Medical Care

Despite Potential for More Money, Doctors Aren't Uniformly Adopting Medicare Wellness Visits

Medical practices that adopted the annual Medicare “wellness visit” for patients saw increased revenue, and their patients were also likelier to stay with them for any given three-year period, researchers say.

But other medical offices, most of which care for the underserved, had lower rates of adopting the practice of the wellness visit – a yearly checkup for Medicare beneficiaries at no cost. The wellness visit was introduced in 2011 as part of the Affordable Care Act.

The new study by investigators from Brigham and Women’s Hospital in Boston examines why some practices have adopted these visits while others have not. Their results are published in Health Affairs.

“Practices that adopted annual wellness visits saw increased revenue, yet half of all practices are missing out on these benefits–particularly practices that disproportionately care for medically and socially complex patients,” wrote author Ishani Ganguli, MD, MPH, a researcher and physician in the Division of General Internal Medicine and Primary Care. “For these gains to be shared more equitably, policy makers might encourage the use of annual wellness visits through mechanisms adapted to underserved populations and the practices that serve them.”

Medicare’s annual wellness visit is designed to promote evidence-based preventive care, including screening for depression and risk of falls. To better understand the ability and motivations of practices to adopt these wellness visits, the researchers examined national Medicare billing data collected from 2008 to 2015 for a randomly selected sample of Medicare beneficiaries. They examined visit rates, practice revenue and the population of patients served by each practice.

The research team found that roughly half (51.2 percent) of practices provided no annual wellness visits in 2015, while 23.1 percent provided these visits to at least a quarter of their eligible beneficiaries. Visit rates were lower in practices that cared for the historically underserved, including racial minorities and those living in more rural settings. Practices that adopted the annual wellness visit generated greater primary care visit revenue, saw greater stability of patient assignment, and brought in patients who were slightly healthier, on average.

The team also found that small and large practices had similar rates of adoption of the policy.

“What small practices lack in resources, they may make up for an agility,” wrote Ganguli. “Adoption may require no more than a single, determined clinician.”

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