NP wants mom in there every 3 mos. Is this normal?

I go to the NP at my husbands office every three months and have bloodwork before I go. It’s routine for both doctors, physician assistants and NP’s to see those over 60 every three months and do bloodwork.

It’s not Medicare fraud and doctors don’t make money with Medicare reimbursements - $47.00 a visit. If a patient has a supplemental policy there is another small payment. Medicare Advantage plans pay even less. The practice I go to does not accept Advantage plans or Medicaid. They are considering not accepting Medicare after January 1, 2021. The practice does not currently charge co-pays, but that is changing in January as well.

The clock drawing is one component of a geriatric dementia checkup. Medicare pays for one per year. Some docs give them, some don’t.

Older people are often asked to come in every 3 months. That's not unusual. Things can crop up relatively quickly and can be found when the patient is seen every 3 months.

However, if you feel it's excessive, cut back to 6 months apart. After all, the dr is YOUR employee!

She has a B12 deficiency he is watching. As long as there is a REASON, then I think you should get the bloodwork. I don't think the actual appointment to see the doctor should be necessary. Speak to the doctor. B12 may need to be administered SQ if patient not taking it by mouth, and in all truth by mouth may not be enough.
Discuss with the NP.
Now to drawing a clock. It is one of the most common Dementia tests. Inability to draw a clock set at a particular time indicates there is dementia. Has Mom been diagnosed with same? If not, it is time to see a neurologist, yes, so you can get information and know what stage you are on.
It is now crucial you have done paperwork for POA and etc? If not, time to do it before you have a diagnosis. She likely has not entered any stage where she cannot understand POA; She should do that, because once you have diagnosis of dementia it is unlikely you can get any of this done. You need advanced directives, posts, POA, make certain you know her wishes now.

Sandola, based on your profile, you're 48 and your mother is 85.    There's a vast difference between medical conditions for people of those ages.   The NP wants to monitor your mother's health on a regular basis, and I think that's reasonable, and desirable.  

A lot of things can change by the time someone's in her 80's.   

I'm not familiar with all the details of a "Medicare checkup" but it probably would include a standard group of tests, including questions for you and/or your mother to answer about any specific or new medical issues.   I've also recently learned that it allows a doctor to include other tests which might not otherwise be given.  

I'm not too clear on this; my niece NP and I were discussing it recently as part of studying what could be provided during a "Medicare exam", but I don't remember the details.

I'm a bit concerned about postponing a visit b/c of the B-12 deficiency.   When I had my political stroke, I learned that even with taking B-12, the deficiency was so great that my surgeon suggested I get a B-12 shot.   Apparently the pills weren't adequate.  

For the B-12 reason alone, I would keep the appointment, and DEFINITELY not wait until the Spring.  

As to what's normal for geriatric patients, the only geriatricians we've seen weren't ones we wanted to keep (b/c of other issues).    But generally appointments were either at 3 or 6 month intervals, the latter with physicians Dad had seen for years and had a good idea of his conditions, strength, and vulnerabilities.

So, if I were you, I'd definitely go in December, as early in the month as you can to avoid the snowy weather.   


Bridger made an interesting comment about supplemental insurance.   We only carried Medicare for some time, until my father had a multiple organ crisis and was hospitalized, eventually for 6 months followed by a one month rehab stay.   He was in two primary hospitals, two sub-acute care hospitals, and I found out how dangerous it is not to have supplemental insurance.

After a lot of research, I chose a BCBSM Medigap Policy, Plan C, which subsequently covered the 20% Medicare doesn't pay.   The only out of pocket costs were for things like lotions.

Hand raised, I am also part of the every 3 month doctor thing, which for us seems unnecessary as our health issues are under control [we are in our 70's]. So when a new appointment is scheduled for 3 months down the road we later call up and reschedule for 4 or 5 months later.

Also deficient in vitamin B12 and D. As for vitamin D, we are spending too much time inside compared to when we were young. I remember seeing in the middle of winter, my parents [in their 90's] would have their sliding patio door open with the screen in place, wearing their winter coats, gloves, and hats, but had their pant legs rolled up to get some sunshine :)

Until this past year, my mom saw her primary every three months to monitor her thyroid levels, since she is taking levothyroxine. Since she entered hospice, however, she isn't seeing her primary anymore.

