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The latest frontier in the fight against opioid abuse: Medicare's annual wellness visits

March 6, 2019

    As the opioid-related death toll soared to more than 47,500 in 2017, CMS and other federal agencies have made curbing opioid use a top priority. Amid other initiatives, CMS released a statement last August aimed squarely at primary care providers: Review of opioid use is now considered a routine element of annual wellness visits (AWVs) for Medicare beneficiaries. 

    Review of opioid use during AWV patient history

    The AWV is a wellness exam where patients work with their primary care provider to develop or update a preventative care plan based on their health and risk factors. As part of AWVs, providers administer a health risk assessment, take a medical and social history, obtain routine measurements, and log patient risk factors. Providers must supply documentation supporting that they delivered all exam elements to submit a claim for an AWV.

    In the statement released last August, CMS alerted providers that they must proactively ask patients about their opioid use during the medical and social history component of AWVs. Providers already had to document family medical events, past medical and surgical history, and medication use. But providers who consult CMS' educational booklet will see a new addition to this list:

    "We encourage providers to pay close attention to opioid use during this part of the AWV, which includes opioid use disorders (OUD). If a patient is using opioids, assess the benefit for other, non-opioid pain therapies instead, even if the patient does not have OUD but is possibly at risk.”

    By revising its minimum documentation standards, CMS is now fully leveraging AWVs to combat opioid use in the Medicare population. As a yearly, preventative office visit, AWVs present a prime opportunity to fast track early diagnosis and treatment of opioid use disorders.

    Next steps for medical group leaders

    1. Educate providers: Physician groups who furnish AWVs to Medicare beneficiaries should educate providers about this policy and the benefits of Medicare’s preventative services more broadly.

      How to help physicians provide Medicare preventative services

    2. Update EHR templates: It is also essential that medical groups appropriately capture opioid-related information in the EHR for both documentation purposes and clinical treatment. This ensures that at-risk patients receive the follow-up care they need and the group secures full reimbursement.

      Why the Annual Wellness Visit is actually a big EHR opportunity

    3. Access best practice research and tools on combatting the opioid epidemic: Explore our latest research on the opioid epidemic, all in one place at our opioid resources landing page.

    4. Your top resources for combatting the opioid epidemic—all in one place

    Learn more: 9 ways to confront the opioid epidemic

    As opioid abuse and addiction continue to spread across the country, urgency grows for hospital and health system executives to respond. Use our infographic to learn how.

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