Is the Head-To-Toe Physical Exam Practically Worthless for Healthy Patients Who Are Asymptomatic?

As a health economist, I try to keep abreast of new trends in health care insurance ISACA CISM. One trend I have found is that consumers can now purchase short term health insurance policies that will pay for doctor visits if the patient is sick, but they will not pay for the standard “complete physical” associated with an initial visit.

Some primary care doctors will not see a new patient unless the doctor can bill insurance for $350 – $500 for a comprehensive visit. If you search on the Internet for “head-to-toe physical” and “outdated,” you will find many web pages that provide arguments and evidence that the complete physical is indeed not necessary but may be reassuring for some patients. In contrast, the blood tests are ten times more important than a complete physical for new patients.

We often hear the argument that a good baseline physical exam with lab work is important and can help engage the patients in their own care as well as identify those patients at risk for heart disease, diabetes, and other problems. The patient centered medical home model is built on coordination of care, not sick care. For standard health insurance policies (those polices other than short term policies), at least one annual “physical exam” or wellness visit is covered 100% by insurance and no cost to the consumer.

I am looking for a new primary care physician and will be seeing one at the end of the month. This appointment is for a new patient and will be coded for insurance as “wellness visit, physical exam” even though there will be little or no physical exam. Instead, I plan to use the time to tell the doctor what blood tests I want on this visit to establish a baseline, and in the process of explaining why I want them, he will learn about my medical history. I doubt there will be any time remaining in the appointment for even a limited physical exam, but we shall see.

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