Medicare annual wellness visits: don't forget the health risk assessment.

Cindy Hughes, CPC F Practice Management (FPM) published several articles and an encounter form last year related to Medicare’s new annual wellness visit (AWV) benefit. Some physicians decided not to offer the AWV due to the complexity of the requirements, but many adapted to Medicare’s version of preventive care and provided these visits in 2011. Unfortunately, the requirements for 2012 have changed. The Affordable Care Act directed the Centers for Medicare & Medicaid Services (CMS) to require that a health risk assessment (HRA) be completed as part of the Medicare AWV. Efforts by the American Academy of Family Physicians and others to persuade CMS to delay the HRA requirement and allow time for physicians and practices to prepare for this change were unsuccessful, and late last year CMS published the final rule making the HRA requirement effective Jan. 1, 2012. The purpose of the HRA, according to CMS, is to help systematize the identification of health behaviors and risk factors such as tobacco use and nutrition that the physician can discuss with the patient in an effort to reduce risk factors and related diseases. The idea is that physicians will use the information from the HRA in developing a personalized prevention plan for the patient. CMS has not required a specific HRA form. The Centers for Disease Control and Prevention published a “framework” for the HRA in a 52-page report in December (http://www.cdc.gov/policy/opth/hra/). The report provides a 6-page example of an HRA, but the example does not contain all of the 34 elements required by CMS in the final rule definition. The HRA must be written at a sixth-grade literacy level and be designed so that most patients can complete it in 20 minutes or less. It does not have to be scored. Compliant HRA tools are presumably being developed by a variety of organizations. One source, Hows YourHealth.org, provides free online assessments that meet the CMS requirements and has developed the paper-based questionnaire published with this article (see HowsYourHealth.org and the Medicare health risk assessment, page 12). So what does this mean to physicians who provide AWVs? Before the face-to-face encounter, your patient