“Tis the Season"
By Christina DeFrancisco, DNP, APN, FNP, CWS
It’s that time again to make a list and check it twice! No, I’m not talking about Christmas and Santa coming to town. Now is the time to make your list of residents requiring an Annual Wellness Visit (AWV) before the end of the year!
*Deep breath in* I know what you’re thinking; how do I perform an Annual Wellness Visit in long-term care for my residents and make it meaningful? Let’s discuss this more.
As a result of the Affordable Care Act, Medicare will cover an Annual Wellness Visit on eligible patients with no additional cost as of 2011. The goal of the AWV is to analyze patient information which includes medical and family history, health risk assessment, and screening information to then formulate a personalized preventative plan and complete advance care planning.
Before exploring how to approach this within the long-term care population let’s discuss the who, what, when, and why of AWVs:
Who - Physicians (Doctor of Medicine or Osteopathy), physician assistants, nurse practitioners, certified clinical nurse specialists, and allied medical professionals (to include health educators, registered dietitians, nutrition professionals, or other licensed practitioners as part of the medical professional team) can complete an Annual Wellness Visit.
What - This resident-specific preventative plan is formulated via thorough review of the following components of the medical record: demographic information, health risk assessment, health status overview, assessment of psychosocial and behavioral risks, activities of daily living, medical and family history, current providers and suppliers, vital signs, screening assessments (e.g., depression, cognitive, falls risk, substance use disorder), and safety. Additionally, as part of the safety evaluation, a hearing impairment screening is performed with all initial Annual Wellness Visits.
By analyzing this data, a personalized preventative plan is created, which includes screening schedules, risk factors, interventions, health advice, and referrals when appropriate. I encourage you to visit the Medical Learning Network - Medicare Wellness Visit to learn more about the specific requirements of initial and subsequent AWV visits.
When - An Annual Wellness Visit is a Medicare part B benefit that has no associated copay. Eleven full calendar months must have passed to bill a subsequent visit after the initial has been completed. The initial AWV (G0438, RVU 2.6) is a once-in-a-lifetime code. Thereafter, a subsequent AWV (G0439, RVU 1.92) code is billed.
Why - Despite a generally slow adoption of Annual Wellness Visits in the United States, studies have shown that these visits have improved the number of screening tests ordered, led to greater pneumococcal and influenza immunization compliance, and increased testing for possible causes of cognitive impairment. Additionally, AWVs contribute to healthy and successful Affordable Care Organizations (ACO).
When considering an AWV in the long-term setting, a common sentiment is, “how do I make this applicable to an aging, older adult?” As a colleague of mine advocates, let's “meet them where they are.” This is especially applicable for residents who have ‘aged’ out of many preventative screenings.
For those 75 years and older, focus on staying up to date with immunizations, with an emphasis on vaccination against COVID-19, influenza, pneumococcal disease, hepatitis B, and herpes zoster. It is not uncommon to encounter vaccine hesitancy from residents as well as their families. In these instances, emphasize empathetic communication while understanding their underlying concerns. Provide evidence-based education to disarm misinformation and address any concerns related to potential side effects. Additional services provided as part of the AWV may include: a review of blood pressure control; diabetes screening; bone density testing; and referrals to audiology, psychiatry/psychology, dental, and optometry/ophthalmology, as determined by the resident’s preferences, health status, and age.
All collected data should be reviewed with a goal of addressing any health concerns revealed. For instance, if a resident has a low BMI, what is their nutrition plan? When there is a noted risk for falls, what preventative measures are in place?
Focusing on screening depression, falls, and cognition is important in our population but it's particularly helpful in our ‘oldest-old’ residents, those 85 years of age or older. These screenings provide valuable insight for providers regarding the residents' quality of life. Additional tools and screenings, such as the FAST tool and Flacker Mortality Index Score, can be beneficial and contribute to meaningful advance care planning discussion with the resident and family. On a side note, remember to use modifier 33 if you bill for advance care planning and include your time.
In conclusion, Annual Wellness Visits empower providers to create an individualized preventative plan for their residents. While collecting data, providers should analyze information to formulate a plan for the upcoming years. Often, providers may face challenges in this process, but I encourage you to 'meet your residents where they are' and tailor your plan to their specific needs at any age to maximize the benefits of this visit!
Resources
1. American Academy of Family Physicians. (n.d.). Annual Wellness Visits (AWV). https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/annual-wellness-visits.html
2. U.S. Department of Health & Human Services. (n.d.). Medicare Learning Network (MLN)
Matters Number: MM7079. https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/MM7079.pdf
3. Centers for Medicare & Medicaid Services. (n.d.). Medicare Wellness Visits. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html
4. The American Journal of Managed Care. (n.d.). Increasing Medicare Annual Wellness Visits in Accountable Care Organizations. https://www.ajmc.com/view/increasing-medicare-annual-wellness-visits-in-accountable-care-organizations
5. American College of Physicians. (n.d.). Medicare's Annual Wellness Visit (AWV).
https://www.acponline.org/practice-resources/business-resources/payment/medicare-payment-and-regulations-resources/medicares-annual-wellness-visit-awv
6. Nicholas, J.A., Hall, W.J., Screening and preventive services for older adults. Mount Sinai Journal of Medicine. 2011 Jul-Aug;78(4):498-508.
doi: 10.1002/msj.20275. PMID: 21748739; PMCID: PMC3142556.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142556/
Any views or opinions presented in this article are solely those of the author and do not necessarily represent any policy or position of PAMED, PMDA, AMDA, its affiliates, and members.
