Homework: How To Prepare For The New Medicare ‘Wellness’ Visits

As of Jan. 1, Medicare covers a free — truly free, no co-pay, no deductible — “wellness visit” every year for its 46 million patients.

That is, if you’re on Medicare, instead of waiting until you’re sick to see the doctor, you can make an appointment to talk about all the ways you can avoid getting sick.

The new coverage is part of federal health care reform, and reflects the thinking that medicine needs to focus more on keeping people well rather than just treating them once they’re not.

Dr. Eddie Phillips, director of the Institute of Lifestyle Medicine at Spaulding Rehabilitation Hospital, is busy these days developing “wellness visit” tools mainly for doctors — or rather, for their offices, since patients will most often see nurses or health educators to talk wellness. But he kindly agreed to take a moment to help prepare patients for the visits. What can you expect? How can you get the most out of yours?

His thoughts, lightly paraphrased:

Overview:

For the first time, doctors are being reimbursed on an ongoing basis to talk about wellness with their patients. This is very good news.
The wellness visit has a lot of pieces to it.

Among them:
-The doctor must perform some sort of cognitive screening. It’s not clear yet what this means. Is it enough to check whether the patient knows who’s currently president? There’s no way to prepare for this one. (Note from Carey: personally, I think I’d have an anticipatory cup of coffee, a known “cognitive enhancer.”)

-The doctor must screen for depression. It might be worth thinking beforehand about whether you believe you are depressed.

-The doctor must assess your risk of falling. That usually means some sort of physical testing. A balance test. Can you get out of your chair without using your arms? That kind of thing.

-The controversial one in the news lately: If you choose, you can have a voluntary discussion of your “advance directives”: Do you have a health care proxy to make medical decisions for you if you can’t? Do you want to be intubated? This discussion is reimbursable, and this is an appropriate time to do it. If you’re interested in an end-of-life discussion, you can prepare for it by learning about health care proxies, power of attorney and the like. You can start the conversation at home, and then ask the doctor about the practicalities of how things really work in the medical system.

Eddie’s favorite part: The Personalized Prevention Plan. This is where we talk about your diet, your exercise, your vaccinations, your sleep, your stress, and plan out what you need to do over the next five or ten years.

How to prepare for this: Perhaps think about which health behaviors in your life you’d most like to change, and begin the conversation with that. Perhaps “It’s finally time for me to get to the gym” or “it’s finally time for me to quite smoking.” Or perhaps even, “I’m not as happy as I’d like to be.” Wellness is about making sustainable choices. Ask yourself: What am I ready, willing and able to change, and what help do I need?

The wellness visit is also the time when the doctor is supposed to coordinate all your caregivers, so you may want to bring in the names and addresses of any doctors you seen in the last several years.

Optional: It’s not in the law — at least not yet — but you may want to fill out a health risk assessment — among the most popular are those that measure your “real age” — and bring it in. The basic idea is for you to do an accounting of your health behaviors — smoking, nutrition, weight, exercise — and give it a bit of thought.

Ultimately, Eddie said, he hopes the wellness visits will lead to “people beginning to make appreciable, sustainable lifestyle choices that are impacting on their health and health care costs and the trajectory of their lives.” One single piece of advice from a doctor may not have a huge impact, he said. But the wellness visit might have an effect similar to a 45-minute catch-up talk with a friend. The next time you meet, even if you only chat for a couple of minutes — “How’s your sick uncle?” “He’s better, thanks so much for asking!” — the conversation quality is better. The medical equivalent would be an in-depth talk about a quit-smoking plan during the wellness visit, and then during an office visit a few months later: “What’s happening with the smoking?”

Please follow our community rules when engaging in comment discussion on this site.
  • Mpgrenier

    Seniors may have to pay for Medicare home health

    Seniors may have to pay for Medicare home health
    (AP) – 1 day ago
    “WASHINGTON (AP) — Medicare recipients could see a sizable new out-of-pocket charge for home health visits if Congress follows through on a recommendation issued Thursday by its own advisory panel” (LastThe Associated Press, 2011)
    I applaud the new program to reimburse for a well visit to address a person’s overall health including fall risk, and end of life issues. I grimace at the possible adaption by the Medicare advisory board, of a co pay for homecare visits. Homecare nurses have been addressing and following up with physicians for years to address these same issues. I find the new Medicare advisory board possible decision to add co-pay to homecare visits except for low income counterproductive to this initiative. What will determine low income? As a home care nurse since 1993 I have seen the devastation that disease plays on the middleclass. Homecare if delivered properly is cost effective and keeps people out of the emergency room therefore lowering Medicare cost. I feel this new incentive on a once a year visit but adding co-pays to homecare services counterproductive. Low income patients have t-19 to cover co-pays middleclass elders to not have the same benefits. A physicians office cannot see how a patient actually performs in their home on a once a year visit. It never ceases to amaze me how a person can muster up the strength and ability to appear well when sitting in a physician office. People who benefit from homecare services may defer due to this co-pay and in the end will this really help to control cost. If Medicare was able to police homecare agencies properly, which they do not, that would contain cost.
    When I was working with the VNA services it was socking to see the amount of waste of T-19 funds for people who received elder services. I often worked with The Agency on Aging whose social workers advised clients to spin down their financial resources in order to receive services. Instead of advising them to use their financial resources to help support their medical and homecare needs they advised them to make purchases that would empty their accounts and allow them to qualify for T19. I felt that this was irresponsible delivery of care and was hurting the programs. Social workers commented that it was the fastest way to get them on T-19. I also found that instead of encouraging families to assist there elder the program made people more dependent and less independent. I was in full agreement when a co pay was developed for these services because it made people less likely to abuse the services. I cannot see how this would apply to those receiving Medicare services due to the service is provided to people who have a skilled nursing need.
    Diane Grenier RN
    217 Westview Dr.
    Meriden, Ct. 06450
    Reference;
    LastThe Associated Press, Initials. (2011, January 14). Medicare advisory panel urges co-pay for home health visits . Retrieved from http://www.google.com/hostednews/ap/article/ALeqM5g7lpBfuzYXX30nSGqS9UV1iWLTSw?docId=e747c7747a0643369e1e5b5bc0f303ef