Medicare AWVs and Preventive Care Research Paper

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Policy Recommendation Paper for ABC Medical Group Regarding AWV

Introduction

The purpose of this policy recommendation paper is to provide education for the managers of ABC Medical Group regarding the Medicare annual wellness visit (AWV). The AWV is a yearly doctor’s visit covered by Medicare in which Personalized Prevention Plan Services (PPPS) are received. The AWV is a health risk assessment, which is beneficial for the patient (CMS, 2017). The AWV is not the same as a yearly physical, nor are clinical laboratory tests included in it. There is no deductible or copay involved as both are waived by Medicare. Offering the AWV is also beneficial for professional health care providers in that it allows their practice to provide preventive care with a value-based model “to keep patients as healthy as possible” (AAFP, 2016). By establishing a process that encourages patients to take advantage of their AWV, practice managers will be able to collect information to gain better understanding of their needs of their patient population and more effective ways to serve them, leading to the development of new business models and services provided by the medical practice as well as the expansion of existing service lines to capture market shares.

Medicare ACO

An Accountable Care Organizations (ACO) is a group of physicians, hospitals, and other health care providers who voluntarily work together to provide quality care to Medicare patients. They coordinate with one another in order to ensure that these patients received the care they require when they require it. Through coordinating their efforts, they also ensure that there is no unnecessary repetition of services and the medical errors are not made with regard to the patient’s health and handling while receiving care from the various outlets available to him or her. The purpose of the ACO is to assist in the streamlining of Medicare delivery to patients so that there is less waste of energy and resources and more efficiency in terms of high-quality care being given to the patient. For its services, the ACO is rewarded with a share of the savings that it is able to obtain for the Medicare program (CMS, 2016).

Medicare Annual Wellness Visit Program Overview

The AWV is similar to the Welcome to Medicare Visit, which is a one-time visit within the first year of a person’s enrollment in Medicare Part B. The AWV, however, is offered once every year and gives the patient a chance to receive an updated personalized prevention plan that can help him or her mitigate risks and “prevent disease and disability” (NCOA, 2016).

At the AWV, the patient will provide the care giver with personal and family medical history information. The personal history will include such information as immunizations, illnesses, hospitalizations, surgeries, symptoms and/or treatments since the patient’s last visit. The patient will also provide a list of medication that he or she is taking or has taken in the past. The names of providers and suppliers of medical equipment is also given to the care giver.

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The professional care giver in turn conducts a routine body measurement/assessment, including height, weight, BMI, and vital signs. A depression screening is performed. A cognitive impairment assessment is conducted. The patient’s functionality and safety levels are assessed. And a health risk assessment is provided. Added to this, the health care provider also gives a 5-10 year schedule of screening and preventive services to the patient along with personalized health advice and referrals regarding health education, falls prevention, smoking cessation, nutrition, weight loss and other health-related issues.

Health care professionals who are certified to deliver the AWV include medical doctors, nurse practitioners, physician assistants, and any other medical professional (such as a registered dietician, nutritionist or other licensed professional) so long as it is under the supervision of a physician.

Reimbursement for Annul Wellness Visits

So long as the health care provider accepts Medicare patients, the beneficiary of the AWV pays nothing. This may change if the AWV is conducted along with other tests and/or services that are not part of the AWV—such as labs or screenings. In such cases (if the extra services are subject to Medicare Part B cost-sharing), the patient may have to pay a deductible plus 20% co-insurance (NCOA, 20160. Providers are “well-reimbursed” for the care they provide, and as a potential revenue opportunity, CMS shows that there is between an $111 and $172 average annual reimbursement for every qualifying patient (Levinthal, Teske, Kontor, 2015). Likewise, Kontor (2015) notes that “even for health systems that aren’t setting out to become population health managers, getting more AWVs is a win. It’s one of few strategies that help transition to value-based payment while also reaping benefits under fee-for-service.” Kontor (2015) also adds that in terms of financial benefits, providers stand to gain substantially: “Right now, only 14% of Medicare beneficiaries receive an AWV. I’ve seen medical groups increase that to over 70%. And the financial impact of that increase is impressive. For a 100-provider practice, the additional revenue can total as much as $3 million annually.” With such a significant return, offering the AWV is easily one of the most business-friendly services a provider can give.

Challenges and Barriers offering Annual Wellness Visits

Currently there are few challenges to offering the AWV. The reason that so few Medicare beneficiaries take advantage of it is that they are either unaware of it as a service that is free for them to obtain, or their health care providers do not offer it as part of their in-house services.

Other barriers that have been known to exist from the provider’s point of view are nothing out of the ordinary: they consist of language barriers and late arrivals (Cuenca, 2012)—but these can be….....

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