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Medicare Wellness Visits

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Medicare Wellness Visits & Welcome to Medicare Visits (IPPE): A Primer July 26, 2011 Outline IPPE/MWV Background Eligibility Components of IPPE/MWV Proposed Medical ... – PowerPoint PPT presentation

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Title: Medicare Wellness Visits


1
Medicare Wellness Visits Welcome to Medicare
Visits (IPPE) A Primer
  • July 26, 2011

2
Outline
  • IPPE/MWV Background
  • Eligibility
  • Components of IPPE/MWV
  • Proposed Medical Wellness Visit checklist and
    smart phrases
  • QI Project
  • Coding

3
Background
  • Until recently, Medicare did not pay for
    preventive services
  • Welcome to Medicare visit initiated January 1,
    2005
  • aka Initial Preventive Physical Examination
    (IPPE)
  • One time benefit within the first 12 months of
    enrolling into Medicare
  • The Patient Protection and Affordable Care Act of
    2010 added a new annual benefit for preventative
    care
  • Annual Wellness Visit (MWV or AWV)
  • Benefit started January 1, 2011

4
IPPE/MVW What Are They?
  • These are not physical exams
  • Directed more towards preventive care in the
    elderly
  • Components are to promote good medicine
  • Although given different names, the exams are
    similar
  • Differ by when you can do them

5
  • No deductible or co-pay for patient

6
Elements of the Initial Annual Wellness Visit
  • Past Medical Surgical History
    Hospitalizations
  • Family History
  • Medications including Supplements/OTC
  • Current Medical Providers
  • Height, Body Weight, BMI or waist circumference,
    BP
  • Cognitive Screen
  • Depression Screen
  • Functional Assessment
  • Minimum Hearing, ADLs, fall risk and home
    safety screens
  • Written Personalized Health Plan based on USPSTF
    and Advisory Committee on Immunization Practices
  • Individualized based on health status
  • Appropriate referrals to health education or
    preventative counseling services
  • Including weight loss, physical activity, smoking
    cessation, fall prevention and nutrition
  • Voluntary Advance Care Planning
  • Verbal or written

7
Elements of Subsequent AWV
  • Update of Medical Family History
  • Update Current Providers
  • Weight or waist circumference, BP
  • Detection of any cognitive impairment
  • Written Personalized Health Plan Updated
  • Appropriate referrals to health education or
    preventative counseling services
  • Voluntary Advance Care Planning
  • Written or verbal

8
Minor Differences
  • IPPE includes visual acuity screen
  • MWV includes cognitive testing and documentation
    of Care Team
  • IPPE does not specify personalized health plan
    but its seems like good policy to do so
  • EKG now optional in IPPE

9
How are we going to do this all?
  • Time Allotment is still open to debate
  • 30 minutes? Is that possibly enough?
  • Team effort with nurses doing intake with
    screening questionnaires
  • SMG already working on workflow with MAs
  • Epic Smart Phrases and SmartSets
  • Pre-filled Adult Patient History form
  • SMG Proposed Medicare Wellness Checklist for
    RNs/MAs

10
(No Transcript)
11
A proposed MWV checklist
  • RN to complete with patient, includes
  • PHQ-2 (with option for PHQ-9)
  • Mini-cog, and
  • Up and Go Test

12
Outside the room
  • Starts outside the room with height, weight and
    visual acuity testing (if doing IPPE)

13
Up Go test
  • In our clinic, MD will probably do this
  • Positive if either of 2 factors are present
  • Did it take them 20 or more seconds to complete?
  • Were they unsteady?

14
Mini-Cog
  • Effective Dementia screen
  • 3-item recall along with clock face
  • Positive screens should be referred to geriatric
    assessment clinic for cognitive testing or formal
    neuropsychiatry testing

15
Care Team
16
Depression screening
  • If the patient answers yes to either question,
    need to complete a PHQ-9 questionnaire

17
Functional/Safety Screen
  • Screen of independent activities of daily living
  • MD will need to make appropriate referral based
    on further questioning to any yes answers

18
Additional Resources for Positive Functional
Screens
  • Senior Services
  • Calls answered live Monday-Friday,
    800am-600pm(206) 448-31101-888-4ELDERS
    (435-3377)
  • Can refer to audiology or optometry/ophthomology
    for hearing/vision
  • Home health with PT/OT for safety evaluations
  • Will do if they are mostly home bound, falling,
    weak or frail
  • Home Visit

19
Voluntary Advance Care Planning
  • End of life decisions and decision-makers POLST
    and healthcare DPOA
  • Not everyone is always ready, but important to
    have them start the conversation with you and
    their families
  • Can be verbal or written documentation
  • Place in problems list under Advance Care
    Planning
  • Also can update Code Status in EPIC
  • Scan POLST into EPIC

20
EPIC Visit Template
21
Personalized Health Plan
  • Must be completed and a copy given to patient
  • Epic Smartphrase, that can be pasted into patient
    instructions and printed as an after-visit
    summary
  • Based on USPSTF (A or B recs), ACIP, and covered
    Medicare screening tests
  • Will cover annual flu, pneumococcal (once after
    65) and hepatitis B (if medium/high risk)
  • Zoster vaccine covered by Medicare Part D
    (patient schedules with pharmacy)
  • Will cover screening PSA (and DRE) to age 75 even
    though USPSTF Grade I recommendation.

22
Personalized Health Plan
23
Non-covered services
  • This box is purely informational if these
    interventions are felt necessary

24
Coding
  • Reimbursed well
  • MWV bills as G0438 (initial) and G0439
    (subsequent)
  • IPPE bills as G0402 (Medicare part B lt12 months)
  • If you do an EKG, also code G0403 for that
    service
  • If acute problem dealt with at same visit
  • Bill as above modifier 25 E/M code
  • Unlikely to be reimbursed

25
QI Project
  • Geriatric Fellows suggest sending out letter to
    those age 65 and above telling them about IPPE
    and MWV benefits

26
References
  • Medicare.gov
  • USPSTF guidelines http//www.ahrq.gov/clinic/pock
    etgd.htm
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