Medicare Annual Wellness Visits: How to Get Patients and Physicians on Board
Patients are more likely to schedule a wellness visit if their physician recommends it, but that won't happen without staff support.
Fam Pract Manag. 2017 Mar-Apr;24(2):12-16.
Author disclosures: The authors' work was supported by grants from the Health Resources and Services Administration and The Atlantic Philanthropies. No other relevant financial affiliations disclosed.
Most family physicians would agree that Medicare annual wellness visits (AWVs) are a good idea. They let physicians develop personalized preventive care plans, review and update medical histories, reconcile medication lists, identify other providers involved in the patient's care, and summarize the patient's acute care.1 As a longer visit – often an hour – the AWV lets clinicians escape the “tyranny of the urgent” and develop a proactive, coordinated care plan, which is rarely possible during short, illness-focused office visits.2
In addition, the AWV is well reimbursed. The 2017 Medicare allowances for HCPCS codes G0438 (initial AWV) and G0439 (subsequent AWV) are $173.70 and $117.71, respectively. By comparison, the rate for CPT code 99214 (level 4, established-patient office visit) is $108.74.
Despite these advantages, relatively few patients get an AWV. In 2012, following the first full year in which AWVs were available, less than 10 percent of eligible patients had one.3 Although the completion rate has surpassed 25 percent in some areas, rates in most of the country remain at approximately 10 percent or less.4 This under-use is all the more surprising given that the Centers for Medicare & Medicaid Services (CMS) waived the copay for the AWV, making the visit itself essentially free for patients.
The Department of Family and Community Medicine at the Eastern Virginia Medical School was concerned by the low rates of AWV completion. At our two residency-faculty practices, which serve a diverse urban population, only 153 of our 2,164 Medicare patients age 65 and older, or 7.1 percent, completed an AWV in 2015.
To change this, we launched a quality improvement initiative that ultimately increased patient recruitment and more than doubled our AWV completion rate.
A quick literature review: Why don't patients get AWVs?
We wanted to know why patients in general were not getting AWVs and, in late 2015, began reviewing the literature. There is not a great deal of published material, but several themes emerge. First, some patients have a negative attitude toward preventive care in general (e.g., “I got the flu shot then got the flu.”).5 Negative news coverage may also be a factor. For example, the AWV benefit was launched amid controversy over so-called “death panels,” or the belief of some critics that giving physicians incentives to discuss end-of-life care with patients was designed to limit life-sustaining treatment for older and sicker patients. Although the death panel furor has waned, it may point to a general distrust, which reduces acceptance of the AWV.6
Experience with other preventive benefits fully covered by Medicare, such as the “Welcome to Medicare” visit, indicated that eliminating out
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3. Escobedo M. How does it feel? Not as good as it should. The John A. Hartford Foundation website. April 24, 2012. http://bit.ly/2eEs747. Accessed Nov. 3, 2016.
4. Bynum JPW, Meara E, Chang CH, Rhoads JM. Our Patients Ourselves: Health Care for an Aging Population. Lebanon, NH: The Dartmouth Institute for Health Policy & Clinical Practice; 2016:26. www.dartmouthatlas.org/downloads/reports/Our_Parents_Ourselves_021716.pdf. Accessed Oct. 27, 2016.
5. Xu WY, Dowd B. Lessons from Medicare coverage of colonoscopy and prostate-specific antigen test. Med Care Res Rev. 2015;72(1):3–24.
6. Dalen JE, Waterbrook K, Alpert JS. Why do so many Americans oppose the Affordable Care Act? Am J Med.2015;128(8):807–810.
7. Salloum RG, Jensen GA, Biddle AK. The “Welcome to Medicare” visit: a missed opportunity for cancer screening among women? J Womens Health (Larchmt).2013;22(1):19–25.
8. Beran MS, Craft C. Medicare annual wellness visits. Understanding the patient and physician perspective. Minn Med. 2015;98(3):38–41.
9. Tetuan TM, Ohm R, Herynk MH, Ebberts M, Wendling T, Mosier MC. The Affordable Health Care Act annual wellness visits: the effectiveness of a nurse-run clinic in promoting adherence to mammogram and colonoscopy recommendations. J Nurs Adm. 2014;44(5):270–275.
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