Boston, MA -- In 2011, through the Affordable Care Act, Medicare introduced the Annual Wellness Visit (AWV), the first annual health check-up offered by Medicare at no cost to patients. The visits are intended to encourage evidence-based preventive care and mitigate health risks in aging patients. To date, there has been little data about how these visits have been used over time across the country. To examine national trends and patterns of AWV use, researchers at Brigham and Women's Hospital analyzed billing data of a random 20 percent sample of Medicare beneficiaries and examined visit rates across categories like race, income, and the type of health system where patients got their primary care. The findings are published online April 19, 2017 in JAMA.
Researchers found that AWV use increased from 7.5 percent to 15.6 percent between 2011 and 2014. In some regions around the country, only about three percent of eligible patients received an AWV visit, compared to 34 percent in other areas. White urban residents, and those from higher-income areas, were more likely to receive an AWV, as were patients who received an AWV in the previous year, or belonged to an Accountable Care Organization, a group of providers who collaborate to provide coordinated care for Medicare patients.
"Patients affiliated with an ACO were more likely to get AWVs, while a small percentage of primary care doctors were offering a disproportionately large share of these visits," stated Ishani Ganguli, MD, MPH, physician in the Division of General Internal Medicine and Primary Care at Brigham and Women's Hospital and instructor in medicine at Harvard Medical School. "Our findings suggest that AWV use is probably driven more by practices and health systems deciding to offer the visit, than by patients requesting it."
Additionally, researchers found that patients reported out-of-pocket costs when an AWV was concurrently billed with a problem-based visit. "In nearly half of these visits, doctors billed for discussing an acute medical issue in addition to preventive care, likely resulting in patients receiving an unexpected bill," Ganguli said.
Researchers note that claims data could not show how often AWVs were performed by non-physicians under physician supervision, while the extent to which AWVs represent delivery of additional visits versus substitution for other visits remains unclear.
"More research is needed on whether AWVs increase use of preventive care or mitigate health risks," Ganguli said.
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The study was funded by a grant from the National Institute on Aging of the National Institutes of Health (P01 AG032952).
Paper cited: Ganguli, MD, MPH, et al. "National trends in use of the U.S. Medicare Annual Wellness visit, 2011-2014," DOI: 10.1001/jama.2017.4342
Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. BWH has more than 4.2 million annual patient visits and nearly 46,000 inpatient stays, is the largest birthing center in Massachusetts and employs nearly 16,000 people. The Brigham's medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in patient care, quality improvement and patient safety initiatives, and its dedication to research, innovation, community engagement and educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Brigham Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, more than 3,000 researchers, including physician-investigators and renowned biomedical scientists and faculty supported by nearly $666 million in funding. For the last 25 years, BWH ranked second in research funding from the National Institutes of Health (NIH) among independent hospitals. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative as well as the TIMI Study Group, one of the premier cardiovascular clinical trials groups. For more information, resources and to follow us on social media, please visit BWH's online newsroom.
Journal
JAMA