Medicare Annual Wellness Visits

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Preventive medicine has the potential to save lives. According to the Centers for Disease Control and Prevention, “if everyone in the United States received recommended clinical preventive care, more than 100,000 lives could be saved each year.”
The Medicare Annual Wellness Visit (AWV) is a preventive care visit introduced in 2011, as part of the Affordable Care Act, provided without cost to beneficiaries.  The Medicare program introduced the annual wellness visit to improve healthy aging among all seniors. The purpose of the visit is for primary care providers to identify and mitigate health risks and to promote preventive screenings among seniors.   The AWV is associated with higher preventive services utilization and has the potential to improve health. 
Elements of the annual wellness visit include assessments of seniors’ health status (including depression screening), psychosocial risks, behavioral risks, cognitive function, functional status (that is, ability to perform activities of daily living, fall risk, hearing impairment, and home safety), and biometric health indicators (for example, body mass index and blood pressure). The visit concludes with a tailored plan for lifestyle interventions and preventive care services.1 
The AWV is an opportunity for both physicians and patients to make preventive care a priority. But it is significantly underutilized:

  1. AWV utilization increased from 8.1% to 23.0% of all beneficiaries between 2011 and 2016.4
  2. A national study by the American Medical Group Association found that under 20 percent of eligible Medicare patients received AWVs in 2016.2

Benefits of the AWV:
  1. AWV’s offer practices a way to improve the health of their patients, increase practice revenues, and improve quality scores in value-based reimbursement programs.2  
  2. Health prioritizes care coordination and utilization management, AWV’s have the potential to improve healthcare quality and reduce cost.3 
  3. In 2019, Medicare reimbursed $175 for an AWV per member per year and the AWV was associated with a $38 per member per month ($456 per member per year) decrease in costs, this data suggests that the additional expenditure on primary care can be worth the costs, particularly for a higher-risk population.3 
  4. Potential benefits of AWV’s that may be missed by underserved seniors include enhancement of patient activation and engagement with their primary care providers; identification of health risks, such as depression; behavioral counseling, such as dietary counseling; and preventive care services, such as vaccinations or cancer screenings.1 
  5. AWVs offer additional benefits. The screening tests and other preventive services arising from those visits can help physicians raise their quality scores in the Merit-based Incentive Payment System (MIPS), CMS’s pay-for-performance program. AWVs can help ACOs improve their scores on Medicare Shared Savings Program (MSSP) quality metrics. AWVs also can support the attribution of patients to ACO providers.2  
  6. In addition to the AWV billable visitation, it also provides a chance to review and attest the patient’s active diagnoses to indicate the severity of illness and disease burden.

McLaren High Performance Network can provide your practice with a list of patients who are eligible for an AWV or a list of those who did have not an AWV completed in 2020.

References:
  1. A Key Challenge For Medicare’s Annual Wellness Visits: Spreading The Benefits To Underserved Seniors”, Health Affairs Blog, February 15, 2018 
  2. Tse A, Leverage the Annual Wellness Visit. Medical Economics, 2020 Jan, Volume 97, Issue 1 
  3. Adam L. Beckman, BS, Adan Z. Becerra, PhD , Anna Marcus, BS , C. Annette DuBard, MD, MPH , Kimberly Lynch, MPH , Emily Maxson, MD , Farzad Mostashari, MD, ScM , Jennifer King, PhD. Medicare Annual Wellness Visit Association with Healthcare Quality and Costs. The American Journal of Managed Care, March 2019, Volume 25, Issue 
  4. Lind KE, Hildreth KL, Perraillon MC. Persistent Disparities in Medicare's Annual Wellness Visit Utilization. Med Care. 2019 Dec;57(12):984-989. doi: 10.1097/MLR.0000000000001229. PMID: 31584462. 
  5. Medicare.gov

For more information or to obtain your patient list, please contact Dr. Michael Ziccardi, CMO, at michael.ziccardi@mclaren.org or (248) 484-4923

 

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