Medicare Coverage

Annual Wellness Visit (AWV) – Patient 66 years of age and older​

• Visit to develop or update a personalized prevention plan, and perform a health risk assessment

• Covered once every 12 months

• Patient pays nothing (if provider accepts assignment)

What is the value of the Annual Wellness Visit?

• Enables opportunities to form a complete medical history for chronically sick patients​

• Strengthens the relationship between the patient and provider​

• Provides active care for patients​

• Increases quality metrics​

• Creates new revenue stream for the practice

Challenges to the Annual Wellness Visit

Older patients sometimes have a negative perception of preventive care. We all know how valuable and cost-effective preventive care is, but Medicare eligible patients are from a different generation and may have become accustomed to the way medicine has historically been practiced: Treating illness instead of preventing illness.

Annual Wellness Visit (AWV) initially received a bad rap from some media. When the Centers for Medicare & Medicaid Services (CMS) initially announced changes to the Medicare program that introduced the AWV, the hot topic in the news was death panels. There was an inherent distrust among the American population when it came time to discussing end-of-life decisions with their practitioners — an important component of the AWV. Some of the media promoted the thought that practitioners were being paid to discourage life-saving treatment for the sickest patients to save on healthcare costs.

Many Medicare beneficiaries remain unaware that they are eligible to receive an AWV or don’t know what it is. Surprisingly, most beneficiaries report that they do not know that Medicare offered this benefit to them, and therefore don’t know to take advantage of it. On the other hand, beneficiaries who have heard of the AWV often get this free service confused with the not-so-free (for Medicare beneficiaries) annual physical exam and choose not to schedule the AWV because they think they will need to pay for the visit. Patients don’t see value in the AWV because it doesn’t include a physical exam.

So what is the solution?

In order to bypass the challenges faced with the Annual Wellness Visit, Osler has rebranded this visit into a new program we call, Osler Connect. Osler Connect will rebrand the AWV so the patient will be more open to the idea of the AWV without any of the attached negative opinions and stigma.

This program will center around marketing the AWV in a new light for Medicare patients and help coordinate the care in a more patient-centered approach.

Osler Connect Components

A health risk assessment, also known as a health risk appraisal, is a questionnaire that evaluates lifestyle factors and health risks of an individual. Questions in an HRA cover topics such as nutrition, fitness, biometric information such as blood pressure and cholesterol, stress, sleep, and mental health.

An HRA will help population health professionals identify risk of chronic conditions like heart disease, diabetes, cancer, and obesity. Health risk assessments are widely distributed among workforce and health plan populations.

Medicare covers an annual AWV for patients:

• Who are no longer within 12 months of the effective date of their first Part B coverage period and

• Who have not gotten either an Initial Preventive Physical Examination (IPPE) or AWV within the previous 12 months.

Medicare pays for only one first AWV. Medicare will pay for a subsequent AWV for each patient annually.

Note: The elements in first and subsequent AWVs, and the codes to bill them, are different. ​

The first AWV includes the following elements:

• A health risk assessment

• Establishment of a current list of provider and suppliers

• Review of medical and family history (Medicare would like to emphasize that review of opioid use is a routine component of this element, including OUD. If a patient is using opioids, assess the benefit from other, non-opioid pain therapies instead, even if the patient does not have OUD but is possibly at risk.)

• Measurement of height, weight, BMI, and blood pressure

• Review of potential risk factors for depression and other mood disorders

• Review of functional ability and level of safety

• Detection of any cognitive impairment the patient may have

• Establishment of a written screening schedule (such as a checklist)

• Establishment of a list of risk factors

• Provision of personalized health advice and referral to appropriate health education or other preventive services.

Subsequent AWVs include the following elements:

• Update medical and family history (As mentioned above, Medicare would like to include opioid use in the ‘Review of Medical and Family History’ element of the AWV. Providers are encouraged to pay close attention to opioid use during this element of the AWV. If a patient is using opioids, assess the benefit from other, non-opioid pain therapies instead, even if the patient does not have OUD but is possibly at risk.)

• Update of list of current providers and suppliers

• Measurement of weight and blood pressure

• Detection of cognitive impairment the patient may have

• Update of the written screening schedule (such as a checklist)

• Update of the list of risk factors; and

• Provision of personalized health advice and referral to appropriate health education or other preventive services.