An older adult’s most valuable medical appointment might be the one that costs her nothing.
 

Kristen Nebel, D.O., said an AWV, which is longer and more in depth, often leads to identifying issues not discussed during a regular office visit.

An Annual Wellness Visit is a free benefit for all Medicare beneficiaries. Kristen Nebel, D.O., Managing Physician at Geriatrics, said an AWV, which is longer and more in depth, often leads to identifying issues not discussed during a regular office visit.

“The goal of an AWV is not to belabor all of an older adult’s chronic conditions but to ask what’s important to them,” she said. “What are their goals for the next five to 10 years, and how can we help them to reach those goals?”

An AWV covers standard health maintenance topics and includes routine screenings, such as blood pressure, hearing and vision. Patients also are screened for fall risk, cognitive impairment, depression, incontinence and nutritional deficiencies.

“The screenings identify red flags and anything that might keep patients from living the way they want to live,” Dr. Nebel said. “Identifying those red flags goes a long way toward determining how long an individual can care for him or herself.”

For example, an AWV might lead to further investigation of cognitive impairment, a referral to physical therapy for balance problems or safety improvements to minimize fall risk.

The extended visit also offers a good opportunity to discuss advance care planning, Dr. Nebel said. A new tool in Epic helps facilitate the conversation, which is generally very well-received, she said.

“We use the AWV as a time to identify whether an advance care plan is present, and make sure the patient and physician both understand it,” she said. “If the patient doesn’t have a plan, it’s a chance to raise the issue and encourage them to create one.”

The AWV also helps physicians identify patients who are frail and at risk for decline or death in the next year. Those patients should have a POLST (Physician Orders for Life-Sustaining Treatment), Dr. Nebel said.

Family members may attend an AWV if the patient chooses, but some parts of the visit, such as the depression screening, are private, she said. An AWV can be illuminating for adult children, who may learn that Mom regularly skips lunch or Dad’s bank account needs a closer look.

“The key to keeping our aging population well lies in prevention,” Dr. Nebel said. “An Annual Wellness Visit helps us to be proactive.”

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