Nurse Coaches are Improving the Medicare Annual Wellness Visit

There are plenty of reasons to have a nurse perform annual wellness visits (AWVs) from a business perspective; however, there is a much greater reason to have a nurse coach perform AWVs from the coach to client perspective.

If you are a nurse coach who is drawn to helping people with healthy aging, then this may be a great opportunity to help people 65 and older.

Let’s explore what an AWV is and how Nurse Coaches can improve better outcomes.

What is the Annual Wellness Visit?

The Medicare Annual Wellness Visit was created in 2010 as part of the Affordable Care Act. It is a yearly visit initiated to create and maintain an individualized preventative care plan. This visit is intended to bridge health maintenance care gaps and assess various risk factors.

The AWV is a highly beneficial program, but…. there is often a misconnection. Patient’s sometimes feel this is a complete “waste of time” and is just a “big money game”. They do not see the value of a conversational visit to help prevent health issues versus a physical exam when a change in health has already occurred.

The AWV is not a head-to-toe physical, but rather a review of health history, risk factors, and health maintenance screenings. It’s a way to personalize a patient centered care plan to lower or prevent disease and/or manage chronic disease.

Being a Medicare Wellness Nurse, I explain the visit as a proactive health session to include everything involved in the wellness exam per Medicare guidelines along with an opportunity to explore positive change based on the client’s perception of better health and well-being.

Who can bill for the Medicare Wellness visits?

An M.D., D.O., or APRN-CNP can bill Medicare. Think of it as any individual provider that carries an NPI can bill for an AWV.

RNs and BSNs cannot bill within their scope of practice; however, they conduct the wellness visits. The nurse is under the direction of the Provider who must review and sign the visit.

What are the benefits of having a Nurse Coach in the role of the Medicare Wellness Nurse?

Although AWVs are not solely conducted by a nurse whether APRN or RN, as a trained nurse coach you are perfect for this role. Having the additional training as a nurse coach, you can better improve patient outcomes by utilizing the nurse coaching process to engage, enlighten, and motivate the client.

We are amidst a shift in healthcare that is driven by a health-guided approach rather than a disease-guided approach. Holistic nurse coaches are leaders in advocating for preventative care…. and AWVs support healthy aging by taking a health-oriented approach, thus making a nurse coach the right fit for this role.

Nurse coaches have approximately 30-45 minutes to spend with the client where a healthcare provider has much less time. This provides a precious opportunity to authentically listen to the client and ask those probing questions to engage and evoke motivation to make positive changes. You are gaining trust and building a relationship with this client who may not have a connection like that with anyone else.

Imagine the opportunities to grow your practice

Let’s say you made a connection with a client during the AWV and that client felt so moved that they cannot wait for their next AWV? That’s a whole year away. What if you helped guide them to realize their meaning of well-being and insight new S.M.A.R.T. goals?  What if they ask to continue seeing you for coaching outside of this one annual visit?

There are many opportunities Nurse Coaches can explore to grow your practice from this one visit:

• Meet with your employer and explore possible opportunities to continue coaching this population of older adults. You can explain the CPT codes for Health and Well-Being coaching to support your proposal. This type of coaching is not billable…. yet, but the client will benefit regardless.
• Coach privately. Talk with your employer about referrals. Perhaps you can rent space in your employer’s facility or offsite for coaching private pay clients.
• Perhaps your employer has a nurse innovation program which would be a great place to vet your ideas.

As the aged population keeps growing as people live longer, the Nurse coach plays an important role in AWVs by partnering with the client to achieve their goals.

Nurse coaches are perfect for performing Medicare annual wellness visits because they can help the client achieve a better perspective of what health looks like to them and then create a plan to achieve their goals.

Stemming from the AWV, a Nurse Coach can potentially turn the connections from these visits into a coaching relationship.

“[Nurse] Health Coaches can provide the instruction, the tools, the information, the facilitation of behavior change and of information exchange that leads to the creation of health instead of the suppression of symptoms or disease.”

-Mark Hyman, MD