CMS incentivizes unnecessary Medicare wellness visits

In November, 2015,  I wrote an essay for Medical Economics detailing how the ethical bind resulting from the Centers for Medicare & Medicaid Services (CMS’s) pay-for-performance (PFP) programs drove me from practice¹. I described how CMS-by financially incentivizing certain clinical actions based on obsolete and/or methodologically-flawed guidelines-forces physicians to choose between doing what is best for the individual patient or doing what will enhance practice revenue.

The Hippocratic Oath directs physicians to act in a manner that advances patient well-being. Yet CMS, by offering financial reward for clinical behavior dictated by other considerations, has created a practice environment at odds with this directive.

 

Related: CMS must stop manipulating small practices 

 

But CMS has not limited its interference in the doctor-patient relationship to its insidious PFP programs alone.  It has also utilized a generous reimbursement strategy to coerce physicians into incorporating the Annual Wellness Visit (AWV) into routine practice. The content of the MWV is almost entirely scripted by CMS, with the physician playing the role of a highly-paid scribe who provides no meaningful expert input regarding the needs of the individual patient. 

Born of the Affordable Care Act, the AWV made its debut in 2011, but for some practices, it wasn’t until several  years later that electronic health record (EHR) templates that captured CMS billing requirements for the AWV became available. Prior to 2011, preventive services such as colon and breast cancer screening, bone density studies, and cholesterol measurement were covered benefits under Medicare, but physician time spent coordinating such testing was not billable. Primary care doctors would, therefore, incorporate health maintenance items like these into periodic problem-focused visits.

 

ICYMI: CMS adds flexibility to its revised Medicare reimbursement program

 

Now, however, not only does CMS cover annual visits with the putative goal of maintaining wellness, it reimburses for these visits at a relatively generous rate.  Medicare assigns 4.58, 4.89, and 3.26 Relative Value Units (RVUs) to “Welcome to Medicare,” “Initial Annual Wellness Visit,” and “Subsequent Annual Wellness Visit” respectively. 

Internal server error