Medicare Wellness Visits: Reassessing Their Value to Your Patients and Your Practice

 

Providing Medicare wellness visits can be challenging but can improve quality and practice revenue.

Fam Pract Manag. 2019 Mar-Apr;26(2):25-30.

Author disclosures: no relevant financial affiliations disclosed.

Editor's note: This is a corrected version of the article previously published.

The Affordable Care Act of 2010 created the Medicare annual wellness visit (AWV) as a way to provide patients with comprehensive preventive care services at no cost. Yet many practices have been slow to provide substantial numbers of these visits. Only 15.6 percent of eligible patients received an AWV through 2014.1 In addition to finding lackluster overall participation, researchers have found AWV rates are lower among practices caring for underserved populations, such as racial minorities, rural residents, or those dually enrolled in Medicaid.2

Physicians and other health care providers do not offer AWVs to their Medicare patients for numerous reasons. Providing and documenting all of the required AWV elements efficiently can be challenging, and some practices may feel their staffing or electronic health record resources are too limited. Many patients and even some physicians may not know what the AWV entails, and patients with complex socioeconomic risk factors may have pressing health conditions that need to take priority over preventive services. These explanations can all be valid, but this article seeks to help physicians reevaluate the AWV, along with the initial preventive physical examination (IPPE) or “Welcome to Medicare” visit, and recognize the value these wellness visits can bring not only to their patients but also to their practices or health care organizations.

KEY POINTS

  • The Medicare annual wellness visit (AWV) and the initial preventive physical examination (IPPE) provide a number of benefits to patients and physicians, but many physicians still do not provide them.

  • Medicare wellness visits can help physicians address care gaps and report quality measures important in pay-for-performance systems.

  • When billed correctly and delivered efficiently along with other covered Medicare preventive services, AWVs can boost practice revenue.

THE VALUE OF MEDICARE WELLNESS VISITS

The main benefit of the AWV to patients is the creation of a personalized prevention plan, a written plan that can help guide their preventive care decisions for the next five to 10 years. This plan includes age-appropriate preventive services, recommendations offered by both the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices, and personalized health advice that identifies risk factors and suggests referrals or programs to address them.3

Providing Medicare wellness visits also offers a structure that helps physicians to close many pay-for-performance quality measure gaps, including those recognized by the Core Quality Measures Collaborative, the Integrated Healthcare Association’s California Value Based P4P program, and the National Committee

ABOUT THE AUTHORS

show all author info

Dr. Cuenca is a board-certified family medicine and sports medicine physician with MemorialCare Medical Group in Mission Viejo, Calif. He is also a member of FPM’s Editorial Advisory Board....

Susan Kapsner is a certified coding specialist and a coding compliance supervisor for the MemorialCare Medical Foundation.

Author disclosures: no relevant financial affiliations disclosed.

References

show all references

1. Ganguli I, Souza J, McWilliams JM, Mehrotra A. Trends in use of the U.S. Medicare annual wellness visit, 2011–2014. JAMA. 2017;317(21):2233–2235....

2. Ganguli I, Souza J, McWilliams JM, Mehrotra A. Practices caring for the underserved are less likely to adopt Medicare’s annual wellness visit. Health Aff (Millwood). 2018;37(2):283–291.

3. CMS. Annual wellness visit, including personalized prevention plan services. MLN Matters. March 2, 2016. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7079.pdf. Accessed Jan. 30, 2019.

4. CMS. Medicare Shared Savings Program: Quality Measure Benchmarks for the 2018 and 2019 Reporting Years, Guidance Document. December 2017. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/2018-and-2019-quality-benchmarks-guidance.pdf. Accessed Jan. 30, 2019.

5. CMS. Advance care planning. MLN Matters fact sheet. June 2018. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AdvanceCarePlanning.pdf. Accessed Jan. 30, 2019.

6. Cuenca AE. Making Medicare annual wellness visits work in practice. Fam Pract Manag. 2012;19(5):11–16.

7. Galvin SL, Grandy R, Woodall T, Parlier AB, Thach S, Landis SE. Improved utilization of preventive services among patients following team-based annual wellness visits. NC Med J. 2017;78(5):287–295.

 
 

Copyright © 2019 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact fpmserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

MOST RECENT ISSUE


Jul-Aug 2019

Access the latest issue
of FPM journal

Read the Issue


FPM E-Newsletter

Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights."

Sign Up Now