Dr. Keith Moss discusses what an annual wellness visit is, if it's covered by insurance, and what the wellness visit includes.
Carl Maronich (Host): This is the Well Within Reach Podcast. I’m Carl Maronich. And joining us today is Dr. Keith Moss. Dr. Moss, welcome to the podcast.
Keith Moss MD, MA, FACP (Guest): Thank you for having me.
Host: Yes, Dr. Moss is the Vice President and Chief Medical Officer and Chief Medical Information Officer for Riverside Healthcare. That’s a long title.
Dr. Moss: Yes, yes, it is.
Host: You went to school for all those years, so you deserve to have a nice long title.
Dr. Moss: Well, at least they gave it to me.
Host: Yes, well well-earned I’m sure. Today, we’re going to be talking about the Medicare Annual Wellness Visit. Which is an important – something important that folks need to think about and know about as they age, as things in their life are changing. It’s something they need to be aware of so we’re going to talk about that. And let’s start by kind of defining what the Medicare Annual Wellness Visit is.
Dr. Moss: So a Medicare Wellness Visit is done once a year and Medicare enrollees are eligible for it one time a year. What it does is it’s a different kind of visit than a normal visit for either what ails you or to follow up on your normal chronic problems. The Medicare Wellness Visit allows people to talk about things that they don’t normally get to in a regular visit. Things like screening for things like cervical cancer, colorectal cancer, abdominal aortic aneurysms which are outpouchings of your aorta or your big blood vessel in your abdomen. And other things like cognitive assessments, immunizations, and also talking a little bit about kind of the things that you would want to have done when it gets closer to the end of life.
Host: So, it’s really an opportunity as you said, to talk about those things. It differs from an actual medical visit or exam.
Dr. Moss: That’s correct. Usually you don’t deal with the chronic illnesses that you normally have like hypertension or diabetes during this visit. Those are things which are outside of this particular visit because they want to focus on these other factors. Things like screenings and immunizations et cetera.
Host: Yeah. Who is eligible for the Wellness Visit?
Dr. Moss: Any Medicare beneficiary whose either been receiving Medicare Part B benefits for at least 12 months and who has not had an initial preventative physical examination which is what’s called the Welcome to Medicare Visit within the past 12 months.
Host: Are they required to have these visits?
Dr. Moss: They are not required but we strongly encourage them.
Host: Yeah, and as you were saying, it really could lead to further discussion about some more serious issues that folks need to be in tuned to.
Dr. Moss: That’s exactly right. It’s exactly right. And it is covered by Medicare Part B.
Host: Yeah and we’ll get to some of the specifics of the exam but as a practitioner yourself, you see patients in the office, I’m guessing, who sure would have been benefitted from a visit like this and then they get a little down the road and now their things are at a stage where they could have been prevented earlier.
Dr. Moss: Yes. When I talk to the medical group at our retreats and this is all of the physicians within Riverside Medical Group; we talk a little bit about this because many of them have been in the very tragic situation of having a patient in the intensive care unit where something has happened and they can’t speak for themselves and they really are at a loss as what to do because that person hasn’t really had the discussion with either the physician or the family about what it is that they would have liked to have done when they can’t speak for themselves. So, it does make for a big difference in terms of treatment.
Host: Sure. So, to that point, those that may be listening that are the children of elderly or older parents; they need to encourage them to take this step.
Dr. Moss: Absolutely. It’s absolutely critical that they do these kinds of things because that way we know, and they know what really, they would want in a situation which becomes critical and at some point, we all have these situations.
Host: Sure, yeah. And let’s talk a little bit about what specifically is in the Wellness Visit. What kind of things can someone expect when they go through that visit?
Dr. Moss: Sure. One of the first things in those exams is a determination of cognitive function. Most of the time, the practitioner will be talking to the patient and will either get some information from family members depending upon the patient, either that they have some problems with cognition, or the practitioner may pick up on that or they may have something that they knew about beforehand and then they can do some assessments. If the patient has no problems with cognition, they are not going to be doing any testing.
Host: And let’s define a little bit about what we mean when we say cognition.
Dr. Moss: Cognition just basically means they are looking for evidence of any kind of memory loss, things like early Alzheimer’s Disease or early other forms of dementia. That’s what they’re looking for.
Host: And this would be maybe along with forgetfulness and things not always clear thinking perhaps.
Dr. Moss: Yeah and these are – we like to make sure that we – the testing actually helps to kind of differentiate between something which could be very serious and things like word finding difficulty which all of us have to some degree.
Host: Right. You listen to this long enough you’ll find that I’m sure.
