Medicare Annual Wellness Visit (AWV)

Clinic A/P, adults

The following 11 points are elements of Medicare annual wellness visit per CMS.gov from August 2018:

  1. Perform a Health Risk Assessment (HRA). This is a form that the patient completes before the provider sees the patient. See the Medicare link below for what should be on the form. Medical assistants can help ensure this is completed.
  2. Get FHx (Medical events of the beneficiary’s parents, siblings, and children, including conditions that may be hereditary or place the beneficiary at increased risk); PMHx; PSHx; Hospitalizations; Allergies; Medications and supplements including vitamins and calcium; assess opioid use and opioid use disorders.  We encourage providers to pay close attention to opioid use during this part of the AWV, which includes opioid use disorders (OUD). Consider switching to other non-opioid meds if possible.
  3. Establish a list of current providers and suppliers that the patient sees regularly.
  4. Measure, BP, Height, weight, BMI; or waist circumference, if appropriate). Other measurements if indicated.
  5. Assess cognitive function by direct observation, while considering information from beneficiary reports and concerns raised by family members, friends, caregivers, and others. If appropriate, use a brief validated structured cognitive assessment tool.
  6. Evaluate / Screen for depression (PHQ-9 score)
  7. Review the beneficiary’s functional ability and level of safety. Use direct observation of the beneficiary or select appropriate questions from various available screening questionnaires, or use standardized questionnaires recognized by national professional medical organizations to assess, at a minimum, the following topics:
    • Ability to successfully perform ADLs
    • Fall risk
    • Hearing impairment
    • Home safety
  8. Establish an appropriate written screening schedule for the beneficiary, such as a checklist for the next 5 to 10 years. Base written screening schedule on USPSTF recommendations and the ACIP vaccination recommendations.
  9. Establish a list of beneficiary risk factors and conditions for which primary, secondary, or tertiary interventions are recommended or underway. Include the following: A) Mental health conditions including depression, substance use disorder, and cognitive impairment. B) Risk factors or conditions identified through an IPPE,  C) Treatment options and their associated risks and benefits
  10. Give personalized health advice and appropriate referrals to health education or preventive counseling services or programs. Include referrals to educational and counseling services or programs aimed at community-based lifestyle interventions to reduce health risks and promote self-management and wellness, including:
    • Fall prevention
    • Nutrition
    • Physical activity
    • Tobacco-use cessation
    • Weight loss
    • Cognition
  11. Furnish, at the patient’s discretion, advance care planning services. Include a discussion about:
    • Future care decisions that may need to be made
    • How the beneficiary can let others know about care preferences
    • Caregiver identification
    • Explanation of advance directives, which may involve the completion of standard forms

 

Also, do the following

  • Vision impairment:
  • Immunizations (Flu, PNA, Shingles):
  • Pap smear:
  • Mammogram:
  • BMD:
  • Colonoscopy:
  • Smoking cessation/lung ca screening:

 

Medicare pays for BMD every two years. Some OB/GYN doctors order it every two years.

 

This link has everything that needs to be included in a Medicare Annual Wellness Visit: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AWV_Chart_ICN905706.pdf.

 

 

Key Points

  • IPPE = Initial Preventive Physical Examination
  • AWV = Annual Wellness Visit
  • PPPS = Personalized Prevention Plan Services

 

References

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AWV_Chart_ICN905706.pdf, Last Accessed 5/29/2019

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