In 2010, before the Affordable Care Act went live and before Medicare began funding it’s Annual Wellness Visit, Innovative Health Media began modifying it’s Personal Health Record to act as a template for that visit.
From the beginning it was apparent that most primary care providers were unable to implement the visit without assistance due to the long list of requirements. Over the years we have seen practice after practice struggle with implementing the Annual Wellness Visit (AWV). Lack of basic understanding of the visit, inefficient business practices and staffing issues have plagued many wellness programs. This was not a problem until recently. Other than not receiving the reimbursement for the AWV, there was really no significant impact on practices. That changed in 2015 when Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA.)
MACRA states, “By 2019 all automatic increases to CMS payments stop and will be replaced with MIPS or APM.” This means providers will need to meet certain quality measures or they will lose a significant portion of their potential reimbursements. Although neither MACRA nor Medicare states the AWV is required, there is a greater chance providers could overlook important quality measures if the visit isn’t a part of a provider’s standard practice. Providers have become accustomed to an annual (albeit small) increase in Medicare reimbursement. This annual increase will stop in 2019. Instead, the increases will be reserved for those providers who meet certain requirements (typically quality measures). Providers who don’t meet measures will see their reimbursements actually decrease, and that money will go to the providers who do meet the measures.
Time is of the essence!! As we all know, data takes a while to crunch. Therefore, the quality measures for 2017 will be used to determine your reimbursement level for 2019, 2018 for 2020, etc. If you have not already implemented a program to help you meet the MACRA requirements you need to do so immediately.
MACRA gave provider’s two tracks to choose from:
- The Merit-based Incentive Payment System (MIPS)
- Advanced Alternative Payment Models (APMs) — ACO’s are an APM
Whether choosing APM or MIPS, providers are left with little choice but to create a comprehensive prevention and wellness program to maintain their current income level. To create and maintain a wellness program, providers will be required to spend a significant amount of time with each patient. The AWV is the best way to be reimbursed for that time. It is unlikely that the majority of primary care providers will be able to carve out an additional forty-five minutes to an hour for every Medicare patient annually. Luckily, if the practice isn’t a FQHC or RHC, Medicare allows the AWV to be done by a licensed Medical Professional (as long as the professional is being directly supervised by a physician.) This rule makes the wellness programs more realistic for a normal practice.
From experience, for practices to be successful meeting the requirements for the AWV and MACRA we know providers will need some very basic policies in place. Visit our blog about to how to make the Medicare AWV more efficient here.
The biggest secret to being successful with your wellness program is to plan ahead. You will need:
- A strong, consistent template that allows you to monitor the nurses who perform your visits (Most EHR templates are incomplete so every provider needs to compare their templates to Medicare’s requirements.)
- A well educated staff who knows how to implement the wellness visit and other preventive services.
- Wellness staff need to be aware of the USPSTF guidelines and be prepared to assist providers with implementing those guidelines with their patients.
- Wellness staff need to be familiar with Medicare’s Preventive services and eligibility requirements.
- A reliable way for your nursing staff to communicate with providers about the needs identified during their preventive service visits. (If you do not actually order the needed services found during the AWV, you will not improve quality scores.)
What we do
Innovative Health Media has spent over 7 years researching and learning how best to implement these programs efficiently in your practice.
You do not have to use our software to use our expertise.
We are more than a software template. IHM can help you with software support, but we also provide consulting, internal audits of existing AWV templates, workflow implementation, hiring wellness staff and education as well as other supports that will lead to your practice’s long term success with prevention and wellness.
If you need software, you may wish to apply for an ongoing research study by visiting www.AWVStudy.org that gives you access to our e-AWV® software at minimal expense.
As a part of your team, Innovative Health Media can help you meet the challenges associated with Medicare’s preventive services to improve the overall outcomes for your patients. We look forward to working with you!