Dr. Moss: Exactly. It does get a little bit worse as patients age. That’s a part of normal aging. But there are other aspects of memory loss which are not normal. Things like forgetting to turn off lights or stoves or things like that. And that’s where family members can come in and help us out.
Host: Yeah, this is probably the category also where driving may be addressed. And I know that’s a big issue for a lot of older folks.
Dr. Moss: Right. Driving certainly can be an issue and if someone sees that there’s significant cognition problems or problems with memory; that discussion needs to come up as well.
Host: Yeah. So, along with cognition, some of the other things that are covered in the visit?
Dr. Moss: Well, there is something called a Health Risk Assessment that’s done and actually the nurse may be doing that or the medical assistant prior to the provider even coming in. That will ask about things like risk for falling, how have you been feeling lately, have you been depressed. Other kinds of more general questions that the provider can address once they get into the visit.
Host: Is it helpful to have somebody come with on the visit, a family member, a close relative, who or friend who may know the individual pretty well?
Dr. Moss: It’s highly variable. There’s an awful lot of very healthy 65 to 70 to even 90 year olds or even more. When those patients start to have trouble either with their memories or with other things or with even severe arthritis or they can’t move as well; it’s actually very appropriate for a family member to come along.
Host: And is there information they should be bringing with them when they come to the visits?
Dr. Moss: Well any information that they have about how their behaving at home and how they’re functioning at home is always a big help. If they are – for a lot of these visits, there’s not a whole bunch that they have to bring though. Because most of the information will be done at the visit.
Host: And screenings. This is a visit that those would be talked about, they would be –
Dr. Moss: That’s exactly right. And these are age appropriate screenings meaning that things like colorectal cancer screening is something that’s done usually up until age 80 – 85 even. It depends on the society that’s making those recommendations. But those are – they are variable, but we do talk about things like colorectal cancer screenings, cervical cancer screening, screening for depression, screening for diabetes, screening for high cholesterol so that those things can all be addressed at the visit and we know what to do with them.
Host: Yeah and the visit – an elemental question, we should have started with, but this visit would take place with their general practitioner, their primary care provider would do this? They don’t have to go to a specialized doctor.
Dr. Moss: Yes, that’s exactly right. It is with their primary care provider.
Host: So, they would call the office and set this up and let them know this is the kind of visit that they are looking for.
Dr. Moss: That’s exactly right.
Host: And again, it’s the Medicaid Wellness Visit, is how it’s referred to?
Dr. Moss: Or the Medicare Wellness Visit.
Host: Medicare. It’s the Medicare Wellness Visit. And there is no cost for this visit or is there a cost?
Dr. Moss: There is no cost. It’s covered by Medicare. I did want to go back real quick though about making sure we talked a little bit about what to bring to the visit in terms of – certainly a knowledge of what’s going on with the patient would be – is always important if they are not able to speak as much for themselves. Bringing either a list of medications or the medications themselves would be very, very helpful to have. And making sure that if family members have extra information about that patient that’s written down; we’d love to see that as well.
Host: Sure. You appear to be a very young man; you’ve been practicing a few years?
Dr. Moss: Yes, 16 years.
Host: And over that time, are we at a place in time where something like this is even more important than it was a few years ago or we realize the value of this now more than we used to?
Dr. Moss: There’s a couple of things. Certainly screenings have gotten better. And we have a little bit more definition around our screenings that we do. We have a little bit more – and we have more to do because we feel – we recognize the benefits of these screenings. We recognize the benefits of the immunizations. So, all of that really makes it much more worthwhile now than ever before.
Host: When you’re seeing patients in your office for these kinds of visits are they there of their own accord willing or did a loved one drag them to it or how are you seeing patients kind of accept these type of wellness visits?
Dr. Moss: We generally don’t have to drag them but there are selective people for whom I know that they were coerced, how about that.
Host: So, to those, we have an opportunity here to speak to some folks what words of advice would you give those who are contemplating or know that they have a loved one who really needs to do this wellness visit?
Dr. Moss: Well, certainly it’s a free visit covered by Medicare. So, it’s not going to cost you anything financially. You may well get some information to contemplate about your own future and about what kinds of things that you’d like to have done. You also get things like immunizations for pneumonia or influenza. Those can be done at that visit. You get a lot of information about your own general health and as well as about what things we can do to help you stay healthy through those years when you are older.
Host: Yeah, so a lot of value packed in to this visit, the Medicare Annual Wellness Visit and there’s a word in there that tips us off that you should have it done very year. It’s an annual. Very good. Well Dr. Moss we appreciate your time. Lot of great information. And hopefully, we’ll have you back on the podcast soon.
Dr. Moss: Sounds good. Thank you very much for having me.