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Any you primary care providers doing Medicare "Wellness Exams" ?

Home Practice Management Any you primary care providers doing Medicare "Wellness Exams" ?

  • Avatar Ykcor 
    Participant
    Status: Physician
    Posts: 86
    Joined: 01/02/2019

    Small regional company came by office today with a proposal for doing the annual Medicare Wellness assessments which is reimbursed around $140 for initial and $100 for subsequent exams by CMS. There would a 65/35 split of revenue (they get the 65). Their projection, based on the number of elderly patients in our five person IM group, is that we would bring in additional $350,000 annually. I am suspicious and reluctant to sign on as I’ve seen too many of these too good to be true deals blow up. I would be more inclined to hire a RN to do these exams within our clinic and keep outside interests from access to our patients and their medical info.

    Any thoughts?

    #213750 Reply
    Avatar GPGP 
    Participant
    Status: Physician
    Posts: 175
    Joined: 05/02/2017

    I do AWV’s as a combo visit – scheduled when they are due for followup for another issue. So, a 99213 or 99214 -25 and the G0438 or whatever.   I’ve only done AWV’s on about 35% of my panel in the last year, despite being on of the better ones in my group.  You hit all your quality metrics, screenings, can code for HCC’s, and it’s good wrvu’s.   If an outside company does them, do they send someone to your patient’s home?  A big barrier to a standalone wellness visit is that patients don’t like showing up for their “free” visit, and then being told that addressing new/chronic problems, refills, labs, etc, is a separate fee & separate E&M.

     

    If you could get a process going,  a dedicated MA, LPN, or RN who just added on AWV’s to patients in the office could be very worthwhile.  The visits are very predictable – health risk assessment you can 90% predict if you know your patient, the screening you can predict from the chart/EMR.

    #213753 Reply
    Liked by jfoxcpacfp
    Lordosis Lordosis 
    Participant
    Status: Physician
    Posts: 1654
    Joined: 02/11/2019

    We do them on request from the patients. However most of the time they get pissed because they want everything done under the free visit. Some of our local insurance companies give discounts or gift cards to patients who do them. Those are the majority of the people who do. Every once in a great while you have a senior with no medical problems. The visit is appropriate in that case.
    It seems like more hassle then it is worth but if you have a dedicated nurse it could work out.
    I would be suspicious of a third party

    “Never let your sense of morals prevent you from doing what is right.”

    #213773 Reply
    Avatar SLC OB 
    Participant
    Status: Physician
    Posts: 531
    Joined: 06/23/2018
    Earnest refinancing bonus

    I know our primary care docs are doing them with RN support and then Chronic care nurse navigation helps too.  The RN does most of the visit.

    #213782 Reply
    Avatar fasteddie911 
    Participant
    Status: Physician
    Posts: 300
    Joined: 05/31/2016

    I may be in the minority on this one but something just doesn’t feel right about an outside company coming in and using your patients to make a buck, then giving you a cut.  It seems like a savvy get-rich-quick individual conjured up this business idea/scheme and while not wrong or illegal (I think), it just doesn’t sit well with me that things like this happen.

    #213829 Reply
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 2851
    Joined: 09/18/2018

    65/35. Your group makes $350k.
    Hmmm, chewing on that seems like you might be leaving $650k on the table if you want to promote it.
    Even if you spent $200 for marketing and a nurse might add $800k.
    The practice difficulties might be worth it. No sure your “partners” will help with that.

    #213908 Reply
    Avatar burritos 
    Participant
    Status: Physician
    Posts: 456
    Joined: 04/23/2018

    Is there proof that wellness exams actually lead to wellness?

    When someone comes into the urgent care for a “full check up” because they suddenly want one, the exam typically lasts 5 minutes with a lipid panel/A1C and a follow up letter to exercise more, eat more greens, and less processed carbs. Depending on their age, the might get a mammogram and a referral for a colonoscopy.

    #213928 Reply
    Avatar GPGP 
    Participant
    Status: Physician
    Posts: 175
    Joined: 05/02/2017

    I don’t think there is proof that wellness exams do anything for patients. However it is dedicated time to discuss all kinds of health behaviors in a way I might not otherwise be able to do.

    Cynically, it behooves me to do them because I get time to do all the ACO and quality metrics and etc and generate some wrvu / money too. As we move towards “value based care” however those perverse incentives and unintended consequences will work out. …

    99214 + awv in 30 minutes (double slot) usually only takes me 20 minutes, so it’s worth it. One of my peers scans his schedule and adds on a few to patients already coming in on his regular schedule.

    #213931 Reply

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