POINT: Should Only Primary Care Physicians Provide Shared Decision-making Services to Discuss the Risks/Benefits of a Low-Dose Chest CT Scan for Lung Cancer Screening? Yes

摘要

Modern primary care continues to evolve as a specialty with a broad agenda. What began as a profession focused on day-to-day problem identification and management now includes disease?prevention and health promotion. The physician fee schedule issued annually by the Centers for Medicare & Medicaid Services provides payment for these added responsibilities. For Medicare patients, the Initial Preventive Physical Examination (also known as the “Welcome to Medicare” visit) and the Annual Wellness Visits were specifically designed to provide physician payment to complete the full medical history and determine appropriate screening, vaccination, and lifestyle recommendations. Most recently, the Medicare Access and CHIP Reauthorization Act establishes a value-based paradigm based, in part, on the premises of?disease prevention and health promotion.Proactive doctoring is fundamental to the disease prevention and health promotion agenda. However, like?much of medicine, the screening agenda is complicated because the evidence base remains unstable. Mammograms for years have been the most widely promoted of all screening tests. This?most sacred of screening practices has been challenged.