Transcription:
Medicare Wellness Visits at Memorial Medical Clnics

Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand.

This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.

Melanie Cole (Host): Welcome to Say Yes to Good Health with Memorial Hospital. I'm Melanie Cole, and I invite you to join us as we discuss Medicare Wellness Visits at Memorial Medical Clinics. Joining me is Laura Maranville. She's a Nurse Practitioner at Memorial Hospital. Laura, I'm so glad to have you with us today. So tell the listeners, what are Medicare Wellness Visits.

Laura Maranville, APRN-FNP (Guest): Well, thank you for having me. So, Medicare Wellness Visits are visits that Medicare does pay for. They help with the care of each patient for a personalized plan to help prevent diseases and disabilities. And it's based on each person's current health and risk factors so it helps to individualize each person while they're getting older.

Host: Well, then who qualifies for these types of visits?

Laura: So it's interesting because the qualification varies. But typically when you think of Medicare, you think of older adults anywhere from 65 to 66 and above, but technically anyone who is on Medicare qualifies. This is people who have qualified for social security disabilities at a younger age. And it just depends on the year they start. If they're under 65, they have to be on Medicare for 24 months prior to the visits. If they're 65 and 66, they qualify for their first initial annual Medicare visit. And then after 66, they qualify for a Medicare Wellness Visit yearly.

Host: Wow. So tell us a little bit about referral. Do they need a referral? Do they call you directly? Do they have to speak to their primary care provider first? Tell us how that works.

So they did not need a referral. Medicare started doing these visits back in 2011. I do believe. It didn't really go into the facilities until about 2015. To referral, there's no need for referral. We do ask that our providers help schedule the appointments and explain to them what Medicare Wellness Visits are.

And then sometimes my staff or myself will call patients to explain and get them on the schedule just to help them out. Interesting because we started it and then we kind of had a pause. And then once again with COVID hit, unfortunately we paused again and have been trying to do these online for protection of the elderly.

And typically with people who are younger with Medicare, of course they have health issues. Also, we don't want to expose anybody to anything that's not natural, of course. And then so they can call us, we call them, we see the providers can do them themselves. They're timely. So sometimes it takes like an hour to get through it.

And that's where I come into play. I can help the providers out, if they would like me to. It's nice because they get a chance to sit down and actually talk. And sometimes a doctor visit can be, you know, 15, 20 minutes to 30 minutes and this way they get like an hour and some with my nurse and myself.

That's cool. That's such great patient care. So before we get into what the visit consists of, why should those who qualify have one of these visits? What's so important about it?

Laura: It's important because it helps individualize each person. It helps prevent diseases and disabilities based on each person's current health and risk factors. It promotes good health through disease prevention and detection. It helps a patient have their voice heard. And another set of eyes on them, making sure that we're doing giving the best care possible to each person.

And a lot of these tests that we do or recommend are paid by Medicare. So these are visits that aren't charged. The patient will never have to pay it's and any tests that we order that Medicare pays for it during this visit. It's stuff that is provided to the patient free of costs at this time.

And a lot of Medicare people do not understand that or have not been told that. So it's nice to have that.

Host: Well, it's so important to have preventive visits. So tell us a little bit, you just mentioned tests. If they're ordered, what does the visit consist of? What is it like for patients? What do you talk about? What kind of tests might be ordered? Tell us a little bit about the visit itself.

Laura: So the first visit would be your Welcome to Medicare visit. Like we talked about. This visit actually the very first visit only, allows an EKG to be done on the very first time. And that's important to have the EKG done is because if you ever do have chest pain, et cetera, it's nice to have a normal EKG when you're not stressed to compare if you were having chest pain to have a second look. Then our preventative screening, we go off, the nurse does their interview and we talk about cognitive impairment, trying to make sure people are safe at home. Do they have carpets at their house? How are they walking? Have they fallen? Do they have advanced care directives like DNR or power of attorney, that kind of stuff, is it on file, are their families aware of this?

We go over their vaccinations. We go over each of their medical diagnoses. We go over any lab work, they have questions about. So basically that is just the you know, the eyesights are they seeing their other doctors, dentist and all that good stuff. Just a friendly reminder. And then the preventative and screening services that we ask for that Medicare does cover, is abdominal aortic aneurysm screening.

