The annual checkup is an almost distinctly American ritual. It’s the single most common reason we see our doctors, despite persistent controversy about it (these pro and con articles sum this up well) and thin evidence about whether it does any good.
Prompted by the Affordable Care Act, Medicare followed the lead of private insurers in 2011 and began paying in full for a yearly checkup. This so-called annual wellness visit was designed specifically to address health risks and encourage evidence-based preventive care in aging adults.
The visit is quite prescriptive, requiring a doctor or other clinician to run through a lengthy list of tasks like screening for dementia and depression, discussing care preferences at the end of life, and asking patients if they can cook and clean independently and are otherwise safe at home. Little is required in the way of a physical exam beyond checking vision, weight, and blood pressure.
Medicare made a hefty investment in this new benefit — by my calculation, the visit fees alone would have come to $5 billion in 2014 if all eligible patients had gotten the visit. Starting this year, Medicare will even throw in a $25 reward to certain patients for making this visit. The American Health Care Act, despite its many catastrophic features, doesn’t touch the ACA’s enhanced Medicare benefits, so the annual wellness visit is likely here to stay.
Yet early research showed that it had a rocky start. At first, many people didn’t know they were eligible, and local adoption has had mixed results. My colleagues and I wondered how these visits were playing out across the country. Using national Medicare billing data, we looked at the adoption of the annual wellness visit from its start in 2011 through 2014, the last year for which data were available. Our results appear in the June 6 edition of the Journal of the American Medical Association.
We discovered that only 8 percent of Americans eligible for the annual wellness visit had one in its first year of operation; that rose to 16 percent by 2014. We saw signs that these rates were driven more by doctors or medical practices offering the visits than by patients asking for them. For example, the chance of getting a wellness visit varied tremendously based on geography — from 3 percent in San Angelo, Texas, to 34 percent in Appleton, Wis. Patients who belonged to an accountable care organization — a group of clinicians who work together to provide coordinated care for Medicare patients — were more likely to get the visits. Nearly half of all annual wellness visits were performed by just 10 percent of the doctors who provided them. We think, and are now trying to confirm, that the doctors and practices that do more of these elaborate visits have had to hire a dedicated nurse or invest in special work processes to make them happen.
Women were a bit more likely to get their visit — 17 percent of eligible women in 2014 compared to 15 percent of men — as were white urban-dwellers who lived in more educated and affluent areas. The single biggest predictor of getting an annual wellness visit in 2014 was having gotten one the year before — 53 percent of patients who had gotten the visit in 2013 followed suit the next year, compared to 10 percent of those who hadn’t.
We also found that many patients may be getting surprise medical bills for these seemingly free checkups. If other problems come up during the wellness visit, like knee pain or a cough, clinicians are allowed to bill for evaluating this problem as well. It turns out this happened in 44 percent of the visits in 2014, validating patient concerns about what should have been free visits, and suggesting that practices need to do a better job telling patients what to expect, ideally well before the visit has started.
I became interested in the annual wellness visit in part because, as a primary care physician, I perform them; about two dozen so far. And I must say that I am conflicted on the subject. I’ve found that the visit can provide a useful space and time to talk with patients about difficult yet important topics that are otherwise crowded out by more urgent issues, such as planning for end of life, and to ensure they are up to date on their colonoscopies, shingles vaccines, and the like. More broadly, these visits represent a well-meaning and needed effort to shunt resources toward primary care; to make an investment, as countries like the United Kingdom have done, in the foundation of health care.
But the reality of the visit can fall short of its intentions — like the woman who sheepishly answered that she wasn’t independent at home because she had hired a cleaning service. The results in our JAMA paper tell us that the individuals getting the visits are more often those who are already well-connected to the health care system rather than the historically underserved, including certain minorities and Medicaid-eligible patients, who may be more likely to benefit from them. As we come up with more sophisticated ways to track aspects of patients’ preventive care needs, an in-person visit dedicated to this purpose starts to feel obsolete.
Is the annual wellness visit the best use of my limited time with my patients? While elements of it are based on solid evidence, the visit itself must answer to the same question that continues to swirl around the ubiquitous original annual checkup: Does it have any measurable impact on the outcomes we care about, like keeping patients healthy and out of the hospital? That is the question we’re hoping to answer next.
Ishani Ganguli, MD, is an instructor of medicine at Harvard Medical School and a primary care physician at Brigham and Women’s Hospital.
I just had my second or third wellness check yesterday. I think I won’t do it again. Without going into the particulars, my conclusion is that it is a useless waste of my time and the clinic staff’s as well to go through this charade. Moreover it is- with no intent on anyone’s part- humiliating by its very nature.
