In response to COVID-19, The Centers for Medicare and Medicaid Services (CMS) offered rule flexibility and expanded payment for telehealth services so providers could continue to deliver care to their patients without the risk of exposing them to the virus at the root of the global pandemic.
Those changes resulted in an astonishing increase in telehealth appointments. A CMS press release from August 3 reported, “Before the public health emergency, only 14,000 beneficiaries received a Medicare telehealth service in a week while over 10.1 million beneficiaries have received a Medicare telehealth service during the public health emergency from mid-March through early-July.”
In August, CMS proposed changes to expand telehealth permanently, consistent with the Executive Order on Improving Rural and Telehealth Access.
While some appointments still beg for an in-person visit, others, like annual wellness visits (AWV), maintain their effectiveness via telehealth and even hold the promise of increasing utilization for members who would have skipped an office visit because of transportation challenges, mobility issues, or other reasons.
The majority of the components of the AWV can successfully be conducted via telehealth, but a revised approach on the part of both the provider and the patient may be necessary to get the most value out of these appointments.
Annual Wellness Visit Components
- Review and update the patient’s Health Risk Assessment (completed during their initial appointment)
- Update the beneficiary’s medical/family history
- Update the list of current providers and suppliers
- Measure weight, blood pressure, and other measures appropriate to the patient
- Assess for any cognitive impairment
- Update the written screening schedule for preventive services and vaccines
- Update the list of risk factors and conditions that require intervention
- Update the Personalized Prevention Plan Services
- If necessary, furnish advanced care planning services
For a successful visit, both the provider and the patient may need to consider how to prepare for a telehealth appointment differently.
Preparing Providers for Telehealth Visits
- Establish a secure and stable connection in an appropriate office setting for telehealth visits.
- Remind providers of the components of the AWV and appropriate billing codes (see https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AWV_Chart_ICN905706.pdf)
- Educate providers about best practices for developing rapport via video and phone calls, including considering the camera angle, lighting, and chat functions.
- Review any questions submitted by patients in advance of the appointment.
- Have ready any documents or educational materials to screen share with patients.
Preparing Patients for Telehealth Visits
- Create communications to ensure patients are prepared with the information they need to have a successful AWV. Let them know what to expect and ease any concerns they may have.
- Create an intake form so patients can submit questions to the provider prior to the call.
- Ensure members are prepared with any vital information, like weight, blood pressure, or a list of current medications.
- Create easy-to-follow instructions to help patients connect to the appointment.
- Direct members who need help accessing a reliable Internet connection to community services that can help.
Maintaining patients’ consistency with AWVs via telehealth will contribute to the important preventive care they need to stay their healthiest.