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Preventive Planning With Annual Wellness Visits

A visit to your provider when you’re not feeling well is a simple and logical decision – one with immediate and tangible benefits. In times of suffering, it is common to think exclusively in the moment. We want one thing and one thing only: a remedy. But this trail of reasoning seldom applies when feeling perfectly healthy. Why waste time on seemingly needless appointments? The answer lies in personalized preventive medicine, an operative approach that aims to monitor existing conditions, and detect and diagnose other complications prior to their onset. Grounded in individualized aid, preventive care identifies medical risk-factors and maintains patients’ prospective well-being, all the while curtailing the crippling economic burden associated with such ailments.



The Annual Wellness Visit

Covered by Medicare Part B, the Annual Wellness Visit (AWV) is a yearly analysis and assessment of one’s health. During the visit, a primary care provider (PCP) will examine any medical updates and modify the Personalized Prevention Plan (PPP), created in the initial meeting, accordingly. Though similar in sequence and process, the AWV is a separate procedure from the Initial Preventive Physical Exam (IPPE), also referred to as the ‘Welcome to Medicare Exam.’ An AWV is also not to be mistaken for a physical exam or specific check-up.


Patients enrolled in Medicare Part B for more than one year are eligible for an AWV. Comprehensive and detailed, AWVs play a critical role in the preventive care movement, allowing providers to support a patient’s well-being and prevent further disease and disability.


COVID-19 Impact

As the ubiquitous threat of COVID-19 circulated, the routines and rituals that had become entrenched in the American experience were hastily forced into rapid adaptation or, if unable, sacrificed completely. Preventive care and AWVs were no different. Amid waves of apprehension and concern, compounded by the knowledge that seniors were at the greatest risk, many visits, including AWVs, were canceled. Considering the preventive and prospective nature of AWVs, the postponing posed minimal immediate detriments. But as the time spent in lockdown grew, and with it, our understanding of the virus, the consequences of continued delay surfaced.


The fearful uncertainty that plagued the nation left prescriptions unwritten and diseases undetected. Noted by the National Cancer Institute, “in March 2020 alone, COVID-19 forced the postponement of more than 800 appointments for lung cancer screening.” There is also evidence that “delays in screening… could mean that the ‘missed’ cancers might be larger and more advanced when they were ultimately detected.”


In regard to heart conditions and diabetes, the decline of monitored treatment options disrupted medical routines and left patients helpless.


As with any patient-physician relationship, the delay in screenings and procedures saw negative repercussions in not only patients’ well-being, but that of physicians. On average, the services of an AWV are reimbursed at a rate of $146.07 per visit. The loss of AWVs signaled the loss of significant reimbursement options. In light of this, practices – particularly smaller offices – buckled under the pressure of the pandemic. According to an April 2020 study conducted by the Medical Group Management Association, “97% of practices have experienced a negative financial impact directly or indirectly related to COVID-19,” with a “55% decrease in revenue and 60% decrease in patient volume since the beginning of the COVID-19 crisis.”


Transition to Telehealth

In response to the aforementioned consequences, in March of 2020, the Centers for Medicare and Medicaid Services (CMS) issued the rapid expansion of telehealth benefits and reimbursement opportunities as part of the blanket 1135 waiver. Under its authority, AWVs can be conducted virtually, without restrictions on location and geographical availability. Telehealth enables practitioners to strike a balance between maintaining social distancing regulations and providing practical care. Beyond reviewing the Personalized Prevention Plan (PPP), AWVs via telehealth allow PCPs to assess a patient’s behavior and, if applicable, enroll them in advanced care programs, such as Remote Patient Monitoring (RPM) or Chronic Care Management (CCM).

As reported by the Centers for Medicare and Medicaid Services (CMS), “the number of services delivered via telehealth surged during the PHE [Public Health Emergency], with nearly 68 million services delivered via telehealth occurring between March and October 2020. This represents an increase of more than 2,700% compared to the same period from 2019. Generally speaking, telehealth utilization increased through April 2020, then began to decline through October, although levels remained substantially higher than prior year levels.”

A similar study found that by virtue of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, “telemedicine was associated with 13% lower odds of missed appointments,” proving how the practice “can enable effective and accessible care.”

To perform an AWV via telehealth, a patient must document their consent to the provisions and procedures. It is also recommended that a provider establishes a trusting relationship with their patient prior to the initial visit.

 

The expansion included the following HIPPA-compliant platforms approved for telehealth AWVs:

  • VSee

  • Skype for Business

  • Updox

  • Google G Suite Hangouts Meet

  • Doxy.me

  • Zoom for Healthcare

The following is the framework for a telehealth AWV:

  1. Complete a Health Risk Assessment (HRA)

  2. The Health Risk Assessment (HRA) can be conducted by a physician or medical assistant and involves a series of questions designed for the Personalized Prevention Plan (PPP). Several components of the questionnaire will appear in subsequent visits. During the assessment, a patient’s Activities of Daily Life and behavioral risks should be noted. Vital measurements should also be documented or self-reported, including but not limited to height, weight, BMI, and blood pressure.

  3. Establish/review patient’s medical and family history

  4. Surgical history, operations, allergies, disabilities, other pertinent medical information

  5. Review patient’s current providers

  6. Review patient’s current medications

  7. In the event of a past or present use of opioids, review alternative benefits

  8. Screen for cognitive impairment

  9. Screen for depression and mood disorders

  10. Review functional ability, gait, balance, and fall risk

  11. Screen for substance use disorders

  12. Develop Personalized Prevention Plan (PPP)

  13. Review Advanced Care Planning options



The AWV is billable under three varieties: Initial Preventive Physical Exam (IPPE), Initial Annual Wellness Visit, and Subsequent Annual Wellness Visit. The 1135 waiver adapted the latter two for telehealth, but the IPPE is not allowable by telehealth.




To learn more about billing codes, check out: RPM Billing: What to Know



Impilo’s Top Picks

Because several components of the telehealth AWV, namely the Health Risk Assessment, rely on self-reported vitals and measurements, it’s important to be equipped with the necessary devices.


Digital weight scales


These devices measure and display weight and are important for the Health Risk Assessment.

Our recommendation: BodyTrace Weight Scale (LTE)

To learn more about digital weight scales, check out: 5 Best Smart Weight Scales 2021

Pulse oximeters

Using a pulse oximeter, you can record your blood oxygen level, pulse rate, and perfusion index.

Our recommendation: Wellue Smart Fingertip Pulse Oximeter

To learn more about pulse oximeters, check out: 4 Best Smart Pulse Oximeters 2021


Glucometers/Blood Glucose Meters

With a glucometer or Blood Glucose Meter, you can regularly monitor your blood glucose levels. These devices are especially helpful for those with Type 1 or Type 2 diabetes.

Our recommendation: Bioland Blood Glucose Meter (LTE)

To learn more about glucometers, check out: 5 Best Non-Continuous Smart Glucometers 2022


Blood pressure monitors

These devices enable you to measure the pressure of an inflatable cuff around your arm. The readings are quick and simple, allowing you to update your PCP frequently.

Our recommendation: iHealth Track - Connected BP Monitor

To learn more about blood pressure monitors, check out: 5 Best Smart Upper Arm Blood Pressure Monitors 2021

For more devices, check out The Digital Health Store

How Impilo Can Help

Help your patients digitally utilize the Annual Wellness Visit with Impilo. Get started today by contacting sales@impilo.health