I just recieved my annual physical from my physician of 30 years who was forced to join a Healthcare System. The receptionist told me to come back in six month even though I am in excellent health so I asked her to go into their new computer system and look up my prior records as I always went once a year and in excellent health so she did not book one.
10 minutes after I got home after driving through a snowstorm I get a call from the Hellcare System’s scheduling department. I knew what they were calling about a Wellness Visit since the receptionist tipped me off. They called me five days later again on Christmas Eve. I didn’t answer and won’t. The greedy corporatation (and that is what it is now under the guise of medicine) want their Medicare dollars from the government. Another healthcare system in my state was just fined and had to pay $10 million dollars for ripping off Medicare.
They have ruined the medical field and the doctors spend too much of their time running around filling out forms and inputting information in the computer. I filled out so many forms at my visit it was like buying a house.
THESE WELLNESS VISITS ARE OPTIONAL ACCORDING TO MEDCARE.GOV
Do not let these healthcare systems harass you into one (unless one is needed) The more people who opt out the better.
Doctors want you to come to them every year for a physical. Then when you turn 65 get on Medicare They just talk to you. Ask a bunch of questions that of their business.What a joke!!!
It’s an absolute waste of time. Many of procedures and tests are conducted with other providers. It cost unnecessary money. Someone’s getting paid. The doctor? Referrals? Drug companies? Doctors don’t do this for free.
Lastly, it’s an insult. At age 73 it’s no one’s business how much alcohol I drink. It’s no one business what I eat or how much. I’m going to lie about all of it so that you’ll stay off my back. Lastly, if I’m going senile, leave me alone about it. I just might enjoy sitting here smoking weed, listening to Hootie and the Blowfish with a flower pot on my head.
I miss the annual physical when my doctor examines me. I want him to look at my eyes, ears, moles and listen to my heart etc. We also sit and talk about any concerns. This is what a wellness exam should be. Not filling out a questionaire and talking. I consider this new deal a waste of my time and a waste of my excellent doctor’s time. Who thought this whole thing up. What a disappointment!
In the time the doctor takes to “discuss” the patient’s health, he or she could be giving a normal health exam along with lab work. The underlying motivation for this trendily-named “wellness” visit appears to be cost savings on lab and ecg work. Basically “all talk and no action.”
I had a wellness exam in April of this year. During the exam the doctor listened to my breathing and my beating heart. He did a blood scan for HDL, LDL, and triglycerides. I showed glucose reading I took at home that indicated my glucose was elevated so he included an A1C in the blood scan. otherwise he would not have looked at my A1C. If I did not show him my glucose data, how would he have known that my A1C was high? The exam did not include a PSA in the blood scan. So how is he to know what my PSA is. In my opinion the Wellness exam does little more than tell the doctor that I am breathing and that my heart is beating. Who is Medicare trying to fool by this waste of time and effort. What a farse.
I hope CMS are getting these comments. If this is such an unpopular program, why are they continuing it? It is my understanding this is a voluntary program. No one has to have a wellness visit done if they don’t want to. I can see the value of it, but I don’t think these evaluations need to be done by a doctor/NP. They could be done by nurses who are trained to do assessements and pick up on things that can cause falls and other life changing events. If anyone knows who runs this program, please let me know. This has been going on for 2 years and I have not see many positive comments that show that this is a worthwhile program…so let’s do something to change the program. My email is [email protected]
Wellness visits are a scam and I was basically forced to do it last year. I refused it this year and will continue to do so. Remember this. IT IS YOUR BODY NOT THE GOVERNMENTS OR YOUR INS. COMPANY. The Dr.’s are paid more then for a regular visit, that is why the push to get them done.
Don’t for one minute think these “wellness” exams are free. Someone is making money off of this. As a reasonably intelligent adult, I know my medical issues and tend to them with the appropriate specialist. I refuse to do double duty with my primary care MD. Let him fire me if he will. I am undergoing no more prodding, poking, etc., than is absolutely necessary. Plus, it’s nobody’s damn business if I trip over my dog and fall flat on my face. Nor is it anyone’s business how much I drink a week or if I plan to become pregnant (I’m 72 for God’s sake).
I accompanied my husband to his AWV and was appalled by how condescending and demeaning it was esp since we both are well educated on our health issues. There was nothing new we learned. However we could see how it would benefit those who don’t bother to read anything about health, are afraid to make own decisions, and so on. We now know why his primary care provider referred him to the AWV – he did not want to be bothered with routine exams and questions and yet the clinic wanted to be paid.
Wellness visits are a scam and I was basically forced to do it last year. I refused it this year and will continue to do so. Remember this. IT IS YOUR BODY NOT THE GOVERNMENTS OR YOUR INS. COMPANY. The Dr.’s are paid more then for a regular visit, that is why the push to get them done.