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Medicare Annual Wellness Visit vs Annual Physical

Co-authored by Ashley Trice, AWV Product Specialist

Understanding the Difference

Jam is to jelly, crocodile is to alligator, pill is to tablet, annual physical is to annual wellness visit… right? All of these things are commonly used interchangeably, yet they have fundamental differences that make them absolutely NOT the same. The only way to ensure the terms are used correctly is to educate on what distinguishes these from each other. In this blog, we will explore what sets an annual wellness visit apart from an annual physical, and why it’s important to know the difference. 

What is an Annual Wellness Visit?

There’s a common misconception in the medical industry that annual wellness visits are the same thing as an annual physical exam. This likely comes with most people being familiar with annual physical exams or checkups, and assuming that an annual wellness visit is the same thing. However, they are quite different. 

Medicare’s Annual Wellness Visits (AWV) are yearly preventive visits for Medicare patients to create or update a personalized prevention plan. These preventative visits are designed to give the patient the opportunity to explain to their provider how they feel about their health status by filling out a health risk assessment. The provider is then able to use the collected information to identify risk factors, suggest appropriate preventive services, and create a personalized prevention plan for the patient.

These visits are comprised of three main components:

  1. Health Risk Assessment (HRA) – The first component of an AWV entails patients completing a self-administered questionnaire that addresses all facets of their health and well-being. In order for the HRA to be deemed compliant, patients must self-report information on the following topics: 
    • Demographics 
    • Self-Assessment of Health Status
    • Behavioral Risks 
    • Medical History and Family Health History
    • Psychosocial Risks 
    • Activities of Daily Living
    • Instrumental Activities of Daily Living

The risk-assessment questionnaire may also include questions about advance care planning. Based on the patient’s answer to the HRA questions, the provider will be able to identify risk factors, such as cognitive impairment, and create a personalized prevention plan to follow.

  1. Vitals – The second component is collecting and documenting vitals. These routine measurements include height, weight, and blood pressure which are essential to analyze when discussing risk factors related to cardiovascular disease, stroke and hypertension. Height and weight are used to calculate and report on body mass index (BMI).
  2. Consultation – The third component of an AWV consists of translating the HRA results into a five to ten-year care plan. Based on patient responses in the questionnaire, providers are able to identify risk factors and discuss a preventative plan of action geared towards a healthier future.

The Difference

Let’s take a look at the differences between Annual Wellness Visits and annual physicals in the table below. One of the most significant distinctions is that an AWV does not require a physical exam, while an annual physical does. Keeping that in mind, it is easy to understand the other differences since there is no physical touch involved in an AWV but there is during a physical. For example, you would not perform blood work during an AWV since physical touch is involved. 

Annual Wellness VisitAnnual Physical
Medical HistoryX
Physical ExamX
Review of risk factors for illnessX
Bloodwork, lab testsX
Personalized prevention planX
Medication reviewX
Address new health problemsX
VaccinationsX
Co-paymentX

One of the other important differences between the two is that there is no coinsurance required for an AWV as Medicare covers this service fully, and reimburses providers for it. Medicare does not reimburse providers for annual physical exams.

What are the qualifications for Annual Wellness Visits? 

So, who qualifies to receive an AWV? Let’s begin with identifying eligible patients. Medicare beneficiaries qualify to receive an Annual Wellness Visit from their provider, completely free of charge on a yearly basis. However, the patient must be enrolled in Medicare Part B along with Medicare Part A (or Original Medicare) in order to reap the benefits of preventive health care services. Patients with Medicare Advantage plans are also eligible to receive preventive services such as AWVs, as long as they are seeing an in-network provider. Ultimately, eligibility comes down to these two things:

  • The patient has been enrolled in Medicare Part B services for over 12 months
  • And, the patient has not received an AWV or the Welcome to Medicare preventive visit in the past 12 months

There are also requirements surrounding who is eligible to offer Medicare annual wellness visits. Great news for all primary care facilities, you qualify to perform AWVs with your patients! But, you are not the only eligible provider able to offer this service. Specialists such as neurologists, cardiologists, rheumatologists, etc. qualify as well. Even urgent care clinics qualify to perform this service. However, since only one AWV can be done per patient, per year, a patient will not be eligible if they have already had their preventive visit with another provider. 

Understanding the “Why”

So, why are Medicare Annual Wellness Visits valuable to health care providers and their patients? As the shift in healthcare from volume-based care to value-based care continues to grow in importance, preventive services like AWVs are crucial. AWVs are a preventative service that identify gaps in care and improve the quality of care that providers deliver. In addition, they are proven to improve patient outcomes and reduce costs:

  • There’s a 105% increase in colorectal cancer screenings for patients who get an AWV.
  • There’s a 58% increase in pneumonia vaccinations for patients who get an AWV.
  • There is a 46% increase in breast cancer screenings for patients who get an AWV.
  • A patient who receives an AWV improves medical outcomes resulting in $570 less annual Medicare expenses. 
  • 1,000 patients with an AWV can deliver more than a quarter million dollars in annual ACO shared savings*

These statistics show us the importance of preventive services like Medicare annual wellness visits. By conducting AWVs, health care providers can prevent future health problems and change the outlook of our healthcare industry as a whole. For more information on how you can start offering a successful AWV program for your Medicare beneficiaries, visit https://www.chartspan.com/solution/annual-wellness-visits/

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