Missed Income Opportunities: The Medicare Annual Wellness Visit

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by Amanda Martin

While most healthcare professionals would agree that preventive medicine is becoming increasingly important, why are so many still missing out on the benefits provided through Medicare's Annual Wellness Visit (AWV)? While the AWV should be straight forward, there remains confusion surrounding the guidelines leading healthcare professionals to not fully realize the revenue and benefits of the AWV.

Created as part of the 2011 Affordable Care Act, the AWV was designed to give Medicare beneficiaries and their medical provider the opportunity to discuss their health and social history in detail and create a plan that puts focus on preventive services. The AWV provides an opportunity to empower the patient with resources, enabling the patient to take active control of their health and treatment plan. It also gives the medical provider the chance to understand their patient's health needs and plan appropriate wraparound and prevention services.

Why does participation in the AWV remain low with providers and beneficiaries?

According to the AJMC, only 16% of eligible beneficiaries received their AWV in 2014, which was only a modest increase since its induction in 2011. Whether or not a beneficiary received an AWV varied greatly by location, suggesting that barriers may be preventing patients from engaging with this free service.

Another reason may be because the AWV guidelines can be confusing, and patients don't always understand what the benefit of the visit truly is. There is a big difference between a yearly physical exam, which is not covered by Medicare, and the AWV, which is covered 100% by Medicare and Medicare Advantage Plans. Patients tend to think this free visit is a great time to discuss all that ails them.

The problem is that Medicare hasn't properly educated patients, so they don't realize that any acute issues addressed during the visit will incur a visit charge. The result? Frustrated patients who complain to you and your billing department about their bill, which is something we'd all like to avoid. This can be avoided by setting clear expectations with the patient ahead of time, or else providing the AWV directly before or after a normal e/m visit.

Another reason healthcare providers avoid performing the AWV is because it can be time-consuming. Medical offices are busy places, and when the schedule is full, it's challenging to slow down to discuss the full gauntlet of topics included in the AWV. This can be mitigated with the use of a specialized AWV or preventive software, or by streamlining the process with patient forms and workflow.

How does the AWV work?

The AWV is a patient visit covering topics such as general health, chronic illnesses, risk of injuries and functional abilities, and cognitive health. During the visit, the provider must create a customized prevention plan for the patient, including a schedule of other recommended preventive services. Medicare also provides for a co-pay waiver when the AWV is conducted with Advance Care Planning.

The holistic nature of the AWV helps create a line of open communication between the patient and the provider, leading to increased trust and maybe even better patient compliance. The AWV must be billed for by a physician or non-physician provider but can be completed mainly by clinical staff under the supervision of the billing provider.

Patient Health Benefits of the AWV

So how and why does the AWV benefit the patient? Patients who participate in the AWV have higher trust and confidence in their provider. They feel communication with their provider is better. Compliance and treatment adherence rates increase because they have a clear understanding of health goals and the outcomes they'd like to achieve or avoid. The patient is better connected to the appropriate health services, and it's a chance to discuss their health and history with their provider and formulate a game plan. And lastly, It's FREE to the patient - Medicare waives all co-pays and co-insurance for the AWV.

Practice and Provider Benefits of the AWV

A lot of providers ask themselves if providing the AWV is worth their time.

The clear answer is yes! The Medicare-eligible population provides healthcare providers with a significant market share. As a result of this huge population of Americans, the AWV is an excellent recurring way to capture this continuous income for your practice. You can increase the income potential by utilizing software or otherwise streamlining the quick provision of most parts of the AWV by your clinical staff.

If the income potential isn't enough to convince you, then here is more food for thought. If your practice is participating in value-based reimbursement programs, capturing AWVs are a great way to meet program requirements and boost your numbers. Really, it's a win-win. The patient is getting a great value for their time, and precision focus on their health, and the practice is promoting best practice standards.

The Price of Healthcare and the AWV

According to the Population Reference Bureau, the American population of people aged 65 and over is 46 million and is expected to more than double by the year 2060. As our aging population continues to grow, medical expenditures will sky-rocket unless we start to focus on the prevention and control of avoidable chronic illnesses through preventive medicine.

A recent study published by the American Journal of Managed Care identified a direct association between beneficiary participation in the AWV and lower healthcare costs. This study also provided evidence that the AWV improved overall clinical care for seniors.

Preventing patients from developing expensive chronic illnesses before they even have a chance to get started will only continue to improve health outcomes, enhance quality of life, and curb overall healthcare spending.

So, what is stopping you?

Annual Wellness Visit Toolkit

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