Study finds 50% of practices that don’t offer Medicare annual wellness visits are taking a revenue hit

Male doctor in white lab coat
Many practices are missing out on revenue from Medicare annual wellness visits. (Getty/Saklakova)

Almost half of physician practices may be missing out on an opportunity to generate revenue by providing annual wellness visits to Medicare patients, according to a new study.

Many practices have been slow to adopt annual wellness visits, which Medicare introduced in 2011 as part of the Affordable Care Act, the study, published in Health Affairs, found.

That’s particularly true for practices caring for underserved patients, according to the Harvard Medical School researchers.

Free Webinar

Take Control of Your Escalating Claim Costs through a Comprehensive Pre-payment Hospital Bill Review Solution

Today managing high dollar claim spend is more important than ever for Health Plans, TPAs, Employers, and Reinsurers, and can pose significant financial risks. How can these costs be managed without being a constant financial drain on your company resources? Our combination of the right people and the right technology provides an approach that ensures claims are paid right, the first time. Register Now!

Wellness visits are intended to help address the health risks of aging adults by focusing on preventive health maintenance. The study found that practices’ adoption of wellness visits varies. Using national Medicare data, researchers found in 2015 that 51.2% of practices did not provide annual wellness visits at all, while 23.1% provided the visits to at least a quarter of eligible patients.

“Adoption of the annual wellness visit may benefit practices financially, yet half of them are missing out on these benefits—particularly practices that disproportionately care for medically and socially complex patients,” the study authors wrote.

RELATED: Wellness programs may not pay immediate dividends

Practices that scheduled annual wellness visits rather than the typical problem-based visits saw increases in primary care revenue, the study found, as Medicare pays doctors more for such a visit. They also had more stable patient assignment and a slightly healthier patient mix.

Wellness visit rates were lower among practices caring for underserved populations, such as racial minorities, patients dually enrolled in Medicaid and those in more rural settings, the study found. Researchers said practices caring for more disadvantaged or high-risk patients may have limited resources or care for patients with more pressing health needs.

Practices with electronic health records were more likely to provide the visits than other practices, along with those participating in accountable care organizations.

Given the benefits, why wouldn’t practices schedule more wellness visits?

Part of that may be explained by the visit’s complex and sometimes confusing requirements, researchers said. Wellness visits have been a topic of discussion at his clinic in rural southwest Missouri, Kurt Bravata, M.D., a family physician who practices primary care, geriatric medicine and addiction recovery, wrote in a post on the American Academy of Family Physicians blog.

Wellness visits have benefits to both patients and practices, he said.

“As a physician, I especially appreciate the opportunity to promote preventive care to my most vulnerable patients: the aging and aged,” said Bravata, who also described the challenges of coding and billing for the visits.

The authors of the Health Affairs study said policymakers should consider ways to encourage more practices to adopt annual wellness visits and look for mechanisms to adapt them for practices with underserved populations.

Suggested Articles

A new Aetna pilot program aims to harness its parent company's pharmacy reach to help address members' social needs.

UPMC posted operating income of $277 million for the first nine months of the year thanks in part to a major boost from its insurance business.

St. Louis-based Ascension Health posted $1.2 billion in net income in the first quarter of its fiscal year that ended Sept. 30.