thank you so much and hope everyone
has a great afternoon. [event concluded]