My experience with the Medicare Annual Wellness Visit
How a wellness visit can actually hurt patients
A patient came in for a routine check up. She was a middle aged woman who was fairly healthy on minimal medications. She had no concerns and she was last seen a couple months ago with normal blood tests and sufficient refills on her medications.
I asked, How can I help?
The patient replied: I don’t know, I got a call from the office telling me I’m due for my check up.
Oh, okay. Well, I don’t have anything new to offer you if you’re not feeling ill and have no other concerns.
I figured I was due for blood tests since I got a call to come in.
Nope, you just had them done a few months ago and everything was normal.
Oh.
Well while you are here, maybe we can go over cancer screenings and vaccinations. Have you considered them?
I started discussing breast cancer and colon cancer screenings, until I noticed she received referrals out for these during the last visit. She hadn’t followed through with her referrals.
I asked, Why didn’t you go?
She said, I’ve been busy between work and taking care of my parents. My parents are requiring more help these days and I don’t have much time for myself.
I immediately felt guilty. Here she was, taking time out of caring for her aging parents so that she can attend this unnecessary office visit that she didn’t even ask for. She was here because we told her to come in.
The patient was called into the office to complete a Medicare Annual Wellness Visit (AWV). The AWV is an office visit performed annually meant to be set aside for reviewing the patient’s health. The doctor and patient would typically go through a form provided by Medicare and answer questions like: when was your last fall, and last hospitalization, are you incontinent of urine or stool? This visit also provides a chance for medication reconciliation and preventive measures like cancer screenings and vaccinations. More importantly, there are significant cash incentives provided by the insurance companies to have physicians complete these forms once a year by a deadline.
She appeared worn and tired from the stresses of life. I could tell that she lives selflessly and probably doesn’t take time for herself. I can imagine that in her mind, coming to the office today was the least she could do to take care of herself. After all, how will she take care of her parents, if she doesn’t do what she can to stay healthy?
The Medicare AWV is not a clinically effective tool. I can see how someone who doesn’t see patients for a living can think these are helpful. But personally, I never found these helpful. Nor have I ever met another physician that finds these helpful. Further, there have been studies suggesting that these wellness visits do not improve patient outcomes. Unfortunately though, all clinics taking Medicare dollars are financially incentivized to have these forms filled out.
At the end of the day, this woman took time out of her busy life so the clinic can check off a box and get paid, at her expense. Experiences like this make me wonder: how many primary care appointments are wasted on complying with insurance incentives and regulations that don’t benefit patients? What if we don’t have a primary care shortage, but rather administrative bloat that drain time and resources away from addressing problems patients need help with?
The worst part is when she received the call from us, she dutifully made an appointment because she trusted us that it would be in her best interest. When actually, it wasn’t a physician making a medical recommendation for her benefit. It was a non-clinical staff member making a financial decision. Her time would have been better spent following up on the mammogram she missed, or perhaps even a spa day or a hike. I’m afraid situations like this will degrade the trust between physicians and patients.
To be clear, I don’t mean to criticize any of the clinics I’ve worked at that do this. In fact, Medicare annual wellness visits are ubiquitous across all primary care offices in the US. Doctors’ offices, especially the smaller, privately owned practices, seem to be under increasing financial and administrative stress. So much so as to feel the need to call patients to persuade them to come in for their “routine check up”.
“Please prioritize your health”, we tell the patients in an attempt to convince them to show up. But this is no longer a professional recommendation. It’s a sales pitch.
>What if we don’t have a primary care shortage, but rather administrative bloat that drain time and resources away from addressing problems patients need help with?
Hit the nail on the head. Why do financial incentives exist for these non-evidence based interventions? And why not incentivize having shared decision-making conversations as the primary goal? The current system incentivizes shaming of patients who are “non-compliant”. Not patient-centered at all. I suspect these low-yield screening programs ironically increase healthcare costs. But if anything, they distract us from addressing issues that matter to patients.
I definitely agree that there is administrative waste and as physicians perhaps we can make some small move away from that in whatever way our individual situation allows. Or, we can even make a bigger leap and start something like a direct-care or cash-based practice. However, maybe there are also ways to make even these ill-advised visits worthwhile?