September 8, 2022

Medical visits that address disease prevention and the promotion of health and wellness are important parts of medical care for older adults. When Medicare was introduced in 1965, however, it did not address this important component of health care. Medicare took an important step to correct this deficit when it initiated Medicare annual wellness visits (AWVs) ten years ago.

AWVs’ emphasis on disease prevention and health promotion for older adults was a huge step forward, but the current one-size-fits-all approach does not adequately meet the wellness needs of a diverse population of older adults.

Dr. John A. Batsis

Dr. John A. Batsis

In their recent special article in the Journal of American Geriatrics Society, Patrick P. Coll, MD, medical director for senior health and associate director for clinical geriatrics at the Center on Aging at UConn Health, and John A. Batsis, MD, associate professor of nutrition at the UNC Gillings School of Global Public Health and of geriatric medicine at the UNC School of Medicine, worked with colleagues to review the need to redesign AWVs in order to better identify crucial issues for each individual patient.

“As a geriatrics care provider, I have learned a lot about why some of my patients are healthier and more independent than others. I know that the wellness goals of my patients are very different depending on their age, health, family support, current function and socioeconomic status,” Coll said. “Medicare’s no-cost annual wellness visit is an opportunity for me to work with my patients and come up with a wellness plan that is right for them. Unfortunately, because of its one-size-fits-all approach, the current Medicare AWV does not help me address the wellness needs of all my patients.”

More than 60 million Americans are eligible for the Medicare AWV at no cost. These visits are an opportunity for primary care providers and their older patients to work together on a wellness plan that promotes good health and functional independence.

“We strive to work collaboratively with patients to achieve their goals. The current structure of the AWV is likely most helpful in community-dwelling older adults who are at lower risk of functional decline and who may have longer periods of disability-free illnesses,” said Batsis. “Yet, we know that health promotion and prevention measures can be offered across various stages of the aging process, and — importantly — they differ based on age, function and socioeconomic status. We believe this is a missed opportunity to use the Medicare AWV to optimize quality of life and physical function among the millions of older adults in the United States.”

“Unfortunately, the current AWV does not recognize that the wellness goals of a fit and healthy 65-year old may be very different than the wellness goals of a 95-year old with complex medical problems and associated disability,” the authors wrote in the special article.

Another concern is that many older Americans have never heard of — and therefore, do not receive — a no-cost Medicare AWV. In fact, it is often confused with an annual physical, but the appointments have very different goals. Many primary care providers struggle to fit these types of visits into their busy work schedule, and may not feel that the current AWV is effective in promoting wellness goals for all of their older patients.

Coll, Batsis and their co-authors would like to see Medicare and other national organizations work with primary care providers and those who represent the views and needs of older adults to update the framework of the AWV so it can better meet the wellness needs of all older Americans.

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