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.
Want to learn more about providing and getting paid for preventive services? Check out our detailed guide!
So, just what are preventive services? Healthcare.gov defines preventive services as "Routine healthcare that includes screenings, checkups, and patient counseling to prevent illnesses, disease, or other health problems." For most primary care providers, preventive services include a wide range of care, counseling, and recommended screenings based on patient age and disease status. Medicare's annual wellness visit offers the perfect opportunity to discuss patient wellness and plan out all the preventive screenings and services the patient might be eligible for.
The Affordable Care Act, enacted in March 2010, solidified some necessary healthcare consumer protections and cost-savings. One of the most significant was increasing access to preventive services for all patients while mitigating the rising out-of-pocket costs to healthcare consumers. Preventive services, when provided by in-network practitioners, are often covered 100% with no expense to the patient.
Research continues to point out the cost-effectiveness of preventive services, and payers and practitioners are well-positioned to reap the rewards when they encourage active patient participation in preventive care. One of the earliest adopters to embrace preventive care cost savings was Medicare through its annual wellness visit. The AWV gives practitioners the perfect opportunity to connect with patients, evaluate chronic disease risk factors, and develop an ongoing preventive screening plan with little to no out-of-pocket cost for the patient. And with the average reimbursement for the AWV coming in at around $120 annually per patient, it's the perfect example of how practices can increase their quality scores and promote patient health and wellness while increasing revenue.
Traditionally, practitioners have focused on reactive medicine and worked to treat illness or disease after onset has occurred. But we now know that prevention is a much more effective care model and, as such, is being rewarded by payers. While proactive prevention may seem easy, it often remains challenging for practitioners to gain the upper hand on the sheer volume of patients who are already in the grips of chronic disease. This makes it difficult to shift focus to prevention as a primary care tactic. However, preventive services are typically paid at 100% of the contracted rate, making them a win-win for patients and practices alike. When practitioners participate in alternative payment models, the completion of preventive services can also translate to more revenue through positive quality measure scores.
For practitioners who accept alternative payment models such as the merit-based incentive payment system, pay-for-performance, or the advanced payment model, the risks associated with unhealthy patients can translate to lower overall reimbursements. Typically, these payment models like to reward practitioners above and beyond the normal reimbursement if they are meeting certain metrics for patient health, quality of care, and patient satisfaction. Payers are interested in making money, and the best way for them to do that is with healthier patients who require fewer covered services. Payers understand that patients who receive preventive care are typically healthier overall and more satisfied with the care they receive, which can ultimately translate to a better payout for practitioners.
The simple truth is preventing the onset or further progression of chronic disease is the easiest and most effective way to keep patients healthier for longer. The earlier chronic disease indicators are caught and mitigated, the better the wellbeing and life longevity will likely be for patients.
For example, obesity is one of the earliest indicators that other chronic conditions may occur, but, more often than not, decreasing body mass index through simple lifestyle changes (e.g., increased physical activity, healthier food choices) can decrease the patient's chronic disease risk significantly. Through the provision of regularly scheduled preventive services, such as Medicare's annual wellness visit, patients can be educated to understand their chronic disease risk factors and how these may impact their future health.
It's prudent to mention that once risk factors are identified, not all patients will actively mitigate their risk factors on their own. However, the provision of preventive services also offers practitioners the opportunity to react to patient risk factors proactively or aggressively from a regular and ongoing medical approach, enabling more consistent medical treatment for symptoms.
When first discussing preventive services with patients, it is important to ensure that they understand the concept. For many patients, preventive services may be unfamiliar "medical jargon." If patients do not understand preventive services and remain silent, they may spend much of an appointment confused about what is being discussed and may leave with lingering uncertainties, which can jeopardize patient follow-through on directions and recommendations. Taking the time to define and explain medical concepts will help patients better understand and feel comfortable with the services they are receiving. Note: In addition to explaining preventive services to patients, make sure they also understand the concept of an annual wellness visit. The AWV is often confused with an annual physical exam, which can lead to costly confusion.
According to a recently published article from Partnership to Fight Chronic Disease, more than one trillion dollars goes into the battle against chronic diseases here in the United States every year and this number is expected to grow sixfold over the next 50 years. While it may take a while to create an impact on that dollar figure, the solution is simple: prevent expensive chronic diseases before they can take hold of patient health. According to the American Journal of Managed Care, patients that participated in an annual wellness visit experienced a 5.7% reduction in total healthcare costs over the following 11-month period. With 44 million Medicare beneficiaries, the potential to create a genuine cost-saving impact through the provision of preventive services is very real.
Practitioners won’t regret placing more focus on prevention within their practices. The rewards and benefits of providing patients with preventive services are numerous and cover patient health and practice revenue. Research continues to support the idea that preventive services cost patients nothing but can significantly improve their overall health and longevity. Preventive services also increase practice revenue and decrease practitioner risk, making the services worthwhile and lucrative. Lastly, the provision of preventive services has the potential to create a positive and lasting impact on the excessive overall annual healthcare spending. For practitioners, missing out on the chance to offer preventive services is essentially leaving money on the table and creates missed opportunities to promote health and wellness with their patients. You can see an up-to-date list of preventive services as defined by Medicare here.