Recently, the American College of Physicians (ACP) convened a workgroup to identify ways practicing clinicians can contribute to the delivery of high-value, cost-conscious health care. They suggest we limit the use of many common screening and diagnostic tests in ways that do not reflect high-value care.
One of their recommendations was to avoid “Repeating screening ultrasonography for abdominal aortic aneurysm following a negative study”. First, who should we screen for AAA?
The USPSTF recommends “one-time screening for AAA by ultrasonography in men aged 65 to 75 who have ever smoked and against routine screening for AAA in women”. They make no recommendation for non-smoking males aged 65-75.
Medicare now covers a one-time screening ultrasound for AAA if referred as a result of the “Welcome to Medicare” preventive visit, which must occur within the first 12 months of Medicare Part B coverage, AND who meet the eligibility requirements:
being a man age 65 to 75 who has smoked at least 100 cigarettes in his lifetime or
a family history of abdominal aortic aneurysm, and never had an AAA ultrasound screening paid for by Medicare previously.
This seems like an easy area for us to save limited healthcare resources for all – limit your AAA screening to older males (age 65-75) who have ever smoked and don’t repeat the test if normal!
-Robert A. Baldor, MD