Medicare Wellness Visits Up Physician Pay, Miss Key Patients

Marcia Frellick

February 05, 2018

Adoption of annual Medicare wellness visits increases primary care revenue, according to a new study. However, adoption has been lower among practices caring for underserved populations, which may deepen disparities, researchers report in an article published online today in Health Affairs.

Ishani Ganguli, MD, MPH, instructor of medicine at Harvard Medical School and Brigham and Women's Hospital in Boston, Massachusetts, and colleagues, used Medicare data from 2008 to 2015 to assess practices' ability and motivation to adopt Medicare wellness visits and found that uptake varied widely.

In 2015, 51.2% of practices offered no annual wellness visits and 23.1% (the adopters group) provided visits to at least one fourth of their eligible beneficiaries. Adopters were concentrated in urban areas and the Northeast. Overall, just 18.8% of all eligible beneficiaries (n = 6,186,679) received a visit.

Dr Ganguli and colleagues found that practices in rural areas were less likely to adopt wellness visits than were practices in urban areas (8.1% vs 24.4%). Similarly, practices caring for high-risk patients were less likely to be adopters (18.2% vs 23%), as were those in areas with high percentages of patients dually enrolled in Medicare and Medicaid (17.0% vs 26.5%).

Hospital-based practices were less likely than independent practices to provide the visits (9.8% vs 24.9%).

More Pay for Wellness Visits

The authors note, though, that primary care practices may be missing out on income because Medicare pays more for wellness visits than for problem-based visits. In addition,  Medicare "allows clinicians to bill for an annual wellness visit concurrently with a problem-based visit — if, for example, a patient brings up an acute concern."

The adopting practices did not have an overall increase in visits, which suggests they have replaced the problem-based visits with the wellness visits, according to the authors.

"On average, practices that adopted the annual wellness visit generated greater primary care revenue and had an increase in revenue over the study period, while nonadopters had a slight decline," they write.

The authors found that offering wellness visits was linked to more stability with patient assignments and a slightly healthier patient mix, according to Hierarchical Condition Category risk scores.

Visits Offered Since 2011

Wellness visits were started under the Affordable Care Act in 2011 and became the first annual checkup offered at no charge to fee-for-service Medicare beneficiaries.

In the current study, the authors found practices in rural areas and those caring for underserved populations — such as racial minorities and dually-eligible patients — may have particular difficulties in offering the visits. Such practices are often behind in electronic health record adoption and have more trouble attracting providers, for instance. Providers serving underserved populations also tend to have heavier workloads and adding these visits to the mix may be challenging.

In addition, the authors say that complex and sometimes confusing requirements that come with adopting the wellness program may be a barrier for overwhelmed clinicians treating underserved populations and that perhaps a "less prescriptive form of the visit" or a new kind of visit used for complex patients may encourage greater uptake.

"Medicare could also extend programs such as Comprehensive Primary Care Plus, in which primary care practices are compensated for caring for complex patients outside of traditional visits," they write.

Among limitations of the study are that authors could not determine whether Medicare beneficiaries took advantage of a preventive visit through employer-based insurance, supplemental insurance, or a federally qualified health center.

The authors have disclosed no relevant financial relationships.

Health Aff. Published online February 5, 2018. Abstract

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