According to a study by Health Affairs, less than 20% of eligible Medicare beneficiaries receive an Annual Wellness Visit (AWV).
More than half of primary care physicians in the United States do not offer them.
Though this routine health check is advantageous, highlighting potential risks for patients, the disconnect poses a question. Why? In our experience, the problem is a lack of awareness and information. Doctors don’t always offer them, so patients are unaware of them. Nothing more.
An AWV is easy for both patients and doctors. They also provide an opportunity to address and plan for any serious conditions an individual may live with.
At ThoroughCare, we've worked with clinics and physician practices across the US to streamline clinical processes to provide AWVs. So, in this article, we’ll quickly review the broad characteristics of an AWV, as well as detail the three different types patients can participate in.
What is an Annual Wellness Visit?
As the name suggests, an AWV is a yearly assessment of one’s current health. It is entirely FREE for anyone covered by Medicare Part B.
A doctor uses the time to discuss health history, identify potential issues and answer an individual’s questions. The overall goal is to establish a record of a person’s physical and mental well-being for the purpose of preventive health planning.
An AWV should not be confused with a routine physical examination. The AWV is more about recognizing possible gaps in a patient’s healthcare and planning the next steps. It should include:
- A review of your medical and family history.
- Developing or updating a list of current providers and prescriptions.
- Height, weight, blood pressure, and other routine measurements.
- Detection of cognitive impairment.
- Personalized health advice.
- A screening schedule (or checklist) for appropriate preventive services.
By participating, a patient will receive a personalized risk prevention plan, targeted for specific diseases or disabilities relevant to their situation.
Wellness visits come in three varieties. There is the Initial Preventive Physical Examination (IPPE), an Initial Annual Wellness Visit, and the Subsequent Annual Wellness Visit.
They all share similarities, but it’s important to understand the differences.
1. What is an Initial Preventive Physical Examination (IPPE)?
This is the “once in a lifetime” option.
When new to Medicare, an individual can receive it. But they must do so within the first 12 months of their enrollment. Once this window closes, it’s gone.
A Health Risk Assessment (HRA) drives this first visit. It is a questionnaire and screening tool, and upon its completion, it provides the patient and doctor with action items.
What Questions Does a Health Risk Assessment (HRA) Ask?
The HRA requires about 20 minutes to complete.
Medicare expects it to be finished prior to or during an annual wellness visit. A patient may also take the assessment at home, either online or over the phone.
The HRA inquires about the following:
- Demographics – age, gender, etc.
- Self-assessment of health/lifestyle – exercise, eating habits, alcohol, and tobacco use.
- Activities of daily living (ADLs) – dressing, bathing, walking; including instrumental ADLs like shopping, housekeeping, medication management, etc.
- Emotional health – mood, stress, life events.
- Physical health – weight, blood pressure, cholesterol levels.
- Medical history – current and previous health conditions.
2. What is an Initial Annual Wellness Visit?
Despite the different labels, this is practically the same as an IPPE.
There are a few distinctions, though.
For instance, the Initial Annual Wellness Visit is only available to patients after 11 months of Medicare enrollment. It includes an optional cognitive exam and “end-of-life” planning. That said, if your patient completes the IPPE, they must still participate in an Initial Annual Wellness Visit.
It is meant to be an individual’s introduction to preventive care planning. It is also completed through an HRA, positioning the patient for future health services and lifestyle changes to accommodate any risky conditions.
At this stage, open communication between the physician and patient is key. Honest, thorough answers enable successful first and subsequent wellness visits.
3. What is a Subsequent Annual Wellness Visit?
This is the yearly follow-up to an Initial Annual Wellness Visit.
Eleven months after this wellness visit, a patient can attend these sessions to modify and maintain their preventive care plan, based on how their health is at any given time.
As the years pass, and the patient’s health evolves, the doctor may use the Subsequent Annual Wellness Visit to guide individuals toward other Medicare preventive programs, such as Chronic Care Management (CCM), Behavioral Health Integration (BHI), or Remote Patient Monitoring (RPM).
That said, a provider may make such introductions with any type of AWV.
For doctors and patients, alike, this is a point of value.
Patients receive additional care opportunities to address specific needs, and doctors develop further streams of revenue, fostered by Medicare coverage.
Medicare may cover most of the cost of these other services for enrollees.
What is the Reimbursement for Annual Wellness Visits?
Again, each of the three AWV types is entirely covered for patients enrolled in Medicare Part B. On the provider end, the AWV is billable by three separate codes, as determined by the three varying types of wellness visits. These codes are GO402, G0438, and GO439.
Rates vary depending on the type of AWV provided and the provider's location.
Please search the Physician Fee Schedule from CMS for the latest information.
Software to Provide Annual Wellness Visits
Remember, more than half of physicians in the US do not currently offer this service. The goal is to increase access to annual wellness visits, so more patients become aware of their benefits and participate.
Their involvement will influence smarter healthcare decisions and further inform individual Americans of their options for preventive care. In the long run, the likelihood of increased savings in medical costs is great. A focus on preventive actions will help thwart critical issues before they occur, become comprehensive, and appear costly.
If you’re a medical care provider, you’ll want to consider what technology or staff will be necessary to successfully manage annual wellness visits.
At ThoroughCare, we’ve developed clinician-friendly software to ease administration and increase efficiency.
For instance, we’ve automatically integrated the HRA into the process, and patients’ answers to the assessment provide recommendations for the next steps. Learn more about care coordination software and its role in preventive health.
