Medicare Wellness Visits: Reassessing Their Value to Your Patients and Your Practice

Arnold E. Cuenca, DO, Caqsm, FAAFP; Susan Kapsner, CCS


Fam Pract Manag. 2019;26(2):25-30. 

In This Article

The Value of Medicare Wellness Visits

The main benefit of the AWV to patients is the creation of a personalized prevention plan, a written plan that can help guide their preventive care decisions for the next five to 10 years. This plan includes age-appropriate preventive services, recommendations offered by both the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices, and personalized health advice that identifies risk factors and suggests referrals or programs to address them.[3]

Providing Medicare wellness visits also offers a structure that helps physicians to close many pay-for-performance quality measure gaps, including those recognized by the Core Quality Measures Collaborative, the Integrated Healthcare Association's California Value Based P4P program, and the National Committee for Quality Assurance's Healthcare Effectiveness Data and Information Set. In addition, accountable care organizations participating in the Medicare Shared Savings Program can use data collected during wellness visits to satisfy specific quality measures for the 2018 and 2019 quality reporting years.[4] (See "Closing Quality Measure Gaps.")

There also are financial incentives to implementing AWVs. Physicians participating in Medicare's Merit-based Incentive Payment System (MIPS) can use AWVs to raise their quality scores, which can potentially lead to positive Medicare payment adjustments. Practices that provide AWVs often generate greater revenue than those that do not – a result of billing AWVs with associated preventive services and same-day problem-oriented services.[2] AWVs also provide physicians another opportunity to assess and report risk-adjusted diagnoses for Medicare Advantage beneficiaries. Future payment rates for higher risk patients are calculated based on risk-adjusted factor (RAF) scores, so addressing Hierarchical Condition Category-related diagnoses in the same visit can be of additional value. (For more on this subject, see "Is Your Diagnosis Coding Ready for Risk Adjustment?" FPM, March/April 2018, and "Diagnosis Coding for Value-Based Payment: A Quick Reference Tool," FPM, March/April 2018.)

"Providing Medicare wellness visits also offers a structure that helps physicians to close many pay-for-performance quality measure gaps."