Medicare Annual Wellness Visit – What are some of the Assessments and Questions asked during this Preventative Service

The Medicare Annual Wellness Visit is the perfect opportunity for a patient to discuss various aspects of their life with a medical professional. This preventative service, offered free each year to Medicare beneficiaries, allows the medical professional to review many lifestyle and health questions with the patient that are typically not discussed during a physical or regular office visit. This program is designed to help patients take control of their health, as a Personalized Health Advice and 5 Year Plan is presented to the patient after the Medicare Annual Wellness Visit is completed.

Below are some of the topics discussed and assessments performed during the patients Medicare Annual Wellness Visit:

A Review of the Patient’s Exercise and Activity Level during the Medicare Annual Wellness Visit

Regular exercise provides substantial benefits to older adults including improved blood pressure, diabetes and neurocognitive function.

Regular physical activity is also associated with decreased mortality and age-related morbidity in older adults. Despite this, up to 75 percent of older Americans are insufficiently active to achieve these health benefits. Few contraindications to exercise exist, and almost all older persons can benefit from additional physical activity.[1]

The Annual Wellness Visit is the perfect time to discuss the patients future plans for physical activity.

Questions about the Patient’s Diet

Nutrition related health conditions are prevalent within the Medicare population. Twenty-eight percent of Medicare beneficiaries have diabetes and 15 percent have chronic kidney disease. More than 35 percent of American men and women are obese, and adult obesity is associated with a number of serious health conditions, including heart disease, hypertension, diabetes, and some cancers.[2]

There are many services available to Medicare patients to assist them with their diet. Medicare provides coverage for nutrition-relation health services such as Medical Nutrition Therapy, Diabetes Self-Management Training, and Intensive Behavioral Therapy for Obesity and the need for these additional services can be discussed during the Medicare Annual Wellness Visit.

Patient’s Alcohol and Tobacco Use

Alcohol consumption has effects on a myriad of physiological systems, particularly at high levels of consumption. The effects of heavy alcohol consumption on the central and peripheral nervous systems, gastrointestinal organs, liver, pancreas, and immune system are well described (U.S. Department of Health and Human Services, 2000). At the same time, moderate alcohol consumption (typically up to 14 drinks per week) is associated with apparent health benefits, including lower total mortality and lower rates of coronary heart disease than abstention or very light drinking among middle-aged and older adults (Colditz et al., 1985;Scherr et al., 1992).[3]

There are preventative services available to Medicare patients to address their alcohol and tobacco use:

The Patient’s Medication History

Pharmacotherapy is an essential component of medical treatment for older patients, but medications are also responsible for many adverse events in this group. Almost 90 percent of people 65 and older take at least one medication, significantly more than any other age group (Agency for Healthcare Research and Quality [AHRQ], 1996). Patient safety is highly important to member health, especially patients who are at increased risk of adverse drug events due to coexisting conditions and polypharmacy. Adverse drug events have been linked to preventable problems in elderly patients, such as depression, constipation, falls, immobility, confusion and hip fractures. Thirty percent of elderly-patient hospital admissions may be linked to drug-related problems or toxic effects (Hanlon et al., 1997).[4]

A Retinal Macular Assessment

This assessment is performed during the Annual Wellness Visit because healthy vision is important to a Medicare patient so they may maintain an independent life.  This assessment screens for early signs of macular degeneration which can be stabilized or prevented with new injectable medications currently available.

In April 2006, the CMS launched a program called the Low Vision Rehabilitation Demonstration. The implementation of the program, designed to assess the financial impact of home-based rehabilitation services, has been touted by the CMS as having the potential to improve patients’ access to low vision rehabilitation services and enhance their independence.[5]

A Functional Capacity Evaluation & Fall Risk Assessment

Functional assessment of the geriatric patient pays close attention to an individual’s mobility and functional capacity—his or her ability to perform basic activities (e.g., walking, bathing, and using the toilet), and instrumental activities (e.g., shopping, cooking, and managing finances or medications). With advancing age, many adults may be less concerned with the particulars of their illness and more worried about the impact of their illness on their ability to function in the community. Reduced mobility (often presaged by a person’s slowed walking speed) and impaired functional capacity are highly predictive of falls, healthcare use, and mortality (Keeler et al., 2010). Considering function should alert healthcare providers to changes in health, inform their prognosis, and guide them in gauging the appropriateness of healthcare interventions.[6]

A Functional Capacity Evaluation and Fall Risk Assessments are both required components that must be confirmed during the Medicare Annual Wellness Visit.

A Mild Cognitive Impairment (MCI) Assessment

The risk of dementia increases with age: its prevalence is 5 percent in people aged 71 to 79, rising to 37 percent of those older than 90. Mild cognitive impairment has many definitions, but the term generally refers to people whose impairment isn’t severe enough to hamper their ability to manage their daily lives. By some estimates up to 42 percent of people older than 65 have it. Mild cognitive impairment is a warning sign, but it may not progress to Alzheimer’s disease, says Dean Hartley, director of science initiatives at the Alzheimer’s Association.[7]

A Depression Screening

Although the risk of experiencing anxiety and depression increases as we age, these mental health conditions often remain undiagnosed. Feeling extremely sad or anxious is not a normal part of the aging process. Treatment is available.

Consider these statistics, courtesy of Mental Health America:

– Approximately 68 percent of adults aged 65 and over know little or almost nothing about depression.

– Only 38 percent of adults aged 65 and over believe that depression is a “health” problem.

– If suffering from depression, older adults are more likely than any other group to “handle it themselves.” Only 42 percent would seek help from a health professional. [8]



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