You know, it's ok to ask the NP if you can stretch out the visits to every 4 months, especially with the pandemic still rearing it's ugly head. The worst he can do is say no - and then you can absolutely ask why are the 3 month visits necessary? It can be done without being accusatory.

One of the biggest things I have had to learn in this caregiving journey is that, as the primary caregiver, I feel I am entitled to know everything that might have an impact on how I manage my mother's care. Sometimes we're a little intimidated by those in the medical profession, but a GOOD doctor should be willing to address and answer ANY concerns or questions you might have. Because, if you don't ask, chances are they won't explain. And, when it comes to caregiving what YOU don't know *might* hurt your LO.
Best wishes!!

The timing may also have something to do with billing, for which there are sets of rules for NPs.

My mom's doctor told me liked to see all her older people every three months in order to become familiar with them and keep on top of any little issues or changes that might signal something major. She made sure we complied by not renewing any medications without an office visit 🙄

In my experience, if she is not sick she doesn't need to go.

Thyroid, my Mom went to a specialist. In the beginning I think we went every 3 months with testing being done before the next appt. Once her levels were stable we went to once a year with a test at 6 months. That way he could adjust what was needed.

When I started doing Moms finances (Dementia involved) I found she was going to her PCP every 2 months and questioned her. She said thats when he wanted to see her. I told myself if he asks her why she is there, I am cutting down on those visits. I even had one of his nurses, a family friend, ask why we were there. I told her I had no idea but if he asks why she is there, we won't be coming every 2 months unless she is sick. He asked, I walked out without making another appt at that time. Yes, he isn't actually defrauding Medicare because they probably allow for so many visits a year but he is taking advantage. I cut back visits with a couple of Moms Drs. once she was stable. A yearly visit with labs in between if needed is enough.

Where I live a NP works with/for a Dr. Even though my RN nurse says with the training they go thru they might as well go for an MD, they are not MDs. They are limited in what they can do. Sometimes the Dr. needs to intervene. I would not trust a NP to handle my Moms thyroid. Some medications can cause damage to the liver. Liver enzymes need to be looked at. Mom had to go off cholesterol and couldn't take Tylenol. Both effect the liver. In my state, you need to see a doctor every 6 months for renewal of certain perscriptions. The Medicare checkup is not a have to. Its just the basic labs and checking vitals.

So no, if Mom is healthy in other ways, other than Thyroid, I think 3 months is a little too much. I would say maybe 6 with you getting her labs done before the appt. If he gives u the order at the appt, then he can have you come into the office for the results. This is also something I find doctors are doing. If labs are good, no need coming back in. I do think they are milking Medicare.

If you plan on continuing with the NP for her Thyroid I would learn to understand what is involved. In the beginning, yes the dosage of the pills will need to be adjusted till her numbers are normal. Once Normal for a while, the dosage may be reduced. I would research what she is taking. Like I said, the one Mom was on effected the liver so her enzymes should be part of your mothers labs. Once Mom reached normal numbers her dosage was reduced and she eventually only took it every other day.

We have to be advocates for our parents as they age. We need to be there with them and question, question, question. We need to research everything they take. The Thyroid gives off hormones. Without these hormones doing their jobs, health problems form. With my Mom she had Graves diseases and it effected her heart rate.

I know, you feel if you go against the NPs recommendations something will happen. If it does, deal with it then. The NP is not dealing with a person with Dementia. He is not the one having to make sure she is ready and driving her there. Some people have to take off work and some employers don't appreciate that. I looked at it as, its now my responsibility, so its done in my time sort of thing.

Here in Canada is is routine for seniors who take medication to be seen every three months. At least in my experience as a MOA.

Doctors will often only do three month Rxs, to ensure the patient comes in.

B12 is not something to mess around with. The under the tongue tablets are easy to take, if they do not boost her levels, then she likely needs B12 injections. Often these are done weekly, for a month, then labs are done, if the levels are up monthly shots may be prescribed.

Lack of B12 can lead to odd behaviours, including dementia like symptoms.

FYI: Medicare offers a yearly Wellness visit - however this is NOT really like a yearly checkup visit.

A "Wellness" visit is primarily to "develop or update a personalized prevention plan to help prevent disease and disability, based on your current health and risk factors. Your provider may also perform a cognitive impairment assessment."