Alcohol misuse screenings and counseling, bone mass measurements, which is the bone density test, cardiovascular disease screenings, cardiovascular disease behavioral therapy, cervical and vaginal cancer screenings, colorectal cancer screenings and there are several different types of that, depression screenings, diabetic screenings, diabetes self-management training.

There's the flu shot. Glaucoma testing, hepatitis B shots, hepatitis B virus infection screening, hepatitis C screening tests, HIV screening, lung cancer screening, mammograms, nutrition therapy services, obesity screening, and counseling. The pneumonia shots, prostate cancer screenings, sexually transmitted screenings.

COVID-19 vaccinations are available, flu shot, hepatitis B shots and pneumococcal shots are all paid for during this visit, if they need to have them or want them. Tobacco use cessation counseling. So these are like preventative. So the main preventative screenings that are available to each Medicare patient, as long as they qualify under each category.

Host: Well, let's talk about that. So how do they qualify under each category? You mentioned colorectal cancer screening and you know, the recommendations to start our colonoscopies at a certain age at age 50 or earlier if there's a family risk, how do they qualify? Based on risk factors, is a based on family history. Is there a Medicare qualification they have to fill out. Tell us a little bit about how somebody qualifies for these screenings.

Laura: Sure. As far as the colon cancer, there are different studies of saying, well, you start at 40, 45 or 50. Typically we do the 50 as of right now, age 50 age. It is based on, we recommend anybody over the age of 50 to do this. We do a referral at that time to our local GI specialist, unless or general surgeon, unless the patient wants to go elsewhere.

And that is perfectly fine. If they want to go elsewhere for any of these prescreenings, we are okay with it. As long as we are taking care of them and making sure they don't get worse or, you know, preventive. We prefer of course, our facility, but if they want to go elsewhere, that's perfectly fine. We don't hold any grudges by any means.

Age 50 to 85 is usually what it is. They cannot show any symptoms of colorectal diseases. As far as a lower GI pain, blood in stools, positive fecal occult blood testing. So, basically you should be symptom-free, cause this is preventative. Now, if you already have a GI bleed or history of ulcers or cancer, then it would not be available at this time because you should already be getting the colonoscopy screenings on a regular basis from your primary and Medicare will be covering that anyway. Average risk would be people who have family history of colorectal cancers, history of polyps, Crohn's disease, that kind of stuff. There are simple DNA testing that you can do, which we can mail to your home called Cologuard. And it measures the stool's DNA. The gold standard of course, is a colonoscopy, but a lot of patients are like, no I don't have any symptoms. Let's do a DNA sample instead. And that's fine, also. Now, if it's positive, then we, of course their provider will reach out to them and say, hey, it's time to get this colonoscopy. This is the best for you. There's also like barium enemas. There's an upper GI.

Host: Oh, there's so many lovely tests, aren't there? Now Laura, how do you go about making an appointment for a Medicare Wellness Visit at Memorial Medical Clinics? Tell us a little bit the actual appointment situation, who do they call? And then we'll talk more about this.

Laura: Sure they can call, they can call their own provider if they want to just make it simple and say, hey, I want a Medicare Wellness Visit. Get them on their schedule. That's just as simple as that. They can call the main Carthage Campus and say I want a Medicare Annual Visit. Do I qualify? The girls up front will know.

And they just put them on a patient's schedule. It's just very easy. And like I said, we also reach out to people. We have a list of who has had it before, who hasn't, we call them and say, hey, this is what it's about. So there's no referral needed. We've just got to get them on the schedule and get it out there that we are here. It's easier to catch a train before it leaves the station than after it leaves the station. So it's so important to do these pre screenings just to make sure things are going well in a person's life.

Host: Well, 100% agree. Preventive medicine is really the wave of the future, you know, and it's so much better to treat something before it happens than to prevent it than to have to treat it once you're sick. So Laura, we mentioned so many different screenings that are so important for people to have. Now, the Medicare Wellness Visits that you talked about in the previous part of our show today, do those visits only occur once or is this something that happens on a regular basis?

