Medicare Medicare Annual Well Visits. CHUG October 23, 2011

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1 Medicare 2011 Medicare Annual Well Visits CHUG October 23, 2011

2 Background/Disclaimers 60 % of my clinical work is Geriatrics 40% Medical Informatics No conflict of interests I do not work for CMS

3 Agenda Background on Geriatric screening Preventive care services for Medicare Essential elements of the AWV and the use of the AWV encounter and the PPP Demonstrate Centricity encounter for Medicare AWV Open discussion and Q&A

4 Geriatric Assessment has been advocated for over a decade Medicare B historically has not covered preventive services As part of MMA the IPPE was added in 2005 Now Annual wellness visits added as part of ACA 1/1/2011

5 Challenges of Geriatrics in Primary Care Short visit times Low reimbursement rates Multiple co-morbidities Needs of caregiver and patient Ever-expanding diagnostic and therapeutic options Cross cultural communication

6 What is Geriatric Assessment? Different models and definitions exist Geriatrics is often best practiced as an interdisciplinary team approach Evaluates different domains: medical, cognitive, psychological, social, physical Expands scope of interest to include caregiver and environment Emphasis on optimization of function and and increase in active life expectancy

7 Why is Assessment Important? Americans are aging! 1998: Age 65+ numbered 34 million 2030: Age 65+ will number 70 million Largest increases in those over age 85 Older population more ethnically diverse Majority of elderly will be cared for by internists and family practitioners ACP 1998: Internists should be measuring functional deficits and identifying dependency needs of older adults

8 Why is Assessment Important? Usual care may not meet elders needs The 80+ survey: 75% said MD unaware of social needs 37% said MD unaware of physical needs 42% said MD was unaware of their emotional needs 50% said Medical Care could be improved Patterson 1998

9 Medicare Preventive Services 2005 Medicare Modernization Act (MMA) IPPE( Welcome to Medicare PE ) Affordable Care Act (ACA) Initial Annual Wellness Visit Subsequent Annual Wellness Visit Additional screening services

10 Medicare Annual Visits IPPE occurs within first year May include EKG and AAA screen Need to include screening for depression and functional status Written summary for patient (new in 2011)

11 IPPE Review PMH,PSH, FH,SH Current medications Risk factors of alcohol, tobacco and drugs Functional and safety evaluation incl: falls risk, hearing impairments, ADL, home safety PE see next slide Advance Directive Education and counseling Brief written plan

12 Physical Exam This examination includes measurement of the beneficiary s height, weight, and blood pressure; measurement of body mass index; a visual acuity screen; and other factors as deemed appropriate by the physician or qualified non-physician practitioner (physician assistant, nurse practioner or clinical nurse specialist), based on the beneficiary s medical and social history and current clinical standards. More is OK

13 Medicare Annual Visits Annual wellness visits 1/year-Initial and then subsequent PPP(Personalized Prevention Plan) Initial GO438 Subsequent GO439 Prostate, Pelvic/Breast, Smoking counseling are additional services

14 Annual Well Visit Comprehensive review of PMH,PSH,FH,SH Medication use including supplements List of current healthcare providers

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16 Annual Well Visit Comprehensive review of PMH,PSH,FH,SH Medication use including supplements List of current healthcare providers Ht,Wt,BMI,BP and other appropriate measures Cognitive and depression screen Functional status and fall risk assessment Personalized Prevention Plan (PPP) Voluntary discussion of Advanced Directives

17 One Stop Shopping

18 Additional reimbursement G codes

19 Personalized Prevention Plan PPP Furnish personalized advice based on patient s risk factors and conditions Establish written screening schedule for next 5-10 years (USPSTF) Include current medication list

20 Documentation and Billing Need to clearly show all elements are covered Document PPP is given which should be same work flow as End of Visit Summary Document Prob # 1 as Annual Wellness Visit Other Problems then documented if E&M charge Be careful not to double count for E&M Don t forget other Preventive Service Charges

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22 Medicare Reimbursement IPPE $ wrvu is 2.43 Initial AWV $163 vs. $75 for level 4 exam Subsequent AWV $ wrvu is 1.5 Breast/Pelvic or Prostate extra E/M charges also possible if justified Good News!

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24 How to get it done Delegation of task is key. CMS estimates 60 min visit but not 60 minute of provider time. Follow the rules but adapt to fit your practice and patient s needs There is value but it is a change

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26 M O R E I N F O R M A T I O N

27 it is Not a REAL Physical

28 Discussion? s Paul R Clark MD FACP Pclark@crhc.org