That's not the same as getting a yearly exam. I had to specify to the doc office I wanted a REAL checkup, along with the usual lab work. No clue what Medicare covers on that - I have an advantage plan, so the only thing I really have to pay is copay for the lab work.

https://www.medicare.gov/coverage/yearly-wellness-visits

This page does list more "coverage", but I don't see lab work on it:

"What it is
The cognitive impairment assessment is performed to look for signs of Alzheimer's disease or dementia.

The personalized prevention plan is designed to help prevent disease and disability based on your current health and risk factors. Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. It can also include (**my note = this says "CAN"**):

*A review of your medical and family history.
*Developing or updating a list of current providers and prescriptions.
*Height, weight, blood pressure, and other routine measurements.
*Detection of any cognitive impairment.
*Personalized health advice.
*A list of risk factors and treatment options for you.
*A screening schedule (like a checklist) for appropriate preventive services. Get details about coverage for screenings, shots, and other preventive services.
*Advance care planning"

A link under that is "Preventative". That shows:
"Medicare Part B (Medical Insurance) covers a “Welcome to Medicare” preventive visit once within the first 12 months you have Part B."

SO, you get this ONCE, after you start Medicare, but with CAVEAT - if doc orders additional tests/services or items not covered, you could pay deductible or all for the not covered items.

See the link above and follow other links from there for more info.

I laugh when the chant Medicare For All is going on... I don't think they understand that
1) Medicare ISN'T FREE (Part A is),
2) plain old vanilla Medicare A only covers inpatient hospital stays, skilled nursing care, hospice care, and limited home health-care services. You typically pay a deductible and coinsurance and/or copayments,
3) Part B isn't free and covers more but not everything,
4) even with gap or advantage plans you could have high co-pays and/or deductibles,
5) there are any number of not covered medical issues and
6) you have to sign up for a medication plan (often included in advantage plans), but there is still the issue of the "Donut" hole you might fall into and also non-covered medications.

I understand somewhat the desire for Universal Health Care, but it will NEVER be "free" - you either pay for coverage or you pay higher taxes, or both.

Comparing other countries is not the way either. GB's NHS really covers basics - many people buy medicals plans/insurance so that they can get better care and go to private doctors. So, UHC isn't always a better way. Granted, our way is awful! The last year I was on company retirement insurance, it cost me almost 12k and all I got was a lousy checkup. That plan added that we had to cover the first $700 of ANYTHING. One ophthalmologist appt and one tick bite appt didn't even cover that, so almost $12,000 to get a lousy check up!!!

I am thankful to be on Medicare now, as it is a LOT less, but dread to know what might happen if I get *really* hurt or ill....

I would definitely do the follow up to ensure that she is getting her b12 levels up.

I would then ask if she really needs to come in every 3 months if nothing has changed and her labs have stabilized. Every 6 to 12 months may be just fine.

I honestly think that it is ingrained, see you in 3 months, whether there is a need or not. I just saw a dermatologist and I was told all is well, come back in 6 months. Why? Nothing noted to keep an eye on, no issues, just wrote to get patients on a rotation of 3, 6 or ?? in my opinion.

I don’t want to say doctors lie but my DH aunts doc said She had to come in every three months because she was on HH. I knew this was wrong because my mom had HH and only went to her docs once a year. I had that established upfront before signing on with any new doctor. Once aunts doc had us wait for two hours and then rushed us out because it was noon. She actually had an issue that time that he felt could wait. I knew it couldn’t. That day I found a geriatric primary and switched providers. We see her once a year and now on Telemed. I provide that days vitals. HH does the blood work. We take aunts vitals daily. Weigh her weekly. Monitor her meds and activities. So her doctor is well informed with much more data that a 10 min visit every 90 days. I don’t think what I do is normal to answer your question but I couldn’t personally handle every 90 days.
The NP does not need to SEE your mom to check her B12.

Thank you all for your input. Disgustedtoo, your answers really made me smile. Not sure if you intended that, but thank you!

Mom has been on thyroid medicine for years, so there is no issue with that needing to be checked closely. I think I will let her take the B12 and D for a few months, then take her for the labs and then sign into the website where I can see the results. If they're good, I can just reschedule the Medicare check up for later.

