Results of a study of the Medicare annual wellness visits reported in the November issue of Health Affairs cast further doubt on the value of the routine checkup and on the wellness visits in particular.
CMS introduced coverage of the annual wellness visit for people in traditional Medicare in 2011. The free visits were one of the first—and least controversial—parts of the ACA to go into effect. They were intended to make high-value, evidence-based preventive care widely available to seniors. If prevention can prevent expensive medical care, then the visits might also reduce health care expenditures.
Using 2008–2015 Medicare claims data, Ateev Mehrotra, an associate professor at Harvard Medical School and a member of the Managed Care Editorial Advisory Board, compared Medicare beneficiaries seen by practices that provided the ACA wellness visits to those seen by practices that didn’t (an “intention-to-treat” design that was supposed to offset selection bias at the individual level). The outcomes they looked at included screening, both appropriate (for example, mammograms for women ages 50–74) and low-value (Pap smears in women ages 66 and older with no cervical cancer history), emergency department visits, and hospitalizations for ambulatory care–sensitive conditions (asthma and bacterial pneumonia, for example). They found some differences between the two groups in appropriate screening and emergency department visits. Those differences vanished when they factored in how the beneficiaries used services prior to the wellness visits.
“In sum, we found no substantive association between annual wellness visits and improvement in care,” concluded Mehrotra and his coauthors.
One of their suggestions: A more targeted approach that would encourage people who are less engaged in their health care to get the wellness visits. A disproportionate number of people who seek wellness services of all kinds are the “worried well” who are already healthy.
Some commentators say the problem is with content of the wellness visits and what the annual checkup has become. In this critique, their failure to produce good outcomes is a consequence of their brevity and a focus “checking the boxes.”