Annual Wellness Visits
by Dr. Jon Hart
This series has been focusing on levers to be pulled that can increase revenue in value-based care (VBC) practices. The second installment started looking at ways to decrease medical expenses, thereby increasing the potential revenue through shared savings or premium risk (Link to Part 2). Part 3 will now dig into the Swiss Army Knife of VBC, the Annual Wellness Visit (AWV).
An AWV can be a revenue generator, paid at a higher rate than a typical office visit, generating more collection revenue and productivity points (RVUs*). This would seem counterproductive in a move to VBC where one wants to decrease medical costs. However, when trying to move a practice or a physician from a fee-for-service (FFS) model based on collections or productivity to an outcomes-based VBC model, the incentives in physician compensation need to be aligned with the work of VBC. Motivating this alignment using encounters that will later yield a big ROI for VBC, like AWV, eases that transition.
Additionally, AWV work doesn’t need to all fall into the lap of the physician. Most of the work can be completed by other medical professionals. This frees up the doc to spend more time with other patients.
While there’s a cost on the front end, the gross revenue value created by helping build patient attribution to a physician and through addressing proper coding of a patient’s burden of illness (Link to Part 1), plus the money saved on the back end through improved outcomes all more than make up for the increased front-end expense.
This is why AWVs are truly the Swiss Army Knife of VBC. So many useful tools all in one convenient package!
Helping ensure attribution of patients
Appropriate coding of burden of illness to set benchmark
Prevention and screening, PLUS any bonuses paid for HEDIS measure completion
Patient safety and appropriate disease management through medication reconciliation
Identification of medical and social risks that would benefit from a guiding hand
Fostering the Patient-PCP relationship
Patient attribution – who is the physician responsible for the patient’s care – is generally determined by the plurality of care, i.e., who has had the most billed touches with a patient. The rules vary from payer to payer, but an AWV will often be given more weight in the equation
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*RVU stands for Relative Value Unit, but in reality, it has little to do with value. It’s a relative cost indicator designed by a Harvard Business Professor and embraced by CMS and the AMA. It’s commonly used for measuring production of physicians and practices, much to the chagrin of PCPs.
than a typical office visit. Doing the AWV will help get a patient on your attribution list. It is only when a patient (member) is attributed to a physician that the physician can get credit for the work done in HEDIS measures, cost and use metrics, and shared savings (or the penalty for work not done).
As noted in Part 1 of this series, Medicare and other payers adjust their premiums and expected expenses based upon the burden of illness documented in the population they’re covering. Accuracy and completeness of burden of illness documentation is essential in calculating a populations’ expected cost of care for the next year.
For Medicare, this determines what CMS is either going to budget for medical expenses or pay to a Medicare Advantage plan in monthly premium. That estimate of spend or monthly premium is the benchmark that a practice or organization will have as a goal in shared saving or an expense risk contract.
An AWV is the perfect opportunity to capture and recapture the accurate and specific coding of a patient’s conditions. Without an intentional effort at appropriately documenting a patient’s conditions and putting them on a claim, this process will often fall through the cracks.
HEDIS Measures dealing with prevention and screening can be addressed during an AWV. It’s a perfect time to ensure immunizations are up to date, preventing acute illness and complications of chronic diseases. Health screenings that a patient is due for can be ordered during an AWV.
Early detection of colorectal cancer and breast cancer greatly improves patient outcomes at a significantly lower cost than treating these conditions in more advanced stages. Checking patients with diabetes for kidney or retinal complications of their disease can be initiated in an AWV. In addition to being able to check the boxes for “HEDIS Quality” measures often tied to VBC revenue, patient care is improved.
Another component of an AWV is medication reconciliation. When done properly, adverse reactions or disease decompensation can be avoided, decreasing the need for ED visits and admissions, i.e., decreasing costs.
Medication reconciliation is one of the most basic, most under-used, most important tasks in modern healthcare (besides hand washing). Patients and physicians need to agree on all the medicines a person is taking, reconciling them with their conditions and with other medicines, looking for potential interactions. Frequent checking of the med list can avoid confusion, poor control of chronic conditions, and possible adverse reactions.
While in the office for an AWV, a patient’s current and new chronic conditions can be discussed. Questions can be asked to discern their need for extra help and support with these conditions. Likewise, social risks can be identified that might negatively impact their health and well-being.
A successful VBC program will have designed programs to support patients clinically and socially to improve outcomes and decrease costs (coming soon in Part 4!). The AWV serves as a great opportunity to assess progress with these programs or identify patients in need of the programs and introduce the patients to them.
Relationship is a factor in healthcare that is difficult to quantify but with known benefits in patient care and outcomes. Relationships improve engagement and adherence to medical advice. Positive rapport opens the doors to conversations about social risks and barriers to care. The stickiness of a relational bond improves the chances that a patient will first reach out to the physician’s office with medical questions and issues rather than immediately trotting off to the Emergency Department.
A good way to build a relationship is to be present with each other. AWVs foster relationships not only through more time spent together with the PCP Care Team but spending that time exploring ways with the patient to improve their health and well-being – helping them feel cared for.
For these reasons, practices need to focus on the timely completion of AWVs for their Medicare population. (Timing of when a patient can get an AWV varies between Traditional Medicare and Medicare Advantage plans – know the rules and who the patient has for a payer.) Dedicate resources to finding who needs an AWV scheduled. Consider flipping a scheduled visit to an AWV. Intentionally attend to the components of a valuable AWV, and get the whole team involved in the office, letting everyone work to the top of their license.
It seems so basic. Start paying attention to AWVs done right. It will smooth your transition to VBC and aid in the success of outcomes-based care.
In Part 4 of this series on VBC Drivers, we will look at lower medical costs through programing to help manage the care of patients based on risk assessment and stratification.
Read more articles from our VBC Drivers series
