Healthcare in the United States has undergone a transformation over the past decade - with providers and payers moving away from a strict focus on disease treatment to an emphasis on wellness and preventive care. Medicare has played a role in this transformation by starting to cover visits designed to prevent disease or disability, or to slow the progression of chronic conditions.
The focus on preventive care is not surprising because, according to a Robert Wood Johnson Foundation report, 99 percent of Medicare’s $500 billion in annual expenditures are for beneficiaries with at least one chronic condition. Furthermore, the Centers for Disease Control and Prevention reports only 33 percent of women and 40 percent of men aged 65+ are up-to-date with all age-specific recommended preventive services.
Medicare recently introduced the Annual Wellness Visit (AWV) to keep Medicare beneficiaries healthy, or help Medicare beneficiaries become healthier, by promoting positive health habits and a healthy lifestyle. Unlike much of medical care, which is primarily directed at treating acute and chronic illnesses, the AWV aims to prevent the onset of disease and disability or to slow the progression and exacerbation of existing illnesses. The AWV is the corollary to the slightly older Initial Preventive Physical Exam (IPPE). While the one-time IPPE, also known as the “Welcome to Medicare” visit, is conducted in the first 12 months of Medicare Part B coverage, the AWV is an ongoing, yearly benefit.
Both visits yield information that can be used to recommend lifestyle changes and health screenings to detect undiagnosed disease. The AWV, however, is more comprehensive than the IPPE and includes a written, personalized prevention plan (PPP) that must be adapted each year to reflect changes in the patient’s health needs.
Although almost all primary care physicians agree that providing information to prevent disease is the best way to care for patients, less than six percent of Medicare beneficiaries received an AWV in 2011. Many beneficiaries do not know to ask for the AWV, and providers frequently do not promote it.
The two most often cited reasons for not offering the AWV: (1) a busy schedule that makes the time-intensive visit impractical for physicians to provide; and (2) inadequate reimbursement (approximately $170) for the lengthy visit.
The reality is, however, that AWVs can be efficiently delivered by non-physician practitioners (NPPs) in a fraction of the time required for a traditional "physical" through the use of innovative software. In turn, AWVs can become an important way for struggling primary care providers to deliver better patient care while generating a substantial, and recurring, income stream.
Potential new revenue
What many physicians fail to realize is that reimbursement for the AWV is just one component of potential downstream revenue for the practice. Medicare covers, and strongly encourages, approximately 15 other preventive services for seniors that are dramatically under-utilized. Additional preventive services, screenings, tests or treatments for chronic conditions diagnosed during the AWV represent additional, ongoing revenue for a sophisticated primary care practice or multi-disciplinary practice. Results from one primary care practice that offers the AWV, for example, show the average reimbursement for all services that arise from the AWV is in excess of $375.
While most physicians believe they offer wellness services, the reality is that most do not offer the AWV. A true Medicare AWV involves not only a review of medical history and medications, but also a conversation about the patient’s functional ability and lifestyle issues that impact health. A list of risk factors, conditions and treatment options must be established. Cognitive function must be assessed, and a 5-10 year preventive screening schedule created.
This information is not discovered in most “sick” visits because the focus is on symptoms rather than a holistic review of the patient’s health. Yet physicians can easily overcome the challenges of scheduling and providing AWVs by:
- Using an NPP to conduct the AWV, develop the PPP, order screenings or tests indicated during the AWV and make necessary referrals. The Affordable Health Care Act allows certain NPPs to deliver the AWV without any physician supervision – enabling physicians to focus on problem-oriented visits.
- Automating the process with an electronic solution that meets the AWV requirements and identifies age- and gender-appropriate health screenings based on the patient’s health risk assessment — especially if it can integrate with the practice’s electronic medical records system. This not only prompts providers to ask the right questions, but also reduces documentation time, ensures an accurate patient health record, and assists with the PPP and with proper coding and billing.
- Implementing an electronic system that does not require staff members to have specialized training in areas such as nutrition or exercise to produce the personalized preventive health plan, but instead automatically incorporates nationally recognized guidelines and evidence-based protocols appropriate to the patient.
According to Medicare, “Preventing chronic disease not only improves health and quality of life – it’s also a significant step toward reducing the $2 trillion the United States spends treating preventable long-term illness today.” The AWV provides physicians with a valuable opportunity to create an additional revenue stream within their practices, while at the same time further improving patient care.
Averel B. Snyder, MD, is co-founder and chief medical officer of Senior Wellness Solutions, which provides innovative technology-based solutions to identify symptoms of early chronic disease and streamline patient care. A board-certified cardiothoracic surgeon, Dr. Snyder also has an AMA certification in age management, an ISSA certification in fitness and nutrition, and a USFA certification in senior citizen fitness.