Welcome to Medicare Visit - American Academy of Family Physicians

2015 Scientific Assembly Needs Assessment
Body System: Population-Based Care
Session Topic: Welcome to Medicare Visit
Educational Format
Faculty Expertise Required
Expertise in the field of study. Experience teaching in the field
of study is desired. Preferred experience with audience
response systems (ARS). Utilizing polling questions and
 Interactive Lecture
engaging the learners in Q&A during the final 15 minutes of
the session are required.
Learning Objective(s) that will close the Outcome Being
Professional Practice Gap
gap and meet the need
Measured
1. Identity patients who are nearing
Learners will
 Welcome to Medicare
eligibility for a welcome to medicare
submit written
Visits (WMV) are
visit
(WMV),
and
systematically
commitment to
underutilized.
schedule the appointments.
change statements
 Older adults are often
2.
Provide
patient
education
materials
on the session
unaware of preventive
promoting the WMV to eligible
evaluation,
services available to them
patients.
indicating how
via the WMV.
they plan to
 Coding/billing for WMV is 3. Use standardized encounter forms to
efficiently
document
all
seven
required
implement
often poorly understood.
elements of the WMV.
presented practice
 Physicians have
4.
Use
proper
coding/billing
recommendations.
knowledge and
documentation
to
ensure
appropriate
performance gaps related
reimbursement of the WMV.
to many of the WMV
elements.
 Cancer screening, such as
mammography and Pap
tests are underutilized
among women aged 65 and
66.
 The required elements of
the WMV have been
updated since 2005.
Faculty Instructional Goals
Faculty play a vital role in assisting the AAFP to achieve its mission by providing high-quality,
innovative education for physicians, residents and medical students that will encompass the art,
science, evidence and socio-economics of family medicine and to support the pursuit of lifelong
learning. By achieving the instructional goals provided, faculty will facilitate the application of
new knowledge and skills gained by learners to practice, so that they may optimize care provided
to their patients.
 Provide up to 3 evidence-based recommended practice changes that can be immediately
implemented, at the conclusion of the session; including SORT taxonomy & reference
citations
 Facilitate learner engagement during the session
 Address related practice barriers to foster optimal patient management
 Provide recommended journal resources and tools, during the session, from the American
Family Physician (AFP), Family Practice Management (FPM), and Familydoctor.org
©AAFP. All rights reserved. This document contains confidential and/or proprietary information which may not be
reproduced or transmitted without the express written consent of AAFP.
Last modified 11-4-14
2015 Scientific Assembly Needs Assessment





patient resources; those listed in the References section below are a good place to start
o Visit http://www.aafp.org/journals for additional resources
o Visit http://familydoctor.org for patient eduction and resources
Provide strategies for identifying patients who are nearing eligibility for a welcome to
medicare visit (WMV), and systematically schedule the appointments.
Provide recommendations and resources for providing patient education materials
promoting the WMV to eligible patients.
Provide recommendations and resources for standardized encounter forms and other
appropriate documentation to efficiently document all seven required elements of the
WMV.
Provide recommendations to ensure that all elements of the WMV are executed,
including relevant current screening guidelines and recommendations.
Provide recommendations for proper coding/billing documentation to ensure appropriate
reimbursement of the WMV.
