Is There a Perfect Workflow for Medicare Annual Wellness Visits?

Only 19% of eligible Medicare patients are receiving their Annual Wellness Visit (AWV) each year and little has been done to investigate why. Unlike some Value-Based Care programs, Medicare’s compliance requirements for AWVs are not onerous. The real challenge to AWV utilization is integrating a preventative care workflow process into the daily workflow of practices that operate, largely, in reactive, sick care mode. 

Since all practices run differently, it does not make sense to mandate a one-size-fits-all AWV product process and workflow. However, there are certain features of an AWV program or product that can help dramatically improve utilization and program results. 

Patient Appointments

Research shows that 41% of patients fail to show for scheduled preventative care appointments. Scheduling patient AWVs is costly, requiring extra staff and significant labor costs. Experienced practices know that the key to increasing AWV utilization is to convert sick visits into well visits and deliver preventative care.    

Waiting until an eligible patient comes to your practice for a sick visit to conduct an AWV ensures high utilization rates and lowered overhead costs.  Conducting an AWV during the traditional time a patient fills out their registration paperwork in the lobby means the interruption to the existing practice workflow is negligible.  Ensuring your AWV operational workflow accommodates this process means more patients will benefit and your practice will maximize revenue.

Eligibility Verification

Within the first year of a patient’s Medicare Part B coverage, all Medicare beneficiaries are eligible for an initial AWV, called the IPPE, or “Welcome to Medicare” visit. After that, each beneficiary is eligible for a subsequent AWV. In an attempt to maximize patient utilization of preventive services, AWVs do not require a coinsurance obligation (copay) from the patient. 

Even though Medicare outlines the requirements for AWV patient eligibility, identifying if a patient is eligible or not can get messy quickly. Since many types of providers (such as primary care providers or certain specialties) can perform an AWV, you may not know if a patient has already received one from a different provider. Additionally, patients constantly age-in to Medicare so there are new, eligible patients all the time. This is why it’s important for your AWV platform or tool to be able to check HETS Medicare eligibility in real-time. This feature is crucial to ensuring that your team does not waste time on ineligible patients, and also can maximize your program by ensuring you perform an AWV on every eligible patient you can.

Demographic Data Reconciliation

Just because your system can run an eligibility check does not necessarily mean that it will work for every patient. That’s because if any of the required demographic data is missing, the eligibility check will be incomplete. To ensure that you can run an eligibility verification on any patient, even if there is missing data, you will need a platform or tool that can do demographic data reconciliation for you. This means that any missing data is collected and entered into your system so that you can proceed with your verification. Without this feature, you’ll likely miss out on eligible patients. 

Staff Flexibility

Medicare allows a wide range of healthcare providers to participate in performing the AWV, including nurse practitioners, physician assistants, physicians, and clinical specialists. Depending on the size of the practice and your preferred workflow, the staff you choose to perform your Annual Wellness Visit program can vary widely. Your platform or AWV tool should allow you flexibility with who you choose to run your program. For example, if your physicians are tied up and unable to participate, your tool should allow for other qualified healthcare providers to complete the AWV instead. Your platform should be user-friendly for every touch point from your front staff to the administering healthcare provider.

Vital Collection

Medicare requires that routine measurements such as blood pressure, body mass index, and weight are reported in each Annual Wellness Visit. Your AWV tool should make sure that vitals are entered, whether it is easier for your workflow to enter them before or after the visit. Your tool should alert you if there are missing vitals so that you do not accidentally bill for an incomplete AWV, causing a rejection.

Accessibility

To work with any workflow and specific patient needs, your AWV program will need to be flexible and accessible to all eligible patients. This means that you will need to make your AWV user interface user-friendly and easy to read with large font, provide language translation services, and be able to conduct a telehealth visit, integrated with your chosen telehealth vendor. Additionally, to really maximize flexibility your AWV tool should be portable so that your patients can work on their portion of the visit in any room of your practice, including the waiting room.

Health Risk Assessment

The Health Risk Assessment, or HRA, is the most robust aspect of the Annual Wellness Visit. The HRA is a self-reported health questionnaire that the eligible Medicare beneficiary completes. The HRA reports on the patient’s perceived family health history, medical history, activities of daily living, medications, immunizations, and overall health status. It is intended to identify risk factors of the patient’s current health for things such as mood disorders, cognitive impairment, behavioral risks, and functional ability. The responses to the questionnaire should generate a personalized prevention plan that recommends the next steps for any identified risk factors. 

You may want to customize certain questions in your HRA questionnaire, so it’s important that whatever you use to conduct your Annual Wellness Visit easily can do so and report on the responses. Without a customizable HRA, you may not be able to accommodate every workflow.

Reporting

The amount of data collected during an AWV can be overwhelming, so it’s crucial that your AWV platform or tool uses special logic for reporting that presents you with the most critical data first so that you do not have to dig through the rest of the information and waste valuable time. The reporting aspect of your Annual Wellness Visit program should be simple to read, straightforward, and robust all at the same time. It’s important that your generated reports have these qualities so that your provider can efficiently provide health advice and recommend additional preventive services to patients when necessary. 

As you can see, there are a variety of features to look for in an Annual Wellness Visit solution that can make your program a success. ChartSpan understands that no two practice workflows are the same and offers an AWV product that allows each customer to customize for their unique workflow process. If you’d like to explore a solution that has these features or talk to an expert about how to best fit an AWV program into your workflow, visit our Annual Wellness Visit page.

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