When COVID-19 hit, it hit hard — mentally, physically, and financially. The initial impact left by the virus was far reaching, wreaking havoc on the health and financial wellness of nearly every American. Among healthcare providers, one of the groups that took a big hit early on was primary care providers (PCPs). COVID-19 risk, fear, and uncertainty contributed to the lockdowns that directly impacted PCPs' bottom lines and productivity. They were forced to postpone what were deemed unnecessary patient visits, including the Medicare annual wellness visit (AWV), and scramble to piece together creative pathways for safe, socially distanced care that could also generate enough of a continuous stream of incoming revenue to keep practices afloat amid the pandemic's storm.
While the public health emergency proved to be a logistics and monetary nightmare for practitioners, the consequences for our senior population were, and still are, more dire. For many healthy Americans, catching the virus might be an uncomfortable inconvenience. For seniors, the consequences are disproportionately harmful and deadly. This fact kept one of our most vulnerable populations hostage as they strived to reduce their risk by strictly adhering to social distancing guidelines and voluntarily skipping over important preventive healthcare services like the annual wellness visit.
The question we are now faced with asking is: How long is too long to put off preventive services? With the advent of vaccines that are proving themselves successful in combatting the novel coronavirus, can we start bringing our most vulnerable patients back into the office for routine preventive care? While caution, social distancing, and mask-wearing protocols are still advisable, for PCPs and specialists that perform the Medicare annual wellness visit (e.g., cardiologists), it may be time to start ushering the Medicare-aged, fully vaccinated patients back into our waiting rooms. The reality is that while COVID-19 exposure is still a concern for vulnerable patients, further delaying preventive services for any longer might just be a bigger medical concern as chronic diseases and conditions such as diabetes, heart disease, and cancer continue to go undiagnosed, unmonitored, and untreated.
Note: Wondering if you’re permitted to perform and bill for the annual wellness visit? Get the answer to your question here.
Missed Preventive Visits: Potential Impact on Patients
Just how much of an impact has COVID-19 had on healthcare services, including preventive services? Two U.S. healthcare system trackers identified some interesting trends, concluding that the use of healthcare services in all capacities began dropping significantly across the entire spectrum of services in the early days of the pandemic.
As the overabundance of caution kept most people away from their doctors' offices and medical facilities, the provision of all healthcare services declined significantly during the first quarter of 2020. According to a study published by the Peterson-KFF Health System Tracker, spring 2020 brought with it a 94% decline in breast cancer and cervical cancer screenings. Colon cancer screenings dropped by about 86%. A report by Komodo Health confirmed that a sharp decline in other important preventive screenings began when COVID-19 arrived, with pap smears falling by 68%, cholesterol tests dropping 67%, and screenings for hemoglobin A1c dropping 65%.
While we don't yet have statistics on how annual wellness visits were affected by the pandemic, it's safe to say that they declined compared to the number performed in 2019. This is not only unfortunate because the share of Medicare beneficiaries receiving an AWV was likely on the rise (as has been the case for Medicare Advantage enrollees), but with every missed AWV, a patient loses out on essential health and wellness benefits.
As Harvard Men's Health Watch notes, besides measuring height, weight, blood pressure, and heart rate, "The [annual wellness] visit also is a chance to review healthy and potentially unhealthy lifestyle choices, such as diet, exercise pattern, smoking status, and alcohol use. Beyond these basics, many primary care doctors now screen for common behavioral health problems, such as stress, depression, anxiety, and sleep issues. They also may review other health-related social needs like home safety and transportation. An annual wellness visit is also an ideal time to discuss the need for specific screening tests, some of which you may not have known about."
Missed Annual Wellness Visits: Financial Cost for Practitioners
An inability to perform — or perform as many — AWVs can have an enormous effect on a practice's bottom line. AWVs are reimbursed well, with practices receiving an average of between $120 and $170 in reimbursement per patient visit. This figure can be increased by performing the many preventive services that can accompany an AWV, when appropriate. These can include:
- Advance care planning
- Alcohol misuse screening and counseling
- Counseling to prevent tobacco use
- Depression screening
- IBT for obesity
Note: To learn about coding and billing for AWVs and supplementary Medicare part B preventive services, click here.
If your practice does not furnish AWVs, this is a great time to add the service. It's also a great time to work to grow an existing AWV program. There are the many beneficiaries who need the service now. In addition, the U.S. Census Bureau states that by the year 2030, America's second largest generation, the baby boomers, will all be at least 65 years old. It is estimated that nearly 10,000 baby boomers are now crossing the 65-year-old threshold daily, making the baby boomer population, and their resulting Medicare eligibility a tremendous, growing pool for sourcing sustainable practice revenue.
There's also this important consideration: The Medicare annual wellness visit is included in the 1135 telehealth waiver, which is intended to remain effective through the end of the health emergency declaration. As a Physician Practice article notes, the AWV "… is relatively easy to provide via telehealth, and has been overlooked by many practices. Providers are allowed to reach out to patients to schedule and perform AWVs, making it a great opportunity to contact some of your most vulnerable patients to check up on their health and educate them on COVID-19 prevention and response. Providers are allowed to reach out to patients to schedule and perform AWVs, making it a great opportunity to contact some of your most vulnerable patients to check up on their health and educate them on COVID-19 prevention and response."
Under the waiver, Medicare even permits providers to perform the annual wellness visit and conduct many preventive services via telephone. Learn more here.
Time to Catch Up on Wellness
For the sake of patient long-term health, practices must focus on catching up on preventive services, including the annual wellness visit. While COVID-19 isn't technically finished with us yet, we're now providing our most vulnerable populations with the inoculation protection they need to feel more comfortable enough to proceed with receiving in-person elective care participation.
The potential effects of unchecked or undiagnosed chronic disease will result in disproportionate healthcare spending and decline in quality of life. If telehealth is not an option, Medicare beneficiaries might still need some encouragement or reassurance that going to their doctor's office is safe, and practices will likely need to play an active role in engaging fearful patients to come in for their annual wellness visits. Ultimately, preventive care plays an impactful role in the health and wellbeing of our senior patients, but it can also play a big role in the financial health and wellbeing of practices everywhere.