Needs Assessment:
In a recent survey, 90% of members of the American Academy of Family Physicians (AAFP)
report having a “Participating” status with Medicare, and 25% of respondents’ patients are
covered by Medicare.1 Outpatient medicare visits to a primary care physician made up
approximately 21.9% of all outpatient visits in 2010.2 While 47.3% of those visits were for
managing chronic conditions, only 13.3% were for preventive care visits.2 Each year, more than
2 million seniors become eligible for Medicare, but only about 100,000 Welcome to Medicare
Visit (WMV), also known as the Initial Preventive Physical Examination (IPPE), are billed to
the federal government.3 The WMV was updated in 2011 and requires several key components,
including medical and surgical history; risk factors for depression or other mood disorders;
functional ability and safety; physical exam to include height, weight, BMI, blood pressure,
visual acuity, and other relevant elements; end-of-life planning; education, counseling, and
referral based on issues identified; orientation to available preventive services.4 However, data
from a recent American Academy of Family Physicians (AAFP) CME Needs Assessment survey
indicate that family physicians have statistically significant and meaningful gaps in the medical
skill necessary to provide optimal management of geriatric assessment, patient education,
polypharmacy in the elderly, adult hypertension, depression/suicide/mood disorders,
cardiovascular physical exam, musculoskeletal exam techniques, and eye exams.5
Older adults may not be aware of preventive services available to them, and that these services
are covered by Medicare; thereby leading to health disparities, particularly by the underserved.6
Often, older adults may rely on their physicians to recommend or refer them for the services yet
health care providers may not remember or take the time to promote their use.6 Additionally,
mammography and Pap tests among women aged 65 and 66 years are frequently underutilized,
despite being covered through the WMV.7
Nearly 12% of people who enroll in Medicare at age 65 wait more than two years before making
use of the WMV wellness visit; which is reflective of patterns of use before enrollment – i.e.
©AAFP. All rights reserved. This document contains confidential and/or proprietary information which may not be
reproduced or transmitted without the express written consent of AAFP.
Last modified 11-4-14
2015 Scientific Assembly Needs Assessment
people who sought preventive care before turning 65 continued to do so after enrolling in
Medicare.8
Even though a small percentage of older adults take advantage of preventive care visits such as
WMV and the annual wellness visit (AWV), providing preventive care visits such as WMV and
the annual wellness visit (AWV) has caused an increased burden to the entire medical team.9 It
can be challenging and frustrating for physicians to provide and document the extensive list of
required elements in a 20 or 30 minute visit. In addition, misconceptions about the purpose and
coverage requirements of the AWV, the Welcome to Medicare visit, and other Medicare
wellness exams are common among both patients and providers. It is not uncommon for
Medicare wellness visits to lack proper documentation.9
Physicians can improve the care they provide to patients with regard to Medicare preventive care
visits by taking a systematic team-based approach to these services, while being appropriately
compensated.9-15 Physicians may want to consider the Adult Clinical Preventive Care guidelines
from the University of Michigan Health System to help them establish standards of care in their
practice.16
Resources: Evidence-Based Practice Recommendations/Guidelines/Performance Measures
 Making Medicare annual wellness visits work in practice9
 What you need to know about the Medicare preventive services expansion14
 Answers to your questions about medicare annual wellness visits15
 Thinking on paper: documenting decision making10
 Exam documentation: charting within the guidelines11
 A nursing home documentation tool for more efficient visits12
 Documenting and coding preventive visits: a physicians's perspective13
 How to Conduct a “Welcome to Medicare” Visit17
 Family Practice Management. Medicare Annual Wellness Visits (various forms)18
 University of Michigan Health System Adult clinical preventive care16
 Preventive Care for Seniors (patient education)19
 Health Care Reform: What It Means for You (patient education)20
 The Affordable Care Act and Medicare: What to Expect (patient education)21
 Health Insurance: Understanding Your Health Plan's Rules (patient education)22
References
1.
2.
3.
American Academy of Family Physicians (AAFP). Practice Profile II. unpublished:
American Academy of Family Physicians; 2009.
Centers for Disease Control and Prevention (CDC). National Ambulatory Medical Care
Survey. In: Ambulatory and Hospital Care Statistics Branch, ed2010.
Fiegle C. Medicare's missed checkups: Few seniors get wellness exam. amednews.com.
2011. http://www.amednews.com/article/20110502/government/305029954/4/. Accessed
June 2014.
©AAFP. All rights reserved. This document contains confidential and/or proprietary information which may not be
reproduced or transmitted without the express written consent of AAFP.
