Not using the Medicare wellness visit is making people sick

Ask most healthcare CEOs the utilization rate for the Medicare Annual Wellness Visit (AWV) and they will probably not know it. Anthony Cirillo While it is reimbursable, the cost/benefit ratio favors practices sticking to what makes them money. They need to see the bigger picture.

The AWV reimburses on average $117 per visit, and to capture all of the documentation necessary to financially benefit the practice, it requires approximately 45 minutes. And if you don’t code properly, well, that’s another story.

Most find the AWV time-consuming, tedious and a financial burden.

There is a marketing term called loss leader. It’s the idea that you provide a product or service that is an enticement to help grow the number of customers you have. You may break even or lose money. But that is the cost to introduce new people to you.

For healthcare organizations, the gamble is that once they have experienced the care you offer they will come back and tell others.


There is another reason to take advantage of the AWV. It will help to broaden the number of patients you see who have potential risks that if not caught early will result in costly hospitalizations and improper use of the healthcare system later.

Consider that the most common chronic conditions among Medicare beneficiaries are:

  • High blood pressure (58 percent)
  • High cholesterol (45 percent)
  • Heart disease (31 percent)
  • Arthritis (29 percent)
  • Diabetes (28 percent)

According to the Department of Health and Human Services, two-thirds of Medicare beneficiaries have at least two chronic conditions, and they account for 93 percent of Medicare spending.

Think of the cost of not catching these earlier and making lifestyle interventions sooner. In an accountable care organization and bundled payment environment, the AWV can help the ACO achieve significant savings. Working with the patient, it is an ideal time to set health goals, put a prevention plan together and provide better care coordination. In essence, the AWV is an essential part of person-centered care.

Looking at the top healthcare utilizers of care, Ian Morrison in a recent Hospitals & Health Networks article suggested, “the best management of many of these top 5 percent utilizers may end up looking a lot more like social work than medical care. Housing, transportation, income support, nutritional support and counseling may be more beneficial and effective than any form of conventional medical intervention.”

The AWV is an opportunity to assess the activities of daily living (ADLs) and instrumental activities of daily living (IADLs), perform a fall risk assessment, review home safety, review medications and refer patients to community resources as noted by Morrison.

There is little excuse not to offer this screening. It can be done as part of a telehealth visit, administered by a physician assistant, nurse practitioner or other licensed professionals. And you can even outsource it.

Better outcomes, better experience, cost savings--why not get on board?

Lindsy Blaze, writing for LaunchMednotes that “The difficult part is in convincing physicians of the importance, and developing strategies with the ACO physicians as to how to implement these visits within their current practices. That can include providing templates or checklists for AWV requirements, training for the billing team, or designating supporting teams to provide this service under the supervision of the physician.”

Frankly, this is another case where we need leaders who can see the big picture and tell a convincing story to others.

Anthony Cirillo, F.A.C.H.E., is president of the Aging Experience, which specializes in experience management and strategic marketing across the continuum of care. Anthony is a monthly contributor on The Charlotte Today program, the expert in senior care, an executive board member of CCAL, and a member of the Dementia Action Alliance.