The Medicare Annual Wellness Visit – It’s not just about
checking the boxes
In 2011, under the Affordable Care Act, Medicare introduced the Medicare Annual Wellness Visit (AWV) as they recognized the need for better preventive care. The AWV is a free benefit to Medicare beneficiaries and is an opportunity for the primary care provider (PCP) to screen the patient for cognitive and functional impairment, discuss issues that may be affecting the patient’s quality of life, perform a health risk assessment to gain insight into any gaps in preventive care, and finally to create a personalized plan for the patient. This all sounds great for patient care, and yet according to CMS, in 2020 only 45% of beneficiaries had an AWV. Meanwhile, 94% had a blood pressure screening and 86% had a cholesterol screening at least once, so the patients are making it into the office.
While there are tons of preventive care benefits for the patient to have the visit, and we’ll touch on that in a minute, the AWV reimbursement is worthwhile and it’s been a metric for value-based care for years, oftentimes carrying bonus dollars for completing it. In addition to all of that, it’s a perfect opportunity to accurately paint the picture of that patient’s health status by submitting their diagnosis codes to CMS to set that year’s Risk Adjustment Factor (RAF) for the patient. The American Journal of Managed Care found that among patients who received an AWV, they had a 5.7% reduction in adjusted total healthcare costs over the next 11 months, so being able to properly submit all the patient’s problems in combination of a preventive care plan is lowering the total cost of care.
When it comes to preventive care, there is no other visit that compares to the AWV. Taking the time to document and discuss when a patient’s last mammogram or colonoscopy was, is a potentially life-saving conversation. Knowing whether a patient is at risk for a fall can help keep them out of the hospital. Gathering the status of all of their preventive services, opens the door to create a care plan to help them live a longer, and potentially healthier life.
All of that being said, completing the health risk
assessment and gathering the current status of a patient’s preventive medicine
is time consuming and can really bog down a provider’s day. Providers then feel
trapped into completing a free follow up visit on top of the AWV and not being
able to bill for additional services once the patient comes into the office and
has a complaint or needs refills, etc. This is when it’s time to look at your
processes and where you have gaps in your workforce to ensure you’re being
reimbursed for that extra work.