Over the past few months, we have seen increased interest in Medicare’s preventive services. We suspect this is a direct result of the approaching deadlines for MACRA. Many of the same questions seem to show up, most of them regarding how to best use the program and how best to allocate resources. The following information is to help practices new to the IPPE/AWV with some basic guidelines that go just a bit beyond CMS’s MLN Matters description of the AWV and for the IPPE. (Which, incidentally, if you haven’t read please do that before you do anything else.)
Manage your Resources
Every practice manager knows that proper management of resources is the number one key to survival in today’s healthcare environment. With this in mind, it is essential that each patient visit be as comprehensive and efficient as possible.
The Introduction to Medicare Visit and Annual Wellness Visit are NO exception. The IPPE/AWV is designed to be a preventive visit to help patients fully understand their health status. Here is what Medicare requires:
- Obtain medical and surgical history, including illnesses, hospital stays, operations, allergies, injuries, and treatments
- Verify immunization status
- Establish a list of all current medications and supplements, including calcium and vitamins
- Obtain family medical history, including diseases that may be hereditary or place the beneficiary at increased risk
- Review potential risk factors for depression and other mood disorders, make referrals as necessary
- Screen patient for hearing impairment, make referrals as necessary
- Screen patient for ability to successfully perform functions of daily living, make referrals as necessary
- Screen patient for fall risk and home safety, make referrals as necessary
- Obtain height, weight and calculate BMI
- Obtain blood pressure and other routine measurements as deemed appropriate
- Establish a list of all the patients current healthcare providers and suppliers
- Assess the cognitive function of the patient, make referrals as necessary
- Create a written screening schedule for the next 5-10 years for preventive services, including all Medicare preventive screenings. Provide copy of this schedule to patient.
- Establish a list of risk factors and conditions of which interventions are recommended or underway for the beneficiary including mental health conditions. Include a list of treatment options, with associated risks and benefits.
- Furnish personalized health advice and appropriate referrals including: lifestyle and wellness interventions, weight loss, physical activity, smoking cessation, fall prevention and nutrition.
The IPPE includes all of the AWV’s requirements plus adds:
- Visual acuity screening
How To Maximize the Introduction to Medicare and Annual Wellness Visit’s Efficiency:
A common question of many practices is if they can perform other services with an AWV that will improve outcomes and also increase profitability? There are some things that can be done on the same visit as an AWV:
- Create a Patient Health Record
Let’s first address the most obvious way to maximize the use of the IPPE and Annual Wellness Visit. The IPPE and Annual Wellness Visit, as required by Medicare, already reviews and records information that is necessary to develop a Patient Health Record. For over a decade, the medical community has promoted patient centered health records, but also complained that they are not trustworthy when filled out by the patient. When a health record is completed by a healthcare professional, it helps to ensure the accuracy and reliability of the information. This results in less guesswork and better patient care from specialists and during hospitalizations. Most EHR portals do not provide this information in a form the patient can understand or share with others.
- Provide Medically Necessary Services and Referrals
Medicare has clearly stated that the IPPE/AWV is to be the primary service offered to a patient during the IPPE/Annual Wellness Visit. However, there are certain situations where separately identifiable, but medically necessary services may be added to the visit.
Although, the practice must be cognizant of the fact that medical necessity must be shown prior to services being performed, the IPPE/AWV is a perfect opportunity to perform beneficial and preventive tests such as EKGs, immunizations, and Neuropsychological screening for cognitive impairment and depression while the patient is already at the practice. Using the IPPE/AWV as a conduit for such services can increase patient satisfaction as well as the profitability of the practice. (Verify with your area MAC to determine if these rules apply in your region.)
While researching methods to make the IPPE/AWV efficient and easy to implement, we discovered many programs that weren’t being offered by physician practices due to time constraints. Our research indicated that the IPPE/AWV was a perfect opportunity to implement some of these beneficial and potentially life saving programs.
- Increase Productivity (AWV only):
Unless you are a Federally Qualified Health Center or a Rural Health Center, Medicare does not require that a physician actively participate in the actual Annual Wellness Visit. The AWV is primarily an educational and administrative visit performed with healthy patients. Therefore, any licensed medical professional can perform the AWV under the physician’s direct supervision. The physician’s limited time should be spent seeing other patients, thus directly increasing productivity. It is important to note that licensure and certification are not equivalent in the eyes of Medicare. The AWV must also fall under the Scope of Practice for that individual’s license.
Please Note: The Introduction to Medicare Wellness Visit is not designated to be done by a “licensed Medical Professional” as described in the AWV.
- Order the Service Needs Identified During the IPPE/AWV
One of the most disturbing trends we have found during our work with Introduction to Medicare and Annual Wellness Visits is that providers often ignore the results of the IPPE/AWV or they don’t put a protocol in place to order the services identified during the IPPE/AWV as needed by the patient.
Medicare doesn’t recommend you do everything you identify on the same day as the IPPE/AWV and actually will NOT reimburse for many of the services if you do them on the same day. We recommend you have protocols in place for your practice that define what services will be ordered and when. Please note, the IPPE/AWV will have zero impact on your MIPS/APMs if you do not order the services needed. You are required, at a minimum, to provide the patient with a schedule of when they are next eligible for each of the Medicare Preventive Screenings.
- Meet your MACRA Requirements
Most experts agree that the Medicare IPPE/AWV is the foundational visit designed to promote quality improvement and meet your MIPS/APM requirements. However, the mistake many providers make is assuming that just performing the IPPE/AWV will automatically qualify them for MIPS/APM requirements. This is most definitely not the case. The IPPE/Annual Wellness Visit is simply an assessment. It does not improve your quality measures by itself. To get credit on your MIPS/APM you must ORDER and document all services identified as needed by the IPPE/AWV. If your patient declines the service you must make note of that in your EHR to ensure that is also well documented. Use the IPPE/AWV to identify needs, document services you offer during the IPPE/AWV such as depression screening and Advance Directive support but follow through on all services needed if you want to maximize its usefulness to your practice.
The Introduction to Medicare and Annual Wellness Visits are wonderful resources to help you meet the new requirements laid out by Medicare. Follow these basic protocols and you can increase patient outcomes, quality measures and even your reimbursement.
For more information about how to integrate the Annual Wellness Visit into your practice contact Innovative Health Media, LLC here. We offer consulting services regardless of whether you use our software. Our goal is to help you help your patients.