It's not like anyone can do anything for her dementia anyway. I quit taking her to the neurologist because he didn't give her Aricept or anything and wasn't really doing anything for her. Why take a 1/2 day off work for that? She's only going to get worse, that's how it works and we (the family) all know it.

As far as the doctors/NPs, profits and malpractice - yes the cost of being a doctor is so high now (med school, malpractice insurance) that there are fewer of them. In fact, where we live, most of the practices have been bought up by the hospital that just merged with two other hospitals and so now it's a huge conglomerate controlling everything. Between the hospital and the university, they probably own half the real estate around here and are getting bigger everyday. I don't think it is necessarily helping the patients, but it's probably saving the previously private practice doctors until they can retire out. The ones that didn't sell out to the hospital sold out to what used to be the free clinic.

Healthcare is a business and so all of us suffer for that, IMO. It seems like quality of care continues to go down and don't get me started on how dirty the hospital and a lot of doctor's offices are. No wonder people go in the hospital with one thing and catch other diseases while in there. I also know it's very hard to get good help, so I guess that's why they are not clean. Anyway, I'm off on a tangent. Sorry about that. Thank you all for your advice.

By the time my siblings and I started caregiving for my parents, they were on a revolving door of constant doctor appointments. Their monthly calendar had barely enough room to write in! I believe this was because of their very good insurance. Also, I think my parents used the appointments as almost a social outing. Often lunch or breakfast out was part of the doctor visit. In the beginning we complied, mostly because as a caregiver you are afraid to second guess the doctor with someone else’s health. As time went on, though, we did begin to question the need and frequency of the visits, especially when a visit involved a great deal of time and effort to get a non-ambulatory parent in the car. We began to need two people with special equipment to accomplish this. As we began to question the necessity of all these visits, the doctors happily agreed to extend the time between visits. I guess all we had to do was ask!

I do believe that seniors (and I’m one!) are over medicalized. And we participate in all this nonsense because doctors know best! Of course, a doctor will want to keep close tabs on his patients, especially if insurance pays for it. In that case, why not monthly! As it was, my father lived to 89, with only, every 6 months, and yearly, routine exams.

Interesting question. I was getting ready to ask this myself of the nurse and doctor, as when the virus restrictions started at my mom's facility I agreed to having her see the nurse practitioner there instead of taking her out to go to her doctor. This NP is taking blood every 3 months. Her doctor had that done once a year, but wanted her in for routine check-ups, which consisted of blood pressure, weight, temperature, and a little talk, every 6 months.

I miss my doctor visits every 3 to 4 months. I'm 80 yrs old and have no close family. The Dr. visits didn't cost much with my Medicare insurance, but it gave me a chance to ask about any concerns (mostly minor). As an old retired RN, I appreciated his advice and willing explanations. I have borderline type 2 diabetes and needed 2 joint replacements plus spinal surgery. Got very good results with these surgeries.

When I moved to an IP living facility and went to a health care organization, I was pleased with the N.P. at first, but now am looking for other coverage. After COVID came, I could not be seen in person. I no longer drive. I was not willing to sit in the clinic parking lot with a cab driver listening to my medical concerns. My ancient laptop had no camera and I don't know how to use all the features on my "smart" phone. When I've tried to learn, I just get frustrated and give up. I do have some minor ALZ sympoms and wearing a low-dose Rivastigmine patch does seem to help. I hate to consult the neurologist about anything, however, because he is SO busy. Is all medical practice requiring computer use now?

Now it has been over a year, I think, since I have had any lab work. Think my diabetes med was giving me hypoglycemia (low blood sugar) so I cut the dose and have not had any medication at all for about 9 mo. Think I have a UTI as well. I finally called the clinic and did manage to get an in-person appointment, but they granted it reluctantly.
I cannot return to my old doctor since he is in a different town and getting transportation there is a problem. Anybody have any suggestions?