Laura: So we prefer, and it is recommended strongly that they are done every year. And it, you know, just every year, it helps to cause people's life changes, you know, their health changes, they get older. We can catch certain things prior. Say you're a smoker. We can do, or you've quit. You can do a low dose lung CT scan, as long as you don't have any symptoms to make sure we don't have any cancer there.

And then if it was suspicious, we shoot for the full dose CT scan, if the patient's willing. So, every year is what we prefer to have happen so we can make sure that we're taking care of our patients. And that's what Medicare's guidelines are, is yearly.

Host: I'd like you to tell us a little bit about what they get out of these visits. Okay. First of all, we know they're improving the health of those who get them because they make them aware of these things like the low dose CT scan or the colonoscopy. And for all you people saying, I don't want to colonoscopy just get it. You know, they take out the polyps. It's one of the few preventive cancer procedures tests that we have out there. And it's not a big deal. It's really not a big deal, but anyway. I'm off my soap box, Laura. But how these visits well, I mean, I have mine every five years right now. So I know what they're like, but how do these visits improve their health with what the information you give them? Tell us a little bit about the after visit summary. What do they get out of this?

Laura: Yeah. So I actually enjoy the after visit summary. I actually enjoy seeing these patients that aren't even mine just to talk to and have them talk to me. And sometimes they tell me stories and I absolutely love it. And we may go over our hour, but that's okay. So, what they get is this after visit summary and it talks about if there's any new orders, it talks about, it shows their upcoming visits to any providers or specialties. We also go over their specialty providers to put them on the chart so that if you start seeing a kidney doctor, but we don't know about it, it's now put in there.

It talks about their advanced directives, gives them information on how to do it, if they want to do it, make sure it's on file in our Epic system. And it gives them a list of all their medical diagnoses. It gives them a current list of their medications. This to me is one of the most parts is that I strongly suggest, I'll make two copies that they want it one they could put in their billfold or purse and one, they put on the refrigerator with their medical history.

It gives them their allergies. Make sure they're up to date. It gives them their personalized Medicare Wellness Plan. I guess it's called Medicare Wellness, Personalized Preventative Plan, PPP. It talks about diet and water, exercise, sleep, home safety, and it each person is individualized just a little bit with what we put in a system. Chronic pain, if you have it, it talks about urinations nighttime, learning to live with pain. It talks about the advanced directives. It gives you numbers you can call or websites that you can visit to get more information about it. Suicide prevention hotline, one of the best things that I do love is that we have Evergreen Facility, which is, like patients are depressed. And you'd be surprised how many lonely people there are out there as far as they've lost their wife or their husband. They miss talking to people. They lost their cat or their dog. And then we can, and this is a free service also, and it's not a referral, but they can, I give them information like, hey, this is, this is the program. You can call them. You don't have to, but you can call them. I don't have to refer you. Anything that happens. If you have any friends that are a Medicare in Hancock County, give them the information, have them call. They can talk to somebody. It's a very nice program that we have available. We talk about their lab work, their hemoglobin A1C if they're diabetic, what to do for that, it also gives them their health maintenance recommendation care, which, you know, it's also individualized for every patient. And it talks about whether it, shows if they've had their annual wellness visit for Medicare. Their yearly physical, which is different.

If they're diabetic, it recommends a foot exam yearly, a urine microalbumin, their hemoglobin A1C, have they had their eye exam, lipids and their vaccinations. And it will show you if it's never been done. It shows you the due date and it also shows you the completion date.

Host: Wow. So, it's really a whole health history of that particular person with a lot of great advice shoved in there as well.

Laura: Yeah. And then it has goals for your blood pressure, hemoglobin A1C that kind of stuff. It's very nice. And then at the bottom of it, it also states their address, who their primary care doctor is, and just make sure everything's up to date for them. That's in their chart and also in the paperwork.

Host: What great information and such a comprehensive visit that is, and I'm glad you mentioned depression and Evergreen because that, you know, people don't realize, like you say that there are a lot of lonely people, but that depression is so common among our citizens that it really is and people don't even realize it. And another one is that stress management and sleep quality and all of those things. Right. And it's important for people to know their numbers, their blood pressure, their A1C, so that they can keep track. Right.

