Why perform the Medicare Annual Wellness Visit? Why not?

Medicare's AWV is one element of Medicare's Preventive Services


Primary care physicians are currently facing many challenges that are placing the future of primary care in the United States at risk. Declining reimbursement coupled with increasing administrative burden is resulting in providers working longer days in order to see more patients for less pay. With the anticipated need for primary care services expected to grow rapidly in the next few years due to the introduction of an estimated 20 to 30 million newly insured patients into the system as a result of the Affordable Care Act, the question becomes will there be enough time in the day for physicians to continue providing all of the components needed to perform high quality primary care?

As a result, it is imperative that primary care physicians and non-physician practitioners begin to focus on how best to efficiently provide high value care to their patients, leading to an increased emphasis in recent years on preventive and wellness services designed to prevent and/or slow the development of chronic conditions. With this in mind, Medicare introduced the Annual Wellness Visit (AWV), a preventive benefit available once yearly to all Medicare beneficiaries with Part B coverage, which reimburses primary care physicians for identifying and acting on potential health risks and recommending age-appropriate preventive screenings.

Few would argue that proactive disease prevention and risk reduction represent the optimal way to care for patients. Individualized health risk assessment and the subsequent development of a personalized health plan have been touted as a cornerstone in the evolution of personalized health care. Why, then, are only about 6% of Medicare beneficiaries receiving their Annual Wellness Visits?

Many seniors are simply unaware of the benefit, which is provided to patients at no cost. A poll released by the John A. Hartford Foundation last year revealed that 68% of Medicare beneficiaries surveyed “had not heard of the benefit or were not sure if they had heard of it.”

Unfortunately, healthcare providers have also been reluctant to promote the AWV. In speaking with fellow primary care physicians about the AWV, I have identified several common reasons they cite for either not performing visits or performing them at much lower rates than they could:

  • The lack of complete understanding of the components needed to fully comply with the Centers for Medicare and Medicaid Services regulations and the resultant risk of recovery audit penalties.
  • The perceived lack of reimbursement relative to the time and effort expended in performing the AWV
  • The extensive staff and office time needed to complete the AWV
  • Questions surrounding the evidence behind, and therefore the true value of, the information and long term benefits generated by the AWV

The above questions highlight a clear need among providers for greater education about the background, structure and benefits of performing the AWV. My aim is to address each of these concerns in turn over the next few weeks with the hope of providing primary care practitioners the knowledge and motivation they need to take the leap and begin offering this potentially valuable preventive service to their Medicare patients.

First up...”How do I do the Annual Wellness Visit?”

Sean K. Martin, M.D. is a board certified Internal Medicine physician and the Chief Medical Officer at AWVSolution.com where he uses the knowledge and insight he gained as a practicing primary care physician to help design and develop digital solutions to improve access and convenience for patients and providers completing Medicare's Annual Wellness Visit. Please contact Dr. Martin at smartinmd@awvsolution.com with questions and/or comments.

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