What is the Annual Wellness Visit and why is it needed for my patients?

By Dr. Beth Hodges

As a primary care physician who has been doing Annual Wellness Visits (AWV’s) since 2014, I have often heard this question from my patients and sometimes from other providers.

AWV’s began as an experiment by Medicare (CMS) to see if encouraging providers and patients to participate in more preventative health measures would improve the health of individuals, identify and avoid potential problems in the future, and subsequently cut the cost of care. Remember the old saying, “An ounce of prevention is worth a pound of cure?”

As experiments go, it was wildly successful, saving millions of dollars in expected future costs for even the small group of individuals originally enrolled.

How is this possible? An AWV looks for preventable adverse outcomes and provides a platform on which to address them. Let me show you some examples (these are not actual names of patients):

1. Mrs. Smith is gradually developing problems with her balance.

1. Possible outcome: nothing is done and Mrs. Smith falls going down her front steps, fractures her hip, which then requires a hospital stay, surgery, and then therapy. Mrs. Smith never regains full function and ends up in an assisted living facility because she can no longer live independently.
2. Alternative outcome: Mrs. Smith’s balance is noted at her AWV and she is sent to physical therapy, correcting weakness in her hip muscles and avoids the fall.

2. Mr. Jones has not received the updated shingles vaccine. He has several chronic medical issues, so his visits to the physician are very full and vaccination is not noted.

1. Possible outcome: Mr. Jones does not get his vaccination. He contracts shingles of his left eye (optic nerve) and subsequently loses vision.
2. Alternative outcome: Mr. Jones is advised and receives a shingles vaccine at his AWV and has no further problems.

3. Mrs. Johnson lives alone since the death of her husband. Her children live out of state. Mrs. Johnson has lost contact with her previous circle of friends, as she had been caring for her ill spouse around the clock for several years. She has no hobbies, and the pandemic has stopped her attendance at in-person church services for the time being.

1. Possible outcome: No one, including Mrs. Johnson, realizes she has developed a clinical depression. Her health declines as she becomes very inactive and starts sleeping 18 hours each day. Eventually, her family intervenes, but by that point she must be moved into a senior living facility, because she no longer has the strength to care for herself.
2. Alternative outcome: Mrs. Johnson’s clinical depression is caught early, at her AWV. Her physician prescribes medication and encourages her to join an online support group for widows. She begins to socialize more and sleep less. Her mental and physical health stabilizes and she lives a happy, independent life for many more years.

These are just a few of the issues addressed in an AWV. The visit can be very helpful in ferreting out potential problems and stopping them from developing. An AWV includes measurements of height, weight, and blood pressure, reviewing what specialists a patient sees, screening for memory loss, screening for depression, a review of recommended tests (such as mammogram, colon cancer screening, etc.), fall risk review, immunization review, and various other screenings.

Who can perform an AWV? Usually, most of the visit is performed with a trained member of the clinical staff. This could be a nurse, a medical assistant, a health coach, or even a dietician.

How long does an AWV take? Sometimes, a good portion of the information for an AWV is organized ahead of the patient’s visit (such as determining whether immunizations or preventative screenings are needed, etc.) If this is the case, an AWV can take as little as 15-20 minutes, once a year. Encourage patients to be prepared for the AWV by bringing a list of specialist providers, current medications, and previous immunizations, especially if he or she received immunizations at a pharmacy or another provider office.

Dr. Beth Hodges is a family practice and palliative care/hospice physician in Asheboro, N.C., as well as a part-time medical director for HealthTeam Advantage.