Scheduling combined visits improves wellness care and reduces no shows

Background and goal: A recurrent barrier to Medicare annual wellness visits, which provide preventative medicine guidance for older and disabled patients, occurs when patients introduce medical concerns to physicians during these preventative visits. In this study, researchers scheduled combined visits in a single, longer slot with patients' regularly seen clinicians and used allowed billing rules so both visits could count to see if they could increase the percentage of annual wellness visits completed and the quality measures captured. 

Study approach: A family medicine department with five clinics ran a nine-month quality improvement effort for patients aged 65 and older on Medicare. The department team started booking longer 40-minute "combined" appointments so patients could complete the Medicare annual wellness visit and, if needed, have regular medical issues handled in the same visit with their regularly seen physician. The team then tracked, month by month, how many eligible patients got a wellness visit, how often people missed appointments, and how many screenings, tests, and vaccines were ordered, comparing results with the nine months before the change to see what improved.

Main results:

• Medicare wellness visits increased from 8.4% to 50.8% over nine months.

• No-show rates were lower for combined visits than annual wellness-only visits (11.9% vs 19.6%).

• Patients had lower no-show rates for annual wellness visits with their regular physician than a different clinician.

• Orders and screenings increased across many measures, including depression, falls, pain, breast/cervical/colorectal/lung cancer, DEXA, A1c, urine microalbumin, Hep C, HIV and pneumococcal.

Why it matters: The findings suggest scheduling longer, combined visits with patients' usual physicians may help increase the completion of annual wellness visits, reduce no shows, and close screening gaps, while still fitting within existing Medicare billing rules.