Implementing Medicare Annual Wellness Visits In A Primary Care Setting: A Quality Improvement Project

Domingos Martins, Sacred Heart University

A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.


Background: Annual Wellness Visits (AWVs) are a service for Medicare beneficiaries that provides the opportunity to establish a personalized preventative care plan. Benefits for the patient include early disease detection and prevention, increased wellness, and reduced risk of hospitalization. The use of AWVs in primary care practices remains low. Many PCPs choose not to adopt them because of barriers such as insufficient time for the visit and documentation requirements.

Purpose: This quality improvement project aims to implement AWVs by utilizing a health risk assessment (HRA) questionnaire and a workflow that limits disruption at a recently established, independent primary care practice that does not provide AWVs.

Methods: The Plan-Do-Study-Act (PDSA) tools from the Institute for Healthcare Improvement (IHI) guided the implementation phase. Staff’s knowledge regarding AWVs was assessed by informal survey after receiving education. A weekly retrospective chart review was done for 12 weeks to determine the number of Medicare beneficiaries receiving an AWV and the number and type of preventative screenings ordered.

Results: After receiving education, staff verbalized key takeaways and felt their knowledge had subsequently increased. Of 11 patients, 63.6% (n = 7) received an AWV. Colorectal cancer screenings were ordered for three patients. Breast cancer screenings were ordered for two patients. Laboratory blood work, including screening for diabetes mellitus and lipid disorders, was ordered on all seven patients.

Discussion: This project successfully implemented a brief HRA questionnaire and workflow that made AWV utilization at this practice achievable. Return on investment includes higher CMS reimbursement rates for AWVs, greater patient satisfaction which is enormously important to a growing practice, and reduced healthcare costs.