Busy with wellness visits? CMS paying for more screenings

You may have noticed this already in your waiting room, but the Centers for Medicare and Medicaid Services' (CMS)  marketing campaign to promote the new annual wellness visit appears to be paying off.

CMS reported in early October that almost 1.3 million Medicare recipients took advantage of the program, which has no copayment or cost-sharing for beneficiaries. That number is up from 780,000 recipients taking advantage of the program as of the end of June, when the campaign began, and 1.06 million at the end of July. Those numbers represent one subset of the 20.5 million people whose care is covered by Medicare and who received some preventive services with no deductible or cost-sharing this year.

Now, CMS has decided to pay for two new programs that may send more patients to your office. One is an annual screening visit for depression, and the other is an annual screening and behavioral counseling visit for alcohol misuse, both in a primary care setting.

For the depression screening, a primary care physician (PCP) would be required to have “staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment, and follow-up,” which the proposed rule defines as, at a minimum, someone such as a nurse or physician assistant who can advise the physician of screening results and can facilitate referral of the patient for mental health treatment.

Ideally, more comprehensive care would be available, including case management by a nurse or other nonphysician working with the PCP, planned collaborative care between the PCP and mental health clinicians, patient education and support for patient self-management, as well as “attention to patient preferences regarding counseling, medications, and referral to mental health professionals with or without continuing involvement by the patient’s primary care physician.”

CMS also has determined that alcohol screening in a primary care setting is necessary to prevent early illness or disability and will pay for up to four brief, face-to-face, behavioral counseling interventions per year for Medicare beneficiaries, including pregnant women.

The program would be for individuals:

who misuse alcohol but whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence (defined as at least three of the following: tolerance; withdrawal symptoms; impaired control; preoccupation with acquisition and/or use; persistent desire or unsuccessful efforts to quit; sustained social, occupational, or recreational disability; or continued use despite adverse consequences); and

who are competent and alert at the time that counseling is provided; and

whose counseling is furnished by qualified PCPs or other primary care practitioners in a primary care setting.

In addition, practitioners would be required to follow the so-called “5 As” adopted by the U.S. Preventive Services Task Force. In that protocol, clinicians performing the screening/intervention would:

Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.

Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.

Agree: Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior.

Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-on goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.

Arrange: Schedule follow-up contacts to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.

The American Academy of Family Physicians and the American Medical Association endorse CMS’ depression and alcohol screening programs.

Go back to the current issue of eConsult.