The population is aging. More than 56 million Americans are older than 65 years and eligible for Medicare. Many of the elderly develop chronic health conditions: heart disease, cancer, cerebrovascular disease, diabetes, arthritis, hearing loss, poor vision, dementia, and many others. Some of these increase the risk of death; others make the “golden years” a time of decline and misery, with limited activity and decreased quality of life. Many of them are potentially preventable. One of Medicare’s goals is prevention. A recent monograph on geriatric care published in the American Academy of Family Physicians’ FP Essentials CME series provided an excellent overview of the facts. The text of the monograph is not available to non-subscribers, so I have summarized the information here for your convenience.
Welcome to Medicare
The Welcome to Medicare visit was established in 2005. It is a one-time preventive service for all new Medicare beneficiaries enrolled in Medicare Part B. It must occur within the first 12 months after enrollment in Medicare part B. It covers patients enrolled in Medicare Advantage plans if they were enrolled when they were first eligible for Part B.
The Welcome to Medicare visit includes a review of the patient’s medical history, current medications, lifestyle factors (such as diet, smoking, and exercise), functional status, a brief physical exam, and education and counselling about preventive services. It includes end-of-life planning and gives the patient a written plan for when preventive services such as screenings and vaccines will be needed.
Annual Wellness Visits
Medicare also covers an Annual Wellness Visit (AWV) once a year. It doesn’t require waiting exactly 365 days between visits but can be scheduled any time in the same calendar month. It updates any changes in information and risk assessment since the last exam. It includes a focused physical exam, assessment of cognitive function and mobility, and screening for depression. It updates the plan for preventive services, providing the patient with a new written 5- to 10-year plan. It usually takes 30-40 minutes. To increase efficiency, multiple team members can be involved. If the physician chooses to provide additional services not covered in the AWV, these are billed separately.
Only focused physical exams are covered. Complete routine physical examinations are not covered by Medicare, since they have not been shown to improve health outcomes. The goal of a complete physical is to assist in diagnosis, while the goal of the AWV is to promote healthful habits and behavior. AWVs have been shown to increase patient use of screenings, preventive services, and vaccinations. They have been associated with reduced spending on hospital admissions and outpatient services. AWVs reduce the cost burden to taxpayers by 5.7%. There is limited evidence about other outcomes.
Since these appointments are free, they could do a lot to address inequities in preventive services for underserved groups. Unfortunately, not many Medicare beneficiaries know about them. Only 19% of Medicare patients have taken advantage of the opportunity. Providers need to spread the word. You can help by telling your elderly friends.