Preventive health care is good. Regularly going to the doctor and getting checked up is good, I think. So Medicare added an annual wellness visit, without any cost-sharing, to encourage beneficiaries to get that regular check-up and to help build a stronger primary care relationship. A study in Health Affairs examines the effects of adding that visit. (HA Article) One item that surprised me right away was how few beneficiaries take advantage of the annual wellness visit. It was added in 2011 and only 7.5% of beneficiaries used it in that year, rising to 18.8% in 2015. Also, there was substantial variation across physician groups in use of the visit, with half of the practices recording no annual wellness visits and 23% providing them to at least a fourth of their patients. The authors attempted to see if the visit succeeded in raising rates of preventive care like screening for cancer, depression or cognitive impairment and if it reduced use of emergency room visits and hospitalizations. They examined these outcomes from 2008 to 2015 among the fee-for-service Medicare population to identify trends before and after addition of the wellness visit benefit. Among other things, they looked at differences between what they defined as adopter and non-adopter physician practices, based on the prevalence of the visit in a practice.
Out of over 23,600 practices analysed, around 15,000 were considered adopters of the annual wellness visit. 30% of beneficiaries attributed to adopter practices had a wellness visit in 2015. Before the visit was added as a Medicare benefit, compared to non-adopter practices, adopter ones had higher rates of appropriate and low-value screenings and of cognitive and functional care, and lower rates of ER visits and hospitalizations and lower total spending. This suggests these practices may have been more attentive to care management. After implementation of the new benefit in 2011, there was no statistically significant difference in rates of use of either recommended or low-value screenings. There was small increase in use of physicial and occupational therapy, but no difference in use of cognitive wellness services. There was no statistically significant difference in trends for ER visits or hospitalizations, including those for ambulatory care sensitive conditions. And there actually was a small but insignificant increase in total spending. So the addition of the wellness visit benefit does not appear to have had the intended effect, but that doesn’t mean it isn’t a good idea. It does suggest that more than one cost-sharing free visit is necessary to see improvements in the health and care management of Medicare beneficiaries.