Medicare Coverage of an Annual Wellness Visit to Establish a Personalized Prevention Plan, A Good Idea if Implemented Correctly


One of the most interesting pieces of legislation in the new Health Reform Bill is the Medicare Coverage of an annual Wellness Visit Providing a Personalized Prevention Plan. This legislation establishes a new type of office visit for a Medicare beneficiary and provides the beneficiary and their provider with some unique information and services. The key features of this new office visit will be:

1) A Health Risk Assessment (HRA)
2) A Visit with their physician
3) The completion of an individual’s medical and family history
4) A List of risk factors
5) The establishment of a screening schedule for the next 5-10years based upon both appropriate screenings for a general population as well as those based on the individuals specific risk factors
6) The furnishing of personal health advice and appropriate referrals to coaching and other health education

This is the first step and a major one to establishing a prevention focused approach to health care for Medicare beneficiaries. It is important that CMS establish this program appropriately. In the current proposed language, CMS is delaying the implementation of key features of this planned Wellness visit, in particular the implementation of an HRA along with the visit. For a truly new type of office visit focused on Wellness, how does one expect to get a Personalized Prevention Plan without the use of a Health Risk Appraisal to assist in the identification of a patient’s risks? Furthermore, a study in the Journal of Occupational and Environmental Medicine, (The Savings Gained From Participation in Health Promotion Programs for Medicare Beneficiaries, Ozminkowski et al, 48:11 p. 1125-1132 Nov 2006) stated the following conclusion:

Health promotion programs that were founded on HRAs saved Medicare money, often hundreds of dollars a year, due to reductions in medical expenditures. Those who participated in programs that involved the use of an HRA saved more than those who did not. Moreover, program participation that was not guided by the HRA usually did not reduce costs. Thus, the HRA should be the center or guiding force for subsequent participation.

For this new Wellness Visit to truly benefit the Medicare beneficiaries and their physicians, CMS should fully implement the program as per the legislation. The comment period for the current CMS proposed rules ends August 24, 2010. If you would like more information or to comment on these rules, please feel free to contact me at (904) 281-0006
The outcomes of these visits could well lead to a reduction in health risks and health care costs as has been demonstrated in employer populations resulting in More Good years for those with Medicare.


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