Practice Notes

AWVs: A hidden gem in quality reporting

by Alexandra Povlishock

This is a guest post from Advisory Board Consulting.

A few years ago, I was sitting in the boardroom of a major health system answering a question I tend to hear often: "How do we improve our quality metrics when our staff is already so busy?" This particular system was looking to improve quality reporting for its Accountable Care Organization, but I'm running into this type of question more and more as organizations prepare for the Medicare Access and CHIP Reauthorization Act (MACRA).

While we're still awaiting the MACRA final rule that will give us clarity about exactly how quality reporting and performance will affect reimbursement, we know quality reporting mandates under MACRA are more robust than ever before. When I hear this question, one opportunity I highlight is the same one that I highlighted that day—leveraging your Medicare Annual Wellness Visits (AWVs).

Harnessing the potential of the AWV

I'm often asked, "Why focus on AWVs as opposed to other quality initiatives?" AWVs have a significant return on investment that often goes unrecognized because many overestimate the complexities of AWV capture. Once the EHR is optimized to easily capture the elements required by Medicare for reimbursement, the work associated with AWVs is really quite simple, yet also impactful to the patient.

For those unfamiliar with AWVs, my colleague John Kontor recently explained:

"[AWVs] are a service that is good for patients and for the health system's strategic objectives alike. They are not performed nearly enough. And, much of the 'work' of delivering the AWV can be guided by the EHR, including patient reminders, documentation, patient education, and determining eligibility."

Aside from the simplicity of AWV capture, there are a number of downstream benefits including increased revenue and improved preventive service delivery and patient outcomes. With a reimbursement rate nearly double that of a typical patient visit, AWVs are also a great mechanism for incentivizing physicians to get on board with robust quality reporting. And, access to this preventive care service is free for patients.

As more organizations shift their focus to quality measure performance, the real value of AWVs is that these encounters can be leveraged to capture information that will positively impact quality scores and, as a result, physician reimbursement. For instance, if a practice decided to focus on AWV delivery, it could tweak its EHR to capture metrics that are also applicable for reporting under MIPS, including:

  • Preventive care and screening: influenza immunization
  • Pneumonia vaccination status for older adults
  • Breast cancer screening
  • Screening for clinical depression
  • Falls: risk assessment

How, and when, to make changes

The reason so many members are quick to get on board with AWV optimization efforts is because it can be a straightforward process. In fact, it only takes about three months to get a practice’s EHR optimized and staff enabled for successful AWV capture—meaning if you move fast, you still have time to implement this before 2017, when organizations must start reporting on quality metrics for MACRA.

While AWVs are a great option for efficiently ramping up quality efforts, I still want to be clear that they are not the panacea for quality-based payment. There are certainly other avenues for achieving high standards of quality, but in my experience, practices have a better chance of achieving a higher return for their hard work if they go the AWV route.

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