THE MEDICARE ANNUAL WELLNESS VISIT: MOVING TOWARD BENCHMARK John - - PowerPoint PPT Presentation

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Jan 05, 2024 465 likes •860 views

THE MEDICARE ANNUAL WELLNESS VISIT: MOVING TOWARD BENCHMARK John Britt and John Wortley 1 1 WHAT IS IT? Beginning 2011, Medicare began covering the Annual Wellness Visit (AWV) is a yearly appointment with a primary care provider (PCP) to

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THE MEDICARE ANNUAL WELLNESS VISIT: MOVING TOWARD BENCHMARK

John Britt and John Wortley

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WHAT IS IT?

Beginning 2011, Medicare began covering the Annual Wellness Visit (AWV) is a yearly appointment with a primary care provider (PCP) to create or update a personalized prevention plan at no cost to the beneficiary. This plan may help prevent illness based on current health and risk factors.

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OF NOTE:

  • Not a routine physical
  • An acute E/M may be

reported separately

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MORE SPECIFICALLY………….

  • A Health Risk Assessment Survey - completed by the

patient

  • Screening for - functional abilities, cognitive function, risk

for falls, depression and safety

  • Biometrics – height/weight/blood pressure and other

routine measures

  • Prevention Services – vaccines and other age-appropriate

Medicare services

  • Plan of Care – personalized list of risks and conditions and

associated education

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SURVEY SAYS!

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% of Patients Getting AWV

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WHO IS GETTING THEM?

14.50% 17.70% 19.80% 75.00% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% 2014 2015 2016 Industry Leading Benchark

Medicare Annual Wellness Visit Utilization By Year and Leading Groups

*2017 data not yet available from CDC

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CORE OBJECTIVE?

14.50% 17.70% 19.80% 75%

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00%

*2017 data not yet available from CDC

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THE RIGHT THING FOR THE PATIENT

  • Health Promotion
  • Disease Detection
  • No co-pay

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THE RIGHT THING FOR THE PATIENT

Screening Mammogram

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THE RIGHT THING FOR THE PATIENT

Hemoglobin A1C

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THE RIGHT THING FOR THE PATIENT

Gait/Balance Assessment & Treatment

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THE RIGHT THING FOR THE PATIENT

Cognitive/Depression

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  • Aligns with Population

Health Management

  • Improves quality

impact/acuity scores

  • Identifies additional services

to be performed at practice/hospital

  • Improves loyalty of patients

to providers and hospital

  • Improves readmission rates
  • Improves risk reduction and

patient safety

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THE RIGHT THING FOR THE HOSPITAL/PROVIDERS

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WHY SHOULD HOSPITALS/PROVIDERS BE IN THE AWV BUSINESS?

  • Annual Wellness Visit $172

(Coinsurance and deductible waived)

  • Annual Wellness Visit (Subsequent visits) $117

(Coinsurance and deductible waived) 13

*Medicare Advantage Plans do Reimbursement for AWVs. The reimbursement is based upon fee schedule, but often within 5%-10% of Medicare.

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WHY SHOULD HOSPITALS/PROVIDERS BE IN THE AWV BUSINESS?

“Downstream” AWV Revenue Per Patient $343 The Downstream Module integrates detailed hospital and ambulatory data at the patient level to construct an accurate comprehensive longitudinal analysis of provider relationship patterns and associated downstream contribution.

The Advisory Board 14

(MGMA $375)

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WHO CAN ADMINISTER THE AWV?

  • A physician who is a doctor of medicine or osteopathy or,
  • A physician assistant, nurse practitioner, clinical nurse specialist, or,
  • A medical professional (including a health educator, registered

dietitian, or nutrition professional or other licensed practitioner) or a team of such medical professionals, working under the direct supervision (as defined in 42CFR 410.32(b)(3)(ii)) of a physician as defined in this section.

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WHAT ARE THE SUPERVISION REQUIREMENTS OF AN AWV?

  • “Direct supervision in the office setting means the physician must be present in

the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed.”

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Who Can Administer the AWV?

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BENEFITS OF AWVS TO HEALTH SYSTEMS

AWV

Radiology Lab Behavioral Counseling Mental Health Services Outpatient Physical Therapy Advance Care Planning Diabetic Management Other Medical Management E & M

Hepatitis Screenings Depression Screenings Glaucoma Screenings Flu/Pneumonia Shots Vaccines Immunizations Pelvic Exams Substance Abuse Counseling Alcohol Counseling Mammogram Screenings Pap Smears Prostate Screening

Improve MIPS Score

Opportunity to capture all relevant ICD-10 codes (Risk Adjustment Implications)

ACOs improve their scores on quality metrics

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PERSONALIZED PREVENTION PLAN

INPUTS

Health Risk Assessment List of current providers and prescriptions Review of medical/family history Height, weight, blood pressure, etc. Cognitive impairment/Depression Screens

OUTPUTS

Risk factors and treatment

  • ptions

Preventive services schedule Personal Prevention Plan Referral initiation, communication, and tracking Laboratory/test tracking Advance Care Planning

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“Aren’t we sort of already doing this?”

PROVIDERS

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“I didn’t know about this!”

PATIENT

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“We don’t have a way to identify the patients!”

PATIENT ACCESS

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“I don’t have time!”

PROVIDERS

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“We don’t have the capacity!”

PROVIDERS/ADMINISTRATORS

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“How many more clicks?”

PROVIDERS

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“The WIIFM Radio Station!”

PHYSICIANS

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IS IT WORTH THE TROUBLE?

“In a practice with a Medicare population of approximately 750 patients per provider, the Initial AWV could result in $129,750 of additional revenue for the first year and $87,750 each additional year per provider, demonstrating the opportunity to generate steady income.”

MGMA

Downstream $$$ Revenue

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IS IT WORTH THE TROUBLE? CURRENT STATE

# G0438 + # G0439 + # 99387 + # 99397 ____________________ # Medicare Panel

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TEN PROVIDERS AT 25%

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25% YEAR 1 Practice $322,500 Downstream $643,125

Total $965,625

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TEN PROVIDERS AT 50%

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50% YEAR 2 Practice $438,750 Downstream $1,286,250

Total $1,725,000

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TEN PROVIDERS AT 75%

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75% YEAR 3 Practice $658,125 Downstream $1,929,375

Total $2,587,500

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“Aren’t we sort

  • f already

doing this?” “ I d i d n ’ t k n

  • w

a b

  • u

t t h i s ! ” We don’t have a way to identify the patients!” “ I d

  • n

’ t h a v e t i m e ! ” “ W e d

  • n

’ t h a v e t h e c a p a c i t y ! ” “ H

  • w

m a n y m

  • r

e c l i c k s ? ”

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THE BALANCING ACT

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75%

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CHANGE IS EASY!!! C h a n g e i s e a s y … Y

  • u

g

  • f

i r s t !

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THE PARADIGM SHIFT KEY ELEMENTS

Stakeholders Vision Change Leadership Team Sponsorship Communication Accountability Urgency Plan Budget Performance Management Culture

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STAKEHOLDERS IN THIS CASE = PEOPLE YOU ARE ASKING TO CHANGE

  • What questions will they have?

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STAKEHOLDER ?????SSSSSS

  • What about me?
  • What is it?
  • Why? Why now?
  • When? Where?
  • How?
  • How am I doing?
  • Who cares?
  • What’s next?

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YOUR NEXT STEPS

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