Health Take-Away: Wellness visits improve quality of care for Medicare patients

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As more and more Medicare patients take advantage of the free annual wellness visits and personalized prevention plans offered under the Affordable Care Act (ACA), older Americans are discovering a highly effective pathway to better physical and mental health. With their care now managed increasingly by close-working teams of health professionals under the direction of their primary care physicians, patients using the benefit are reporting they're healthier and have a much clearer sense of how to stay that way.

Medicare began offering the no-cost annual wellness visit benefit in 2011 as a way to proactively address risk factors and improve the health of Americans 65 and older. Not to be confused with an actual physical performed by a primary care doctor, wellness visits are once-a-year sessions at which patients are interviewed in detail - either by their doctor or a nurse practitioner (NP), physician assistant (PA) or a nurse affiliated with the practice — about their physical, cognitive and emotional health.

Other than getting weighed and having their blood pressure and other vital signs taken, the visit is essentially an interview and guidance session. It's a comprehensive risk assessment, updated annually, that looks at medical history, current conditions, current medications, fall risk and other home safety issues, physical functional ability, the level of stress in a patient's daily life, and a wide range of lifestyle factors such as diet, exercise and alcohol and tobacco use. Screenings for depression and cognitive impairment, including Alzheimer's and other forms of dementia, may also be ordered as part of the annual assessment. Finally, the visits also provide an opportunity to do advanced care planning, to

make decisions about the care you would want to receive if at some point you become unable to speak for yourself.

Once the assessment is complete, the patient receives a personalized prevention plan detailing what was discussed and providing specific recommendations for follow-up screenings, immunizations and vaccines, general health maintenance, personal safety measures and various health services the patient needs to schedule during the coming weeks and months. Those recommended services may include appointments with medical specialists, nutrition counselors, mental health therapists and others who can help improve the patient's health. The plan becomes the patient's personal health checklist until the next annual wellness visit.

Patients new to Medicare must schedule an initial Welcome to Medicare visit with their doctor's office before the annual wellness visits can begin. That free introductory visit involves the same comprehensive risk assessment, but also includes a physical examination.

One of the great advantages of annual wellness visits is that they allow primary care physicians to create a team-based approach to patient care. Doctors who once worked largely on their own to manage the day-to-day, year-to-year health of their patients now are able to share some of that work with NPs, PAs and other qualified health professionals associated with the practice. So not only is the patient receiving a deeper degree of expert attention for whatever time it takes to do the assessments, but the physicians themselves are able to focus fully on the active care of their patients. They're freed up and better informed to provide a higher, more personally attentive level of care to each patient.

Since Medicare introduced the free wellness visits benefit seven years ago, the number of physician practices offering the visits and the number of patients signing up for them has grown steadily. But there's a still a large number of patients who either are unaware of the benefit or slow to take advantage of it. If you're 65 or older or know someone who is, it's important to know that these annual wellness visits truly can become the center-point for staying healthy in your later years. For more information on the free Medicare annual wellness visit or to schedule one, ask your primary care physician or call his or her office.

Daniel Doyle, M.D., is chief of staff at Berkshire Medical Center.


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