Laura: Excellent point. Back to mental health real quick, you know, it's always been a quiet topic, if you have mental health or depression, especially for men. But we have to understand that mental health is so important. It'd be like you broke your ankle or you have a sore throat, or you have a migraine, people go to doctors and providers for those problems.

Mental health is just as important if not more important. So, it's important to, to get these done. The Annual Medicare Visits, we also go over depression screenings. So, that's important. And I have people are very honest. I have not had anyone, the ones that come it's honest to, gosh, it's been a joy doing this. It's one of my personal favorite things to do.

Host: I can hear that because I can imagine that you work so, well with patients, especially patients that are a little reticent to come in. Some patients, as you said, the ones that don't want to have a colonoscopy, some patients don't even want to know what their blood pressure is. I know my husband was one of those and tell, and I'm an exercise physiologist. I'm like, okay, we are going to know your blood pressure on a near daily basis. But you know, some people don't want to know these numbers, but it's so, so important as you say, for preventive health. And what else do you feel is really important in these screenings? Cause you've mentioned sleep and diabetes and exercise and tell us about some of those.

Laura: So as far as your blood pressure, you know, the gold standard to my knowledge is 140 over 90, below 140 over 90. So if you get 140, that's great, but we really want you at 138, that's the gold standard. And then body mass index, your weight and a height, Medicare wants you below 30%. And a lot of patients aren't, don't know what all that means. They go off of your height and your weight combined and the body mass index. So we talk about that and a lot of elderly and I'm 50, so I have lovely arthritis is a long story. We won't go there.

Host: And you're the age to get a colonoscopy

Laura: It is, but I haven't had done it yet, but I'm going to by the end of the year, because of after in this year. Yes, exactly. So, and my friends are too. We actually, I just emailed everybody the other day on Facebook. I'm like, oh yeah, we've gotten ours. We got our scheduled, get your husband going. So we do it as a team. And same with mammograms. Make it a lunch date with your friends and go get your breasts squeezed yearly or every two years, and then go out for dinner. Or margarita is, or something limited.

Host: Nice.

Laura: Make it a fun

Host: Mammograms and margaritas. Let's start that club. That's a great club.

Laura: So like and your blood sugars, you know, hemoglobin A1C, it measures three months worth of your blood cause your RBCs recycle every 90 days. So it's what you been for three months? So when we ask for hemoglobin A1C, people are like, oh, I didn't eat anything last night. I should be good. Well, no, it measure the whole three months. So you don't get to cheat per se. And it helps the provider have that baseline of, okay, so your hemoglobin A1C is like 8.2. We want you at 6.2 instead, your sugars are about 150 daily is with the 8.2. You know, those are just examples. Don't quote me on that. That's just a, off the top of my head.

Host: Well. Okay. So we'll, you're going to have to come back on to talk to us about exercise because we've run out of time, but there's so much and these Medicare Wellness Visits are really such a gift to people because they are so comprehensive. So I would like you to wrap this up. I want your best summary. I want you to really tell the listeners right now why the Medicare Wellness Visits at Memorial Medical Clinics are so important for their overall health and why that helps them to be their own best health advocate. And if they don't have a health advocate, you know, that they can get someone to go with them to these, whatever it is that they need to do. So they get this information.

Laura: I think life is busy, no matter what. And it's hard for people to come in sometimes, but this gives them the chance to come in initially. We can do others by Tele-health if they want to every year. It's so important because it gives them a little bit of social visits. It gives them, we go over their medical, their social health history.

We go over preventative services. Things that they are offered, reminding that if they, this visit is free, it's a hands-off visit. You know, we can go over if there's questions that aren't medical-related like hey can you ask so-and-so to work with this? So I send the doctors a note, what the patient wants or requests. It promotes good health through disease prevention and detection. It validates their concerns. It lets them know that they're not alone with whatever's happening. There's just so much more to it.

Host: Well, it's a wonderful comprehensive way to really take control of your health. And thank you so much, Laura, for joining us. To make an appointment for Medicare Wellness Visits at Memorial Medical Clinics, you can call 217-357-2173. Or visit our website at mhtlc.org, and search Medicare Preventative Visit to schedule your visit today.

I'm Melanie Cole. Thanks so much for listening to this episode of Say Yes to Good Health with Memorial Hospital.

Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand.

This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.