JAPhA: Medicare annual wellness visits spell opportunities for pharmacists

WASHINGTON — Medicare’s Annual Wellness Visits present potential opportunities for pharmacists based in physician offices, concluded two experience articles published in the July/August 2014 edition of the Journal of the American Pharmacists Association.



The two articles and a related editorial explore the financial and logistical challenges associated with a pharmacist-led AWVs developed and delivered within a physician’s office.



AWVs are an underutilized benefit of Medicare, APhA noted. They are cost- and copayment-free services that keep patients healthy and well. AWV providers must assess medical and family history, risk factors, routine measurements and vital signs, as well as provide yearly immunizations, a complete medication review and cognitive impairment and depression screenings.



The viewpoint article “Medicare Annual Wellness Visits: Patient need and pharmacist patient care services intersect” by Pamela Heaton stated. “Our older patients need the preventive care provided through AWVs, pharmacists are uniquely qualified for providing medication management and other health-and-wellness services, a reimbursement mechanism is available, and we have an ample — and growing — supply of pharmacists. We must play an important role in filling this gap and should now step boldly into this currently available space.”



An analysis of the first experience article, “Development and implementation of a pharmacist-delivered Medicare annual wellness visit at a family practice office,” by M. Thomas and J. Goode, stated, “As the pharmacy profession's role in health care continues to evolve, more responsibilities in primary patient care services are being assumed by pharmacists. However, this growth has been inhibited by minimal cognitive service compensation by payers. AWVs present a new opportunity for pharmacists to provide a financially viable patient care service that is covered for Medicare beneficiaries through the Affordable Care Act. Pharmacists can successfully be integrated into the healthcare team to provide AWVs and thereby enhance the health and wellness of Medicare patients.”



An analysis of the second experience article, “Financial implications of pharmacist-led Medicare annual wellness visits,” by I. Park, et al, stated, “Pharmacists are not currently recognized as healthcare providers under the Social Security Act, which limits reimbursement potential and impedes the ability to establish outpatient clinical pharmacy services. The Affordable Care Act of 2010 presents a unique opportunity for higher reimbursement than that traditionally available via AWVs. By conducting wellness visits, pharmacists can be both valuable assets to the primary care team in practices of varying sizes and generators of revenue to support their positions.”



These experiences conclude that the challenge in expanding this type of service will be in providing a reimbursement mechanism that will enable pharmacists in any setting to develop relationships with primary care providers and offer AWVs. To enable this possibility, pharmacists need be recognized as providers by the federal and state governments and by private payers, APhA stated.

The full-text articles are available on the Journal’s website at JAPhA.org.