Medicare Annual Wellness Exam
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Introduction
Also see health maintenance in the elderly
- introduced in 2011 through the Affordable Care Act[1]
Clinical significance
- for healthy adults, routine tests during annual checkups are of low value[2]
- routine medical tests may trigger cascades of further medical services of uncertain value & cause harm to patients & clinicians[2]
- one shortcoming is the 'one size fits all' strategy, that is the annual visit fails to account for the diversity of the elderly population[3]
Management
- Affordable Care Act requires a cognitive assessment for Medicare recipients during their annual wellness visit[1]
- MKSAP says cognitive assessment should be limited to elderly who elderly who note concerns or display symptoms of cognitive impairment[4]
- CMS advocates assessment of cognitive function during the annual wellness visit by direct observation as well as by report of symptoms from the patient, family members, friends, & caregivers
- in the absence of symptoms or reported symptoms a mini-Cog or other screening for cognitive dysfunction is not indicated[4]
- see annual physical examination for USPSTF recommendations
- all patients
- screening for diabetes mellitus in elderly <= 70 years who are overweight or obese
- approaches to geriatric care including the 4Ms of an Age-Friendly Health System & clinical Glidepaths could guide a more patient-specific geriatrics focused approach to the Medicare annual wellness visit[3]
More general terms
References
- ↑ 1.0 1.1 1.2 Ganguli I, Souza J, McWilliams JM, Mehrotra A. Trends in Use of the US Medicare Annual Wellness Visit, 2011-2014 JAMA. 2017 Jun 6;317(21):2233-2235 PMID: https://pubmed.ncbi.nlm.nih.gov/28423397 PMCID: PMC5815054 Free PMC article
- ↑ 2.0 2.1 2.2 Ganguli I et al. Assessment of prevalence and cost of care cascades after routine testing during the Medicare annual wellness visit. JAMA Netw Open 2020 Dec 1; 3:e2029891. PMID: https://pubmed.ncbi.nlm.nih.gov/33306120 PMCID: PMC7733154 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774080
- ↑ 3.0 3.1 3.2 Coll PP, Batsis JA, Friedman SM Medicare's annual wellness visit: 10 years of opportunities gained and lost J Am Geriatr Soc. 2022 Oct;70(10):2786-2792. Epub 2022 Aug 17 PMID: https://pubmed.ncbi.nlm.nih.gov/35978538 https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18007
- ↑ 4.0 4.1 4.2 Medical Knowledge Self Assessment Program (MKSAP) 19. American College of Physicians, Philadelphia 2021
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ Seematter-Bagnoud L, Bula C. Brief assessments and screening for geriatric conditions in older primary care patients: a pragmatic approach. Public Health Rev. 2018 May 1;39:8. PMID: https://pubmed.ncbi.nlm.nih.gov/29744236 Free PMC article. Review.