It's really pretty simple: Medicare's annual wellness visit (AWV) -- established as a preventive service available to Medicare beneficiaries effective Jan. 1, 2011 -- aims to help keep senior patients healthy.
So when the AAFP and six other national organizations learned that some commercial entities that purport to offer services above and beyond those offered by most primary care physician practices were possibly "subverting that benefit" and "misleading patients," they called on CMS to investigate.
That's the gist of an April 30 letter(2 page PDF) to CMS Acting Administrator Andrew Slavitt that was signed by the AAFP, the AMA, the American College of Osteopathic Family Physicians, the American College of Osteopathic Internists, the American College of Physicians, the American Osteopathic Association and the Medical Group Management Association.
"We believe the AWV encourages Medicare beneficiaries to engage with their primary care physician or other usual source of care on an annual basis for prevention and early detection of illness," says the letter.
- The AAFP spearheaded an effort to make CMS aware of actions taken by some commercial entities that stand to undermine the benefit of the Medicare annual wellness visit (AWV).
- In a letter to the agency, the AAFP and six other organizations said the AWV is intended to encourage Medicare beneficiaries to engage with their primary care physicians on an annual basis for prevention and early detection of illness.
- The letter stressed the importance of continuity of care and noted that some entities offering the exam have no previous relationship with the presenting patient and are not positioned to offer follow-up care.
The letter references a 2013 issue of MLN Matters(www.cms.gov) from CMS' Medicare Learning Network that describes the AWV as a benefit that helps eligible health care professionals determine on an annual basis whether patients have risk factors and whether they are eligible for other preventives services and screenings that Medicare covers.
In their letter, the organizations stress the importance of continuity of care -- a special relationship in which a long-term patient-physician partnership is foundational. "The physician knows the patient's history from experience and can integrate new information, such as that obtained from an AWV, and (make) decisions from a whole-patient perspective."
Patients may be denied some of the essential benefits of the AWV because some entities offer the service even though they "often have no prior relationship with the patient and have no intention of caring for the patient after the AWV is done," says the letter.
The organizations call on CMS to "ensure Medicare beneficiaries are fully informed to seek and receive connected, continuous and comprehensive primary care."
"Another concern is that the patient's primary physician often does not know that the patient has received an AWV from one of these entities until his or claim is denied after the fact," says the letter.
CMS should ensure that physicians have a way to determine whether Medicare has already paid for an AWV for a particular patient in the past 12 months, says the letter. Doing so will ensure that physicians will be paid appropriately for health care services they provide to patients.
Some of these same entities have engaged in direct-to-consumer marketing that has been called to the attention of the Federal Trade Commission by consumer groups concerned that the advertisements are misleading, contain false information or omit content that is important for consumers to consider.
"This raises serious question for us about potential program integrity threats that these entities may pose to Medicare, concerns we hope that CMS would share," say the organizations.
"We would like CMS to engage with our organizations in a conversation about creative ways to ensure that the benefit of the AWV is preserved rather than perverted," the letter reads. At the very least, the groups add, anyone performing an AWV should be required to share results with the patient's primary care physician or usual source of care.