You’ve barely had time to process the new material in the 2012 Physician Fee Schedule final rule, but some of your peers are already blasting CMS for making annual wellness visits (AWVs) tougher to bill. The new component to the AWV is called the health risk assessment (HRA), and it basically requires your patients to complete a comprehensive data sheet as part of the wellness visit.
Problem is, the AWV was already confusing to patients because it’s too restricting, includes no physical exam and is different from what patients and providers are used to as far as a “physical,” one angry caller told CMS during the agency’s latest open door call Nov. 7.
Oh, and the AWV doesn’t pay well enough either, she said. CMS officials were diplomatic, and said they were bound by the Affordable Care Act to incorporate HRAs in some form into the wellness visit.
Right now, primary care physicians are divided into two camps on the AWV, believes Glen Stream, MD, president of the American Academy of Family Physicians.
The first group feels the same way as the caller, that the AWV is more trouble than it’s worth and is too cumbersome to be realistically billed en masse. The second group – a minority in Dr. Stream’s opinion – is determined to make the AWV work, and have adjusted their entire office workflow to make the service time-efficient and profitable, while complying with the rulemaking as much as possible. These practices call patients and ask them to bring in lists of all providers and suppliers that treat them, and a list of their meds, and have non-physician staff handle most of the visit. The doctor steps in for a few minutes at the end to review the work and issue a personalized prevention plan and any referrals, say to a dietician or nutritionist.
“I would look at the [AWV] like any other innovation or change,” Dr. Stream says. “Some people are going to jump on the bandwagon early on, like those who got into EHRs in the last decade, and were willing to go through the pain of dealing with systems not ready for prime time. Then they wind up showing the rest of us how to make it work.”