Primary-care docs to get 10 percent Medicare bump next year. New wellness exam covered, too.

December 3, 2010

As part of an effort to boost America’s flagging primary care industry, Medicare says it will offer a 10 percent bonus to doctors who perform mostly primary care services in 2011, and will begin paying for an annual “wellness exam” to supplement its one-time-one “Welcome to Medicare” physical.

As part of an effort to boost America’s flagging primary care industry, Medicare says it will offer a 10 percent bonus to doctors who perform mostly primary care services in 2011, and will begin paying for an annual “wellness exam” to supplement its one-time-one “Welcome to Medicare” physical.

For struggling primary care physicians, these changes should be warmly received. Yet they are still not well known, even though they begin next month, in part because the details them have just recently been finalized through the regulatory process-but also because Medicare has done its usual sub-par job of communicating changes to providers.

Medicare patients will love the annual wellness exam, during which physicians (nonphysician providers such as NPs and PAs are also eligible) are to draw up an individualized prevention plan for patients to include “a written screening schedule for the next [five] to 10 years, based on recommendations of the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices,” according to the American College of Physicians. Find out more about what’s to be covered here. The exams figure to be lengthy, but the Centers for Medicare and Medicaid Services (CMS) said it will pay for them as level-4 visits. In 2010, Medicare paid $131.37 for a 99204 (new patient) and $92.37 for a 99214 (established patient).

Patients who’ve already had the Welcome to Medicare exam can get the new wellness exams starting Jan. 1. Others must first get the Welcome to Medicare physical; they would then be eligible for the annual wellness exam the following year, and each year thereafter.

CMS also said that in 20011, it will begin paying a 10 percent bonus to family physicians, internists, geriatricians, pediatricians, NPs, PAs, and certain clinical nurse-specialists “for whom primary care services represent 60 percent or more of their [Medicare physician fee schedule] allowed charges in a prior period.”

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Primary care practices, get ready for the onslaught of appointment requests you’ll likely be getting this month and next, as millions of seniors begin to realize that the wellness exams are available. The changes are part of health reform, and several things are striking. First, this is genuinely good news for the primary care specialties that need all the help they can get, but I don’t think very many people - patients and providers alike - know about this new benefit. I’m wondering how many of you were even aware that Medicare would begin offering annual wellness exams on top of its Welcome-to-Medicare physical. How prepared are you to begin providing them, and billing for them? (Note: Speaker and consultant Betsy Nicoletti is offering a Webinar on getting ready for the new benefit on Tuesday. We have no role in the Webinar and I can’t vouch for it, but I can say that Betsy is a contributor to Physicians Practice and has been a source for years.)

And I’m curious to see how perceptions of health reform will be affected (if at all) by the slow dawning of public awareness of benefits like this. Medicare patients will love this new visit, but will they even realize that it comes courtesy of “Obamacare,” or will they just see it as an unrelated administrative decision by Washington bureaucrats? It’s clear that the Obama administration has done a terrible job of explaining exactly what people will be getting, benefits-wise, as a result of reform. Instead, officials have been more focused on the various “abuses” of the private insurance industry that will be prohibited under reform, like insurance rescissions and lifetime coverage caps. It’s all fine and good that those things are going away, but the fact is that very few people (in percentage terms) were ever affected by them in the first place. Yet eliminating them - along with covering the uninsured - were the primary selling points for reform. Both laudable goals, but both are problems that affect a minority of citizens. This new wellness benefit, on the other hand, will be available to every single Medicare beneficiary and will be among Medicare’s most popular benefits right from the start. And most people are unaware of it, or only dimly aware.