Medicare Annual There is no co pay for this preventative service - PowerPoint PPT Presentation

5/18/2017 Overview • Annual Wellness Visits are covered for all Medicare beneficiaries on an yearly basis (prior visit + 1 day) Medicare Annual • There is no co ‐ pay for this preventative service (Z00.00) Wellness Visits • Good way to ensure that patients preventative services are up to date and for the completion of ACO measures • 91% of all FIHN members are in need of an Annual Wellness Visit (AWV) February 25, 2016 1 2 Benefits Future Benefits • May want to add Advance Care Planning (ACP) code • Enhanced revenue for practice (direct revenue; more (99497, 99498; modifier 33) shared savings) • Good starting point for Chronic Care Management • Help to maintain attribution of patients (CCM) initial discussion and subsequent codes (99490) • Better scoring on ACO / PQRS measures • Consider adding diagnoses to maintain HCC scores (Hierarchical Conditions Categories) • Improved member health 3 4 1

5/18/2017 Financial Benefit ‐ 2016 How To Start Annual Wellness Visit • Take Medicare patients as they come up in the schedule Initial visit G0438 $176.61 (2.43) ‐ or ‐ Report separately (no charge as a preventative exam) Subsequent G0439 $119.93 (1.50) • Recommend 30 ‐ 40 minutes for the exam Office Visit (established) • Consider no more than 1 ‐ 2 per day 99213 $ 75.15 (0.97) 99214 $110.66 (1.50) • Pairing with regular health visit (and use 25 modifier) 99215 $149.03 (2.11) • Will take ~ 1year to capture all your Medicare lives Advance Care Planning (1 pt/day x 5 days/wk x 52 wks/yr = 260 pt/yr) 1st 30 min 99497 $87.66 5 6 add 30 min 99498 $76.24 Work flow • Could get midlevels to do • MD has to sign off nonproviders doing the exam Annual Wellness Visit • Get nursing staff to handle as much as they can • Use EMR to document as much as possible • (FIHN may report % attributed pts with AWV exam) 7 8 2

5/18/2017 Acquire Beneficiary Information Checklist for MCW Annual Visit • Administer Health Risk Appraisal (HRA) • Use “ A Checklist for Your Medicare Wellness Annual • Must include: Visit ” (handout; will be available on website) Demographics • Have patient (or family member, if patient unable) Self ‐ assessment of health status complete ‐ may be done ahead of time Psychosocial risks Behavioral Risks • Scan into record ADL ’ s (Activities of Daily Living) Instrumental ADL ’ s 9 1 0 Other Elements Other Elements • Review the beneficiary’s potential risk factors for • Establish/update a list of current (medical) providers Depression (including current or past experiences with and suppliers depression or other mood disorders) • Establish/update the beneficiary’s medical/family history • Review the beneficiary’s functional ability and level of safety: (may use a combination of paper questionnaires and Fall risk EMR templates) Hearing impairment Home safety 1 1 1 2 3

5/18/2017 Begin Assessment Cognitive Assessment • Assess via direct observation (integrating concerns of • Measure: Height, Weight, BMI, and BP family, friends, and caretakers) – required • Consider other measurements as deemed appropriate • May do screening for cognitive impairment (Mini ‐ COG; based on medical and family history AD8 Dementia Screening Interview) • Assess cognitive function (direct observation and input • If positive recommend having the patient return for from family / friends / caretakers) another visit (or refer out for assessment) 1 3 1 4 Depression Screening Fall Risk Assessment • Questions on AHR (17, 18): • Suggest using PHQ ‐ 2 as screening tool Have you fallen 2 or more times in the past year? Are you afraid of falling? Over the past 2 weeks, how often have you been bothered by any of the following problems: • Timed Up And Go (TUG) Test 1) Little interest or pleasure in doing things Time in seconds for a patient to rise from a seated 2) Feeling down, depressed, or hopeless position in an arm chair, walk 10 feet, turn around, walk back to their chair, and sit back down • If response to either question is positive, recommend (dependent pts generally >30 seconds) doing a follow up PHQ ‐ 9 • Consider follow up visit to discuss (or refer out) 1 5 1 6 4

5/18/2017 Counsel Beneficiary Counsel Beneficiary • Establish a list of risk factors and conditions for which • Use “Counseling and Referral of Other Preventive the primary, secondary, or tertiary interventions are Services” form (handout; will be available on website) recommended or underway for the beneficiary • Written 5 ‐ 10 year plan reviewing Preventative Services • Furnish personalized health advice to the beneficiary and a referral, as appropriate, to health education or • Given patient a copy of form to take home with them preventative counseling services or programs • Establish a written screening schedule for the beneficiary, such as a checklist for the next 5 ‐ 10 years, as appropriate 1 7 1 8 Help With Measures (GPRO) BMI (65yo and older) • If BMI < 23 write a plan to increase weight • If BMI 23 ‐ 30 no plan needed; weight satisfactory Help With Measures (GPRO) • If BMI > 30 write a plan to decrease weight (for under 65yo BMI’s should be >18.5 and < 25; document if patient refuses plan) 1 9 20 5

5/18/2017 Help With Measures (GPRO) Help With Measures (GPRO) Tobacco Use Blood Pressure • Offer counseling • Pre ‐ HTN 120 ‐ 139/80 ‐ 89 record plan; f/u 1 year (plan must include lifestyle change: DASH diet; • Refer to an established smoking cessation program – FMH Outpatient Cessation Program (240 ‐ 566 ‐ 3622) increase activity; decrease weight, sodium, or alcohol) • With proper documentation can bill in office 99406 • HTN >140/90 create plan; return < 4 wks (Smoking and tobacco use cessation counseling visit; 3 ‐ 10 (if BP remains >140/90 on follow ‐ up visit, then must minutes) or 99407 (>10 minutes); use modifier 25 initiate EKG, labs, or begin medication) 21 22 Help With Measures (GPRO) Other Measures • Mammogram • Colonoscopy Subsequent Exams • Vaccines • Depression / Fall Risk 23 24 6

5/18/2017 Subsequent Exams • Note date of visit in “comments” field in EMR, such as “smc 2/25/16” • Timing must be a year (and a day) from previous exam Advance Care Planning • Watch schedule for when a Medicare patient comes up • For q3 ‐ 6 mth visits, time as soon as last AWV as possible • Run reports to capture patients who do not have a follow ‐ up appointment (?FIHN) 25 26 Advance Care Planning Questions • 99497 (1 st 30 minutes) • use modifier 33 with preventative service (AWV – no copay or deductible) • Includes: Advance Directive MOLST Living Will Durable POA for Health Care Health Care Proxy 27 28 7