Use Annual Wellness Visits to Amplify Overall Quality

Whether you are delivering primary care through a multi-state integrated system or a rural independent practice, benefits abound in optimizing this fully reimbursed Medicare service.

Despite primary care providers' celebration when the Centers for Medicare & Medicaid Services began paying for the preventive service now known as the Annual Wellness Visit (AWV) in 2011, the majority of PCPs continue to forgo those dollars.

But according to our Clinic Clients who have made a concerted effort to promote and perfect the service, revenue is far from the only benefit of a strong AWV strategy.

Success Key No. 1: Educate Providers

Nationally, in 2016, 19.8% of eligible Medicare Part B beneficiaries utilized the AWV, according to a CMS report, despite the fact that CPT codes G0438 for the initial visit and G0439 for a subsequent AWV are paid 100% by Medicare and can be combined with another visit with the addition of a modifier.

The barriers to higher uptake are mostly cultural. In particular, there is a common perception among physicians that the service is unnecessary. Doctors often argue, for example, that the questions raised in the AWV about recommended cancer screening and immunization are already raised during the course of regular primary care.

Oftentimes, providers also experience or fear seniors being dissatisfied with coming to the office for a visit that involves no physical exam. An important first step for MassCare was just getting physicians acquainted with what it is. After that it's really about removing as many impediments as possible to getting it done.   MassCare accomplishes this by hiring and installing a Medical Assistant (MA) and PharmD within the Clinic to schedule and manage all aspects of the AWV program.

MassCare has developed a complete toolkit that explains what should be included in an AWV, how to bill for it, and when and why a copay might be required.

The toolkit started as an internally developed communication outlining the reason for prioritizing the AWV, as well as, a summary of the documentation requirements and tips for coding the visit. It also includes some tools available from the CMS Learning Network and others including potential workflows, scripts, explanatory articles, and other tips.

This includes education on coding, the EHR workflows we developed, a scheduling/registration workflow, and scripting to encourage patients in the office, and over the telephone to get an AWV.

Success Key No. 2: Engage Patients

Sometimes the most challenging part of the AWV is selling it to the patient. From a flow standpoint it can initially be a struggle, and a lot of that is getting patients to come in specifically for that wellness visit. For that generation, it's a new thing. To them, you go to the doctor when you're sick. It doesn't make sense to them to come to the doctor when they feel fine.

MassCare has found much success in scheduling AWVs in conjunction with other follow-up and acute visits. Patients who come in for a diabetes follow-up visit, for example, can undergo their AWV the same day.

For many seniors, especially those with transportation problems, the twofer visit has a social appeal as well. It's their chance to get dressed and get out of the house. And if they're coming on one of the senior buses they get to visit with peers. They seem to appreciate the fact that they're not just in and out for a so-called eight-minute visit.

Once patients participate in one or two recurrent AWVs, their engagement in their overall health seems to be on an upswing.

Success Key No. 3: Take a Team Approach

The team approach is supported by MassCare's collaborating team of MA and Pharmacist. We've designed the program so that it can managed successfully between our MA and PharmD. For example, MAs will often call patients before their AWV and ask several screening questions then. So when they come in, it's a shorter time in the clinic. But even a full AWV takes an average of 30 minutes total. Another key to efficiency is that care teams review a patient's EMR prior to any visit and know of any issues, such as an elevated A1C level, before walking into the room. The MA or PharmD is fully prepared by the time she/he gets the patient out of the waiting room, and reviews the recommendations with them while walking back out.

Success Key No. 4: Connect to Quality

With an average reimbursement of $172 for an initial AWV and $111 for subsequent AWVs, the revenue can add up for primary care practices of all sizes. But the value is best measured in terms of benefit to the patient. CMS is asking us to be good stewards by making this available, and we want to make sure we're delivering the aims they intended when they created the opportunity to do an AWV.

Success Key No. 5: Celebrate Success

With the wrinkles ironed out, AWVs can also have a positive impact on providers and employees.

By providing proactive care, Clinic staff can easily observe the positive impact they have on patients enrolled in the AWV program. This fact increases overall staff morale, while also increasing patient satisfaction, Quality Scores and Clinic revenue.