An Ounce of Prevention
Prevounce Health, creators of the Prevounce Care Coordination Platform, congratulates Alyssa Johnston, the recipient of the first Prevounce Preventive Health Undergraduate Scholarship.
Update: The story below provided a brief overview of this breaking news. As of 2022, the information remains accurate. If you are interested in learning about noteworthy changes for 2022, view an on-demand webinar here.
In a recent blog, we described preventive services as "The Missing Link to Wellness." Research backs this claim up, showing that preventive services have the potential to dramatically reduce healthcare spending, improve economic output by billions of dollars, and save tens of thousands of lives. To help you better appreciate why preventive services should be offered by your practice and what to know before proceeding with adding such an offering, here is some of the essential information to understand about the preventive services Medicare covers.
For practitioners, preventive services, such as Medicare's annual wellness visit (AWV), are an important offering and should be a significant part of the day-to-day operations of every primary care practice. When furnished effectively and appropriately, preventive services are typically no cost to patients, encourage improved patient health and wellness outcomes, and increase practice revenue while decreasing practitioner risk — all while positively impacting our nation's out-of-control annual healthcare spending.
If you came to this blog looking for instructions on setting up a Medicare annual wellness visit (AWV) template for your practice, you won't find that here. But don't go anywhere! We provide a link to a blog at the end of this piece that explains how to create an AWV template. The reason we put it at the end is because we think it's important to explain a few of the most significant reasons why your practice should not default to using a paper template or rigid electronic template (e.g., fillable PDF). Our guidance is largely centered around the fact that at its core, the AWV is a fairly complex set of requirements that have the potential to lead to compliance pitfalls.
You schedule a patient's first Medicare annual wellness visit (AWV). The patient comes into your practice, or perhaps you meet via telehealth. You furnish the AWV, seemingly checking all of the boxes necessary to deliver this critical yearly appointment that helps prevent illness and get your practice paid. And yet a few weeks after submitting your claim to Medicare for the service, it's denied. The reason: You incorrectly used HCPCS code G0438.
Research from leading expert organizations confirm time and time again the importance and effectiveness of preventive screenings and exams. Yet why are practitioners still having difficulty meeting this relatively inexpensive need for their patients? One argument is that payers place too many obstacles in the way, over-incentivizing reactive care and making the provision of preventive services difficult for practitioners to provide. Another argument is that patients may not be aware they are eligible to receive such services, often at no cost to them, and do not ask about what such services are available. A final argument is that, as a society, we are so focused on taking care of our over-abundance of chronically ill people that practitioners simply lack the time to flip the healthcare paradigm to a preventive care model. It's probably reasonable to assume that all the above play some role in the underutilization of preventive services. The Centers for Disease Control and Prevention (CDC) supports this notion, citing a lack in implementation on the behalf of practitioners.
The U.S. healthcare system has made some big advancements in the acceptance and usage of telemedicine and remote patient monitoring devices. While the benefits of these services are proving to be valuable for all patients, they are even more important for patients with chronic conditions, including those with lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), and bronchiectasis. With the looming threat of COVID-19 exposure, it may no longer be realistic or safe to continue permitting vulnerable patients to visit a practice for respiratory services. However, the exciting news is that peak expiratory flow can now be measured and monitored remotely with the help of a connected smart peak flow monitor.
The COVID-19 pandemic has fueled the adoption of telehealth, with millions of Americans taking advantage of virtual care options over the past several months — many for the first time. While rates of telehealth utilization have recently declined as in-person care resumed, EHR company Epic reported that telehealth visits still accounted for 21% of all visits in July compared to a rate of less than 0.01% prior to the health crisis. A significant contributor to this remarkable increase in usage of telehealth by consumers is the embracing of remote patient monitoring (RPM) by practices and patients, as well as payers and the federal government. When we look at some of the more common examples of remote patient monitoring applications, it is easy how RPM has the potential to transform the delivery of care in the United States.
"It's usually covered by your health insurance, it doesn't take much time, and it's a great way to learn about your present and future health." So begins a Harvard Men's Health Watch article on why men need an annual wellness visit (AWV), but the sentiment expressed in the article applies to any Medicare beneficiary. The Medicare AWV is a valuable service for practices to offer their patients. It's valuable from a health and wellness perspective as the AWV can help physicians prevent disease and detect health issues faster. It's also valuable from a financial perspective as the AWV is reimbursed well, with practices receiving around $160 in average reimbursement per patient. This can be increased by performing, when appropriate, the many preventive services that can accompany an AWV. If you want to capture that revenue, you will need to know and understand the billing codes for the Medicare annual wellness visit.