By Christina DeFrancisco, DNP, APN, FNP, CWS
It’s that time again to make a list and check it twice! No, I’m not talking about Christmas and Santa coming to town. Now is the time to make your list of residents requiring an Annual Wellness Visit (AWV) before the end of the year!
*Deep breath in* I know what you’re thinking; how do I perform an Annual Wellness Visit in long-term care for my residents and make it meaningful? Let’s discuss this more.
As a result of the Affordable Care Act, Medicare will cover an Annual Wellness Visit on eligible patients with no additional cost as of 2011. The goal of the AWV is to analyze patient information which includes medical and family history, health risk assessment, and screening information to then formulate a personalized preventative plan and complete advance care planning.
Before exploring how to approach this within the long-term care population let’s discuss the who, what, when, and why of AWVs:
Who - Physicians (Doctor of Medicine or Osteopathy), physician assistants, nurse practitioners, certified clinical nurse specialists, and allied medical professionals (to include health educators, registered dietitians, nutrition professionals, or other licensed practitioners as part of the medical professional team) can complete an Annual Wellness Visit.
What - This resident-specific preventative plan is formulated via thorough review of the following components of the medical record: demographic information, health risk assessment, health status overview, assessment of psychosocial and behavioral risks, activities of daily living, medical and family history, current providers and suppliers, vital signs, screening assessments (e.g., depression, cognitive, falls risk, substance use disorder), and safety. Additionally, as part of the safety evaluation, a hearing impairment screening is performed with all initial Annual Wellness Visits.
By analyzing this data, a personalized preventative plan is created, which includes screening schedules, risk factors, interventions, health advice, and referrals when appropriate. I encourage you to visit the Medical Learning Network - Medicare Wellness Visit to learn more about the specific requirements of initial and subsequent AWV visits.
When - An Annual Wellness Visit is a Medicare part B benefit that has no associated copay. Eleven full calendar months must have passed to bill a subsequent visit after the initial has been completed. The initial AWV (G0438, RVU 2.6) is a once-in-a-lifetime code. Thereafter, a subsequent AWV (G0439, RVU 1.92) code is billed.
Why - Despite a generally slow adoption of Annual Wellness Visits in the United States, studies have shown that these visits have improved the number of screening tests ordered, led to greater pneumococcal and influenza immunization compliance, and increased testing for possible causes of cognitive impairment. Additionally, AWVs contribute to healthy and successful Affordable Care Organizations (ACO).
When considering an AWV in the long-term setting, a common sentiment is, “how do I make this applicable to an aging, older adult?” As a colleague of mine advocates, let's “meet them where they are.” This is especially applicable for residents who have ‘aged’ out of many preventative screenings.
For those 75 years and older, focus on staying up to date with immunizations, with an emphasis on vaccination against COVID-19, influenza, pneumococcal disease, hepatitis B, and herpes zoster. It is not uncommon to encounter vaccine hesitancy from residents as well as their families. In these instances, emphasize empathetic communication while understanding their underlying concerns. Provide evidence-based education to disarm misinformation and address any concerns related to potential side effects. Additional services provided as part of the AWV may include: a review of blood pressure control; diabetes screening; bone density testing; and referrals to audiology, psychiatry/psychology, dental, and optometry/ophthalmology, as determined by the resident’s preferences, health status, and age.
All collected data should be reviewed with a goal of addressing any health concerns revealed. For instance, if a resident has a low BMI, what is their nutrition plan? When there is a noted risk for falls, what preventative measures are in place?
Focusing on screening depression, falls, and cognition is important in our population but it's particularly helpful in our ‘oldest-old’ residents, those 85 years of age or older. These screenings provide valuable insight for providers regarding the residents' quality of life. Additional tools and screenings, such as the FAST tool and Flacker Mortality Index Score, can be beneficial and contribute to meaningful advance care planning discussion with the resident and family. On a side note, remember to use modifier 33 if you bill for advance care planning and include your time.
In conclusion, Annual Wellness Visits empower providers to create an individualized preventative plan for their residents. While collecting data, providers should analyze information to formulate a plan for the upcoming years. Often, providers may face challenges in this process, but I encourage you to 'meet your residents where they are' and tailor your plan to their specific needs at any age to maximize the benefits of this visit!
Resources
1. American Academy of Family Physicians. (n.d.). Annual Wellness Visits (AWV). https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/annual-wellness-visits.html
2. U.S. Department of Health & Human Services. (n.d.). Medicare Learning Network (MLN)
Matters Number: MM7079. https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/MM7079.pdf
3. Centers for Medicare & Medicaid Services. (n.d.). Medicare Wellness Visits. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html
4. The American Journal of Managed Care. (n.d.). Increasing Medicare Annual Wellness Visits in Accountable Care Organizations. https://www.ajmc.com/view/increasing-medicare-annual-wellness-visits-in-accountable-care-organizations
5. American College of Physicians. (n.d.). Medicare's Annual Wellness Visit (AWV).
https://www.acponline.org/practice-resources/business-resources/payment/medicare-payment-and-regulations-resources/medicares-annual-wellness-visit-awv
6. Nicholas, J.A., Hall, W.J., Screening and preventive services for older adults. Mount Sinai Journal of Medicine. 2011 Jul-Aug;78(4):498-508.
doi: 10.1002/msj.20275. PMID: 21748739; PMCID: PMC3142556.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142556/
Any views or opinions presented in this article are solely those of the author and do not necessarily represent any policy or position of PAMED, PMDA, AMDA, its affiliates, and members.