Beginning 2011, Medicare began covering the Annual Wellness Visit (AWV) as a yearly appointment with a primary care provider (PCP) to create or update a personalized prevention plan at no cost to the beneficiary. This plan may help prevent illness based on current health and risk factors. It is not a routine physical, and an acute E/M may be reported separately.

More specifically, an Annual Wellness Visit is…

• A Health Risk Assessment Survey completed by the patient.
• Screening For functional abilities, cognitive function, risk for falls, depression and safety.
• Biometrics measured are height, weight, blood pressure and other routine measurements.
• Prevention Services including vaccines and other age-appropriate Medicare services
• Plan of Care is a personalized list of risks and conditions and associated education

We want to encourage your organization to promote these Medicare Annual Wellness Visits, as from the patient perspective they promote healthy habits, lead to disease detection, and for most services, are offered at no co-pay to the patient.

Benefits of Offering Annual Wellness Visits to Your Health System

1. Improve MIPS Score
2. ACOs improve their scores on quality metrics
3. Opportunity to capture all relevant ICD-10 codes (Risk Adjustment Implications)
4. Aligns with Population Health Management
5. Improves quality impact/acuity scores
6. Identifies additional services to be performed at practice/hospital
7. Improves loyalty of patients to providers and hospitals
8. Improves re-admission rates
9. Improves risk reduction and patient safety

Why Should Hospitals/Providers be in the Annual Wellness Visit Business?

The average reimbursement to the practice for the initial AWV, is around $172 and $130 for the subsequent AWV. AWV’s can be done once per year for all Medicare and Medicare Advantage enrollees.

The “downstream” revenue per patient from AWV visits is between $343 – $375 based on longitudinal studies performed by MGMA and Healthcare Advisory Board. The Downstream Module integrates detailed hospital and ambulatory data at the patient level to construct an accurate comprehensive longitudinal analysis of provider relationship patterns and associated downstream contribution.

These visits can be done virtually as well. Below we outline what can be done during virtual visits and who is eligible for them.

• Health Risk Assessment: A nurse or MA can perform them
• Medical History: A nurse or MA can gather this information
• Vitals: The patient can self-report their vitals. You will need to include a note saying the patient reported.
• Cognitive Assessment: A nurse or MA should ask the three mini cognitive words.
• Fall Risk Screening: While completing the HRA a nurse or MA can ask about fall hazards around the home.
• Prevention Plan: A physician should complete this part of the AWV.
• HIPAA Compliant: Ensure you are completing these virtual visits over a safe platform such as Zoom for Healthcare, Skype for Business or Google Hangouts.

It is important to remember that virtual visits still requires the patient’s consent to a virtual visit and it needs to be documented.

Are AWVs Right for Your Organization?

Blue & Co.’s Physician Practice Management Advisory Team has worked with clients to determine if there is an opportunity to improve its current process and volume of providing Annual Wellness Visit services to its community. We start with an Assessment of a client’s current state, which includes primary care practices that are owned or operated by Hospital and other settings that provide or can provide the AWV services.

During the assessment, we will interview clinic personnel and collect data to determine:

• The providers’ volume of patients who have received AWV services.
• An estimate of the provider’s Medicare and Medicare Advantage population available for AWV services.
• Barriers which may be reducing AWV utilization.
• Alignment of potential financial incentives related to the AWV.
• Potential staffing and workflow issues and opportunities for improvement.
• How the current electronic record is being used for AWVs and potential improvement opportunities, including virtual AWV’s.
• Opportunity for additional Hospital and practice screening services that might be needed, based on AWV findings.
• The potential financial impact of the current utilization related to AWVs utilization as the percentage increased toward those of leading practices.

Client Success Story

Over a year ago, we began working with a client to develop their AWV program. When we began, they had an AWV penetration rate of just 4%. By working closely with system leaders, physician leaders and managers, they now have reached a penetration rate of over 35% in just nine months! They went from doing only 241 AWV’s per year to performing 2,345 between June 2020 and March 2021. That has equated to a projected practice and system net revenue of over $1M.

As a first step, we began planning and meeting within various groups within the hospital. For any new initiative, we recognize that having input and buy-in from hospital leadership, physicians and staff are keys to success. With the help of the client’s IT team, we were able to build a template that made it a lot easier for the providers to complete the AWV, traditionally and “virtually.”

Next, we needed to establish a “Pilot” location. While in the pilot stage, Blue & Co. along with the client fine-tuned the workflows, patient communication (letters/phone calls) and long-term sustainable strategies for replicating the pilot location’s success. COVID-19 then happened and we were forced to pause our project. Not to be discouraged, after three months of downtime, we determined that we were ready to ramp back up. Site-by-site, we were able to roll-out the AWV program to all six primary care locations. This client is now performing, on average, over 60 AWVs per week.

If you would like to learn more about Medicare Annual Wellness Visits, please reach out to your local Blue & Co. advisor or John Wortley, Brandon Bond, or Steve Jarosinski.