THE MEDICARE ANNUAL WELLNESS VISIT: MOVING TOWARD BENCHMARK John Britt and John Wortley 1 1
WHAT IS IT? Beginning 2011, Medicare began covering the Annual Wellness Visit (AWV) is 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. OF NOTE: • Not a routine physical • An acute E/M may be reported separately 2
MORE SPECIFICALLY…………. • A Health Risk Assessment Survey - completed by the patient • Screening for - functional abilities, cognitive function, risk for falls, depression and safety • Biometrics – height/weight/blood pressure and other routine measures • Prevention Services – vaccines and other age-appropriate Medicare services • Plan of Care – personalized list of risks and conditions and associated education 3
SURVEY SAYS! % of Patients Getting AWV 4
WHO IS GETTING THEM ? Medicare Annual Wellness Visit Utilization By Year and Leading Groups 100.00% 90.00% 80.00% 75.00% 70.00% 60.00% 50.00% 40.00% 30.00% 19.80% 17.70% 20.00% 14.50% 10.00% 0.00% 2014 2015 2016 Industry Leading Benchark *2017 data not yet available from CDC 5
CORE OBJECTIVE ? 100.00% 90.00% 75% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 19.80% 17.70% 14.50% 20.00% 10.00% 0.00% *2017 data not yet available from CDC 6
THE RIGHT THING FOR THE PATIENT • Health Promotion • Disease Detection • No co-pay 7
THE RIGHT THING FOR THE PATIENT Screening Mammogram 8
THE RIGHT THING FOR THE PATIENT Hemoglobin A1C 9
THE RIGHT THING FOR THE PATIENT Gait/Balance Assessment & Treatment 10
THE RIGHT THING FOR THE PATIENT Cognitive/Depression 11
THE RIGHT THING FOR THE HOSPITAL/PROVIDERS • Improves loyalty of patients • Aligns with Population Health Management to providers and hospital • Improves readmission rates • Improves quality impact/acuity scores • Improves risk reduction and • Identifies additional services patient safety to be performed at practice/hospital 12 12
WHY SHOULD HOSPITALS/PROVIDERS BE IN THE AWV BUSINESS? • Annual Wellness Visit $172 (Coinsurance and deductible waived) • Annual Wellness Visit (Subsequent visits) $117 (Coinsurance and deductible waived) *Medicare Advantage Plans do Reimbursement for AWVs. The reimbursement is based upon fee schedule, but often within 5%-10% of Medicare. 13
WHY SHOULD HOSPITALS/PROVIDERS BE IN THE AWV BUSINESS? “Downstream” AWV Revenue Per Patient $343 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. The Advisory Board (MGMA $375) 14
WHO CAN ADMINISTER THE AWV? • A physician who is a doctor of medicine or osteopathy or, • A physician assistant, nurse practitioner, clinical nurse specialist, or, • A medical professional (including a health educator, registered dietitian, or nutrition professional or other licensed practitioner) or a team of such medical professionals, working under the direct supervision (as defined in 42CFR 410.32(b)(3)(ii)) of a physician as defined in this section. 15
Who Can Administer the AWV? WHAT ARE THE SUPERVISION REQUIREMENTS OF AN AWV? • “ Direct supervision in the office setting means the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed.” 16
BENEFITS OF AWVS TO HEALTH SYSTEMS Prostate Pelvic Exams Screening Hepatitis Screenings Radiology Vaccines Other Immunizations Medical Lab Management Pap Smears E & M Glaucoma Screenings Substance AWV Diabetic Behavioral Abuse Management Counseling Counseling Mammogram Screenings Flu/Pneumonia Advance Mental Shots Care Health Planning Services Outpatient Physical Therapy Depression Alcohol Screenings Counseling Opportunity to ACOs improve capture all relevant Improve their scores on ICD-10 codes (Risk MIPS Score quality metrics Adjustment 17 Implications)
PERSONALIZED PREVENTION PLAN INPUTS OUTPUTS Health Risk Assessment Risk factors and treatment options List of current providers and Preventive services schedule prescriptions Review of medical/family Personal Prevention Plan history Referral initiation, Height, weight, blood communication, and pressure, etc. tracking Cognitive Laboratory/test tracking impairment/Depression Advance Care Planning Screens 18 18
PROVIDERS “Aren’t we sort of already doing this?” 19
PATIENT “I didn’t know about this!” 20
PATIENT ACCESS “We don’t have a way to identify the patients!” 21
PROVIDERS “I don’t have time!” 22
PROVIDERS/ADMINISTRATORS “We don’t have the capacity!” 23
PROVIDERS “How many more clicks?” 24
PHYSICIANS “The WIIFM Radio Station!” 25
IS IT WORTH THE TROUBLE? “In a practice with a Medicare population of approximately 750 patients per provider , the Initial AWV could result in $129,750 of additional revenue for the first year and $87,750 each additional year per provider, demonstrating the opportunity to generate steady income.” MGMA Downstream $$$ Revenue 26
IS IT WORTH THE TROUBLE? CURRENT STATE # G0438 + # G0439 + # 99387 + # 99397 ____________________ # Medicare Panel 27
TEN PROVIDERS AT 25% 25% YEAR 1 Practice $322,500 Downstream $643,125 Total $965,625 28
TEN PROVIDERS AT 50% 50% YEAR 2 Practice $438,750 Downstream $1,286,250 Total $1,725,000 29
TEN PROVIDERS AT 75% 75% YEAR 3 Practice $658,125 Downstream $1,929,375 Total $2,587,500 30
We don’t have a “Aren’t we sort “ I d way to identify i d n ’ t of already k n a o b w o the patients!” u t t doing this?” h i s ! ” e v a h t ’ n o ” d ! e I m “ e i v t a h ” t ! y ’ n t o i c d a p e a W c “ e h t “ H o w m m o a r e n y c l i c k s ? ” 31
THE BALANCING ACT 75% 32
CHANGE IS EASY!!! … y s a e s i e g n a h C ! t s r i f o g u o Y 33
THE PARADIGM SHIFT KEY ELEMENTS Stakeholders Urgency Vision Plan Change Leadership Team Budget Sponsorship Performance Management Communication Culture Accountability 34 34
STAKEHOLDERS IN THIS CASE = PEOPLE YOU ARE ASKING TO CHANGE • What questions will they have? 35
STAKEHOLDER ?????SSSSSS • What about me? • What is it? • Why? Why now? • When? Where? • How? • How am I doing? • Who cares? • What’s next? 36
YOUR NEXT STEPS 37
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