Using the Annual Wellness Visit to Generate Revenue and Improve Patient Care

The annual wellness visit (AWV) is a specific wellness and prevention-focused visit for Medicare beneficiaries that can be performed by registered nurses. The purpose of the visit is to engage Medicare beneficiaries as active participants in their health and to provide them with an annual plan for wellness and chronic disease management including recommendations for routine preventive screening tests, e.g. mammograms. This study details the creation of a nursing team who provided AWV via remote/telehealth methodologies over a three-year period to Medicare fee-for-service beneficiaries in an accountable care organization (ACO). The outcomes achieved include provision of over 16,000 AWVs per year. These visits generated over $2 million annually and improved quality scores significantly. The improved quality scores were the result of closed gaps in care and generated an additional $1.1 million in revenue and ultimately resulted in shared savings payment of $31 million to the ACO for the 3 years of this study.

Purpose: To determine if RNs working at the top-of-license could improve patient outcomes and generate revenue by performing the CMS annual wellness visit to Medicare fee-for-service beneficiaries in the ACO.

Description: A team of registered nurses was assembled and tasked with engaging patients in their preventive healthcare plan. The nurses were trained in motivational interviewing for patient engagement and adult health screenings were reviewed. They used a structured risk assessment and formatted templates to document their interactions with the beneficiaries.

Evaluation/outcome: Ten RNs collaborated with the primary care providers to provide up to 16,000 AWV annually. The visits generated over $2 million revenue each year and significantly improved quality scores in the ACO. Improved quality scores are evidence of closing gaps in care and ensuring beneficiaries receive the appropriate preventive care they need. The improved quality scores resulted in enhanced Medicare part-B revenue of over $1 million annually as well as achieving shared savings payments of over $31 million in 3 years.