With Medicare there is suppose to be a cognitive test once a year. Drawing the clock with the numbers & time is only one part. They are asked to remember 5 objects & after (I believe)1 & 5 mins they are asked to repeat those 5 objects. There are several types of tasks that are asked of pts. to get a baseline & then each year they can compare & note the changes. Did you ask the doctor why she has to be seen every 3 months especially during the pandemic? I feel that every 6 months is reasonable since mom doesn't have heart disease, diabetes, uncontrolled high blood pressure, lung disease or on meds that require close monitoring. It would be worth it to ask them to teach you how to give B12 shots so her levels would increase, so many complications arise from low levels. Thyroid is main issue which you noted as stable. There doesn't appear to be a need for every 3 month visits unless there is something else going on. The yearly Medicare visit which is the Wellness visit is to make sure patient knows their meds, why they're on them, understands their conditions, & gives them an opportunity to ask questions, as well as the cognitive test. Don't be afraid to speak up & ask questions that are for your mom's best interest. Handle POA, MPOA, Advance Directives & will if they have not been done before the cognitive test.

Tell them that is is difficult to take mom out, don't want to expose to her to unnecessary covid//// HAVE A DOCTOR EVALUATE HER FOR PALLIATIVE CARE/ AND OR HOPSPICE. This way they come to you. IT'S AN EVALUATION. THEY WILL DETERMINE WHAT IS BEST good luck They may give you a couple weeks repreve to see her in her home, but at least you don't ahve to take her out.

Caroli wrote:

"Doctors can get damaged financially (even with malpractice insurance)and sometimes professionally with a malpractice conviction."

It's not my desire or attempt to criticize you, but I do think that some errors should be addressed.

A "malpractice conviction" is not an appropriate description.   Malpractice is a civil issue; a conviction is a criminal issue.   If a doctor were found to have been negligent, by legal standards, governmental prosecution could ensue, resulting in a conviction.    Civil suits result in judgements, no cause for action (a legal term), or settlements, but not convictions.

Perhaps you understood this but just used the wrong terminology.  Again, it's not my intent to criticize, but to explain one aspect of law.


"Especially with an elderly patient, by scheduling return visits frequently, the physician minimizes the risk that something serious goes wrong between appointments, and the patient or patient's family ends up suing for negligence."

Suits alleging negligence are malpractice suits and must conform to very specific legal and case law standards.   This I think is an error that many people make.   Someone can't just file a suit and allege malpractice.   It has to be documented, and when I worked for medmal law firms, the standard was to have the patient's medical records reviewed by a medical practitioner in a similar field, with that practitioner agreeing to testify.    That established medical standards, which most nonmedical people (including me) are not familiar with to a degree of determining negligence.

Dosmo, I do think you'll get more responses by creating your own thread.  You have valid concerns, and they're similar to those that many others have and for whom advice has previously been requested.    The time factor is also relevant to your situation.

As to transportation, are you located near a city which has public transportation, and provides what is variously known as "small bus", or something else depending on the system?   These aren't the full size buses, they're smaller, about the size of an ambulance.

The purpose is to provide transportation for people who don't have it, and can't access full sized buses with established routes.

Some Senior Centers have these buses, through arrangements with the local transit  company.

When I shopped around for transportation to a surgery center for my cataract surgery, I called a lot of companies, but found that most were expensive, charging $3 or more per mile, plus a flat fee.    The local transit company provided small bus service, with pick up, delivery, and pick up after surgery.  The cost was either $1 or 2 each way.    Can't beat that!

I also learned that some ambulance services have nonemergency vans also providing service.  It wasn't cheap, but it worked for me.  

Your profile doesn't indicate where you live, so I can't do any research for you.   But you might want to read these threads and posts on point to point transportation and do some research on your own.

https://www.agingcare.com/search?term=small+bus+transportation

Another group of similar threads:
https://www.agingcare.com/search?term=point+to+point+transportation

Anyone who wants to criticize me for redirecting the tenor of this thread can feel free to do so.    I felt that Dosmo needed some support, regardless of this not being "her" thread.

Doctors make very little on Medicare patients so I doubt they're trying to get rich on having your mom come in. They could get a lot more money with a non-Medicare patient in that slot, so I think your sister is nuts with er conspiracy theories.

I think your mom's NP is just being proactive, which I think is a good thing for an 86-year-old patient.

If my mother had had blood work that often we'd have known she wvs bleeding internally before she was suffering from full-blown anemia. As it was, once she finally was clearly sick, her doctor pooh-poohed her lethargy symptoms and proclaimed her to be in need of more exercise. An hour after they drew blood on our way out from that appointment the doctor was on the phone telling us to get her to the ER ASAP. She was in the hospital for five days and had five blood transfusions.

Little things can become big things quickly in older people, so I think you should listen to the NP.