Strategies to Improve Annual Wellness Visit Completion Rates and Enhance to Role of the RN in Primary Care

Background: The annual wellness visit (AWV) is a benefit established by Medicare for its beneficiaries in 2011. The intent of providing this benefit was to proactively address chronic health conditions and provide preventative strategies to mitigate the development of certain chronic health conditions. This benefit is free to Medicare recipients; however, only 18.8% took advantage of this type of visit with their primary care provider (PCP) nationally.

Historically, the AWV had been completed by the patient’s primary care physician or as a collaborative visit with the PCP and a pharmacist. Medicare allows other clinicians to perform an AWV, including a registered nurse. This allowance provided the foundation for the establishment of a protocol for a RN-led annual wellness visit.

Methods: Three primary care locations were identified to participate in a pilot project which included education on team using established Team STEPPS strategies and developing a workflow for RNs to independently complete an annual wellness visit. Workflows were developed to facilitate the independently performed AWV. Surveys were conducted pre- and post-team building education to assess knowledge base and comfort level related to annual wellness visits. The collection of data includes AWV volumes, volume of additional patient visits scheduled with providers, and completion of preventive testing.

Result: The anticipated results include increased number of AWVs completed at each site, enhanced collaboration between team members, and increased job satisfaction for the RNs in primary care.

Conclusions: Primary care practices continued to be challenged with sufficient access to meet the needs of their patient population. Allowing RNs to independently perform annual wellness visits for eligible Medicare recipients improves access for that population and for other patients in need of primary care services. The primary care RN has the appropriate knowledge and skill set to successfully perform an annual wellness visit and the use of team STEPPS strategies to enhance interprofessional collaboration provides a foundation for transition from a provider only approach to care to a team-based care delivery model. Establishing protocols and workflows to allow the primary care RN to work at top of license supports patient care needs and improves RN job satisfaction.