What GPs Should Know About Medicare Annual Wellness Visits

Insurance is a tricky issue. There are so many types including private and public insurance not to mention the various plans and what each plan includes. It’s also been a hot topic recently with Obama bringing in Obamacare and now with all the reforms and changes being made. Insurance is important for every single citizen and although medical attention is a basic human right not everyone can afford it.

There are too many movies about how someone struggles to pay for a life saving operation that someone they love needs, just ask Denzel Washington. In the workplace medical insurance is also important as it can be the difference between the job offer you accept and the one you refuse. It’s also something struggling companies may cut funds to much to the distaste of their employees.

Medicare is a federal health insurance program. It’s not for the entire population though. It’s for people over 65 years of age, people with certain disabilities of all ages, and those with End Stage Renal Disease. End Stage Renal Disease is when a person’s kidneys can no longer perform their jobs which are excreting waste products and many metabolic adjustments. With the accumulation of waste products the body starts to suffer and due to the lack of some metabolic functions such as vitamin D activation patients may suffer from osteomalacia. These patients need dialysis in order to survive. Dialysis is a machine that basically removes all the waste and toxins from the blood and returns it to the patient waste free. Dialysis is really expensive all over the world so it’s really important that it’s covered by federal insurance. End Stage Renal Disease’s main cause is diabetes which is a very common disease.

There are 4 plans or parts in Medicare. Part A (also known as Hospital Insurance) covers hospital stays (as the name implies), care in an advanced nursing facility, hospice care, and some forms of home health care. Medicare Part B (also known as Medical Insurance) covers some doctor services, outpatient care, medical supplies, and preventive measures such as screening.

Medicare Part C (also known as Medicare Advantage Plans) is a little more complex and advanced. Medicare Part C is basically when a private insurance company works with Medicare in order to provide you with benefits from both parts A and B. If you’re covered by Medicare Part C most of your health services will be paid for by it and not the Original Medicare. Another benefit of this plan is that it usually provides prescription drug coverage too. Finally, Medicare Part D (also known as Prescription Drug Coverage) adds prescription drug coverage to your original plan so that you don’t have to pay for any prescriptions yourself.

Medicare Part B includes what are called Yearly Wellness Visits. These are basically where you visit your doctor once a year in order to have an almost complete check up to determine your current health status and set a plan for the future in order to keep you at optimum health. These Medicare annual wellness visits are covered by your plan so you don’t have to pay anything extra. If during the visit your doctor finds something out of the ordinary such as knee pain for example or anything else that will require additional testing and investigations then these will have an extra charge. This visit is done once every 12 months.

For doctors these visits aren’t a mandatory thing. If your patient doesn’t ask for them you’re not obliged as a physician to remind them and make sure they have the checkup. You’re also not obliged to do them if a patient asks for them, but why not? Of course you know your patients and you could simply tell them that you already have and know everything you need to. If you’re taking good care if your patients you probably also already have a plan set for them to make sure they’re screened for everything they’re supposed to. However, there’s no harm in performing the annual checkup. It will reassure your patients and may even reveal something you may have missed about their health or something they may not even be aware of.

So what exactly does the visit consist of?

• First of all there’s a health risk assessment. This usually includes a questionnaire that will help assess how healthy a patient is and risks such as injury and behavioral risks.
• Next there’s the medical and family history which you should already have if you’ve had the patient for a long time.
• Patients will also make a list of their providers and any medications they’re receiving. This includes both prescription and over the counter medications and even vitamins.
• As a doctor you will create a five to ten year screening schedule for your patient. The schedule and items will depend on each specific patient and their health.
• You will also identify any current medical conditions or risk factors in addition to current treatment being received.
• Blood pressure, weight, height, and body mass index measurements.
• Screening for cognitive impairment is an essential part of the visit. This includes conditions such as delirium and forms of dementia such as Alzheimer’s. Doctors are not required to do this assessment using a test. It can be done through a physician’s direct observation of the patient or based on history received from the patient or others who know him or her.
• Assessment of the risk factors of depression.
• Reviewing a patient’s level of safety and functioning. This includes assessing the risk of falling and sensory impairments such as hearing disabilities. The activities of daily living are also assessed such as the patient’s ability to perform basic activities such as eating, showering, dressing, and more.
• Finally as a doctor you’re required to give the patient advice based on your findings or refer them to a specialist if needed.

These are all to be performed during the first Medicare annual wellness visit. Subsequent visits will mostly consist of updating your findings and making sure that your patient is getting better or at least stable.

It’s important to keep in mind that these are all done under the umbrella of Medicare which mostly includes people over the age of 65. It doesn’t really make sense to assess the risk of dementia for instance in twenty year olds, but for someone over 65 it can make a huge difference. The activities of daily living are also essential because if a patient can’t perform them independently then their quality of life is really affected.

More awareness needs to be raised regarding Medicare’s annual wellness visits as statistics show that the majority of people don’t undergo them. In fact most of the people who do have their annual visits are those who are well connected to their physician in the first place and are taking good care of their health. As opposed to minorities and people who don’t get much health care access who don’t follow up and may not even know about this option.

Physicians aren’t obligated to perform them, but if it may add to the quality of life of their patients then there’s no harm in doing them. A doctor may notice that their patient is depressed for instance, which is something they may miss during a regular visit where the focus is solely on the patient’s complaint. It’s also a break for doctors who are always rushing between patients and those with serious conditions. Taking time to sit down with a patient in a stress free in environment to find out how they’re really doing overall will do both the doctor and the patient a world of good.

Setting a 5-10 year plan will also decrease the morbidities a patient may suffer from which will save them a lot of pain and money. A lot of benefits come from an annual visit and perhaps more people need to know about it.