Doc: Annual wellness visits generate ethical concerns for physicians

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In 2011, CMS rolled out new codes reimbursing doctors. (Getty/everydayplus)

The generous incentives offered to doctors for Medicare patients’ annual wellness visits (AWV) can give rise to ethical problems for some physicians, according to Peter C. Cook, M.D., M.P.H.

In 2011, the Centers for Medicare & Medicaid Services (CMS) rolled out new codes reimbursing doctors for zero-copay wellness visits, including one for the AWV. Writing in Medical Economics, Cook sees several problematic areas in the “relatively generous” reimbursement offered by the agency for these visits.

  • The setup makes the AWV a financially attractive opportunity for hospital administrators, who might then pressure the physicians they employ to schedule such visits even if they already address similar issues during periodic “problem-focused” visits, writes Cook.
  • CMS controls the documentation of AWV visits very tightly, in part to collect data the agency can then use to advance population health goals. Cook sees this as “usurping the well-established fiduciary nature of the doctor-patient relationship,” and therefore a “radical departure from accepted ethical practice.”
  • Cook sees “no evidence that a yearly physical/health maintenance/wellness exam has any benefit above and beyond that realized by following an evidence-based health maintenance schedule.”

Evidence demonstrating the efficacy of annual physicals has been mixed at best, per previous reporting by FiercePracticeManagement, though some doctors see benefit in these types of visits as an investment in the physician-patient relationship. In Cook’s view, practically all of the programs CMS has put in place as it seeks to shift incentives from volume-based care to quality-based care, including the Physician Quality Reporting System, Meaningful Use, and the Medicare Access and CHIP Reauthorization Act, interfere with physicians’ duty under the Hippocratic Oath to act in the best interest of their patients. He suggests that doctors would be unlikely to treat self-paying patients the same way they treat those they treat under Medicare if all things were equal.