Despite Their Value, Medicare Wellness Visits Are Underused

Learn why this is a missed opportunity to enhance patient care and increase practice revenue.

Medical practices—especially those that serve complex, low-income populations—could be doing a far better job of making sure their older patients receive a Medicare annual wellness visit (AWV).

That’s the chief finding of a study published this month in the journal Health Affairs. The study found that less than one-fifth of all eligible Medicare patients receive a wellness visit, and more than half of primary care practices offer no annual wellness visits to their Medicare beneficiaries at all. Only 23% of practices provided AWVs to at least a quarter of their eligible patients.

Low rates of uptake for annual wellness visits

That’s a startlingly low rate of uptake for a covered benefit, says Katherine Hempstead, Ph.D., senior adviser to the executive vice president at the Robert Wood Johnson Foundation, Princeton, N.J. “In general this benefit hasn’t been used very much,” she says. “Fifty percent of providers haven’t had any wellness visits. That’s not too inspiring.”

The study, led by Ishani Ganguli, M.D., clinical investigator in the Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, used Medicare data from 2008 to 2015 to assess practices’ ability and motivation to adopt the annual wellness exam.

What is a Medicare Annual Wellness Visit?

Medicare began offering the annual wellness visit benefit in 2011 under the Affordable Care Act (ACA) as a way to proactively address risks and improve the health of older adults. CMS reimburses medical practices for the visits, which are offered free of charge to beneficiaries.

A Medicare annual wellness visit can provide an important opportunity to assess a range of factors, including functional status, health risks, cognitive function and health indicators such as blood pressure. The visit can also be a good time to coordinate care and increase patient activation. But, as the study found, the percentage of eligible Medicare beneficiaries who actually receive AWVs is very small (18.8%).

The challenge of getting patients to take advantage of valuable covered services extends beyond wellness visits. While rates of some cancer screenings among Medicare patients have increased in the years since the ACA removed copays for many preventive services, other types of screenings have shown no rise in uptake.

Is the Medicare annual wellness visit mandatory?

Medicare covers an annual wellness visit for recipients who have had Part B coverage for at least 12 months, but the visits are not mandatory. According to CMS, the purpose of the visit is to assess health and risk factors and develop an individualized prevention plan. The visit is not a physical, nor is it the Welcome to Medicare visit, a one-time preventive visit for new enrollees. To get the most out of Medicare annual wellness visits and avoid confusion, providers should be sure to clearly communicate to patients the goals of the annual wellness visit and what it entails.

Missed opportunity for additional revenue

Low annual wellness visit rates also mean lost dollars for practices. Experts say AWVs can be reimbursed beyond the standard office visit and can even offer the opportunity to discuss advanced care planning, another separately billable consultation.

In fact, the recent study drew a direct connection between the annual wellness exam and increased revenue. That’s because Medicare provides higher reimbursement for AWVs compared to traditional problem-based visits. “On average, practices that adopted the annual wellness visit generated greater primary care revenue and had an increase in revenue over the study period, while non-adopters had a slight decline,” the study authors wrote.

So why are annual wellness visits and other Medicare preventive benefits underused? The study offered no definitive answers, but reasons might include a lack of buy-in from all members of the care team, difficulty incorporating the AWV into clinical workflows or even challenges in incorporating it into electronic health record systems.

The researchers found that Medicare annual wellness visits were less likely to be adopted in practices that serve rural areas, those that care for high-risk patients, and in practices with high percentages of patients enrolled in both Medicare and Medicaid. These findings indicate that AWVs could be a rich source of potential new revenue, especially for practices that need it most—those providing care in medically underserved communities. It could also pay off for patients who could benefit from annual wellness visits, especially sicker or lower-income patients who may experience unequal access to wellness care.

The key takeaway? Practices should check the rates of annual wellness visits and other preventive services in their own organizations, and look for ways to systematically promote, schedule and provide these covered benefits, especially to underserved seniors.

Phreesia’s Clinical Support workflows allow you to identify patients who are eligible for Medicare preventive screenings, provide them with education and prompt them to schedule appointments. Request a Demo to learn more.