By Shon Wettstein, Vice President, Business Development, Intalere
Physician groups that truly want to succeed in the new pay-for-performance era must transform themselves, focusing on a directed initiative to move to a population health management approach.
In doing so, they should explore the pros and cons of an aggressive health risk assessment (HRA) program, namely using the Medicare Annual Wellness Visit (AWV) as a tool for assessing the risk of an entire population of patients.
Because the AWV is a billable event, many physicians are unwilling to take on this tool because of the “cost” it adds to the expense side. However, evidence shows the “cost” is quickly outweighed by the “benefit” realized by reduced ER and hospital stays, less chronic disease costs, and lower medication and ancillary costs. The model of using the Medicare AWV as a vehicle of assessment can be a powerful tool in patient management and revenue generation.
One thing to keep in mind in this discussion – primary care doctors today are overwhelmed by time constraints. For this reason, a method of engaging patients proactively without using physician time or resources must be at the core of any assessment program. Merely putting a new template in your EHR won’t cut it, instead you need an affirmative program of patient engagement.
In terms of documentation, it is critical that the vehicle used to document the AWV correctly (to the absolute standards of the Centers for Medicare and Medicaid Services (CMS)) is also effective for the physician’s use. This document must be clear and succinct and must include a Risk Factor analysis, 5-year Plan and Personal Health Advice for the patient.
The other key piece of the puzzle is data, and the ability to access population data. If possible, the goal should be an integrated data analytics system that gives care coordination teams access to claims data, EHR data and prospective risk assessment data.
What can it mean to a typical practice? A practice with 1,000 Medicare patients can generally expect 70% of their patients for annual wellness visits. That can mean an average of an additional $200,000 in generated revenue.
Emphasizing proactive care to keep patients healthy, and improving communication and coordination among patients, doctors and other healthcare providers, is a foundational piece to the healthcare model of the future and the ability to provide sustainable, lower-cost, higher-quality care. The AWV can be the vehicle to drive that model.
To learn more, read our full article The Annual Wellness Visit Helps Maximize Revenue and Care Quality.