Last modified 11-4-14
2015 Scientific Assembly Needs Assessment
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Centers for Medicare and Medicaid Services. The ABCs of Providing the Initial
Preventive Physical Examination (IPPE). In: Network TML, ed. ICN 006904 ed2014:8.
AAFP. 2012 CME Needs Assessment: Clinical Topics. American Academy of Family
Physicians; 2012.
Centers for Disease Control and Prevention. Enhancing Use of Clinical Preventive
Services Among Older Adults. In: Administration on Aging, Agency for Healthcare
Research and Quality, Centers for Medicare and Medicaid Services, eds. Washington
DC: AARP; 2011.
Salloum RG, Jensen GA, Biddle AK. The "Welcome to Medicare" visit: a missed
opportunity for cancer screening among women? Journal of women's health (2002). Jan
2013;22(1):19-25.
Sloan FA, Acquah KF, Lee PP, Sangvai DG. Despite 'welcome to Medicare' benefit, one
in eight enrollees delay first use of part B services for at least two years. Health Aff
(Millwood). Jun 2012;31(6):1260-1268.
Cuenca AE. Making Medicare annual wellness visits work in practice. Family practice
management. Sep-Oct 2012;19(5):11-16.
Edsall RL, Moore KJ. Thinking on paper: documenting decision making. Family practice
management. Jul-Aug 2010;17(4):10-15.
Moore KJ. Exam documentation: charting within the guidelines. Family practice
management. May-Jun 2010;17(3):24-29.
Kalish VB, Burns OB, Unwin BK. A nursing home documentation tool for more efficient
visits. Family practice management. Mar-Apr 2012;19(2):19-21.
Owolabi T, Simpson I. Documenting and coding preventive visits: a physicians's
perspective. Family practice management. Jul-Aug 2012;19(4):12-16.
Hughes C. What you need to know about the Medicare preventive services expansion.
Family practice management. Jan-Feb 2011;18(1):22-25.
Hughes C. Answers to your questions about medicare annual wellness visits. Family
practice management. Mar-Apr 2011;18(2):13-15.
National Guideline Clearinghouse. Adult clinical preventive care. 2011;
http://www.guideline.gov/content.aspx?id=35253&search=medicare+wellness+visit.
Accessed 6/10/2014.
Card RO. How to conduct a "welcome to Medicare" visit. Family practice management.
Apr 2005;12(4):27-29, 31-22.
Family Practice Management. Medicare Annual Wellness Visits. FPM Tools 2014;
http://www.aafp.org/fpm/topicModules/viewTopicModule.htm?topicModuleId=76.
Accessed November, 2014.
FamilyDoctor.org. Preventive Care for Seniors. 2012;
http://familydoctor.org/familydoctor/en/seniors/staying-healthy/preventive-care-forseniors.html. Accessed June, 2014.
FamilyDoctor.org. Health Care Reform: What It Means for You. 2010;
http://familydoctor.org/familydoctor/en/healthcare-management/insurance-bills/healthcare-reform-what-it-means-for-you.html. Accessed June, 2014.
FamilyDoctor.org. The Affordable Care Act and Medicare: What to Expect. 2010;
http://familydoctor.org/familydoctor/en/healthcare-management/insurance-bills/newhealth-care-law-and-medicare-what-to-expect.html. Accessed June, 2014.
©AAFP. All rights reserved. This document contains confidential and/or proprietary information which may not be
reproduced or transmitted without the express written consent of AAFP.
Last modified 11-4-14
2015 Scientific Assembly Needs Assessment
22.
FamilyDoctor.org. Health Insurance: Understanding Your Health Plan's Rules. 2002;
http://familydoctor.org/familydoctor/en/healthcare-management/insurance-bills/healthinsurance-understanding-your-health-plans-rules.html. Accessed June, 2014.
©AAFP. All rights reserved. This document contains confidential and/or proprietary information which may not be
reproduced or transmitted without the express written consent of AAFP.
Last modified 11-4-14

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