Jaime Lewis (Host): This podcast is for informational purposes only, and is not intended to be used as personalized medical advice. According to the Centers for Medicare and Medicaid Services, millions of Americans are eligible for Medicare annual wellness visits, yet many don't take advantage of this important preventive care benefit.

Here to help us understand more about these visits and their importance is Dr. Alexa Celerian, an internal medicine physician with Skagit Regional Health. Dr. Celerian brings a unique perspective to patient care as an osteopathic physician focused on holistic and compassionate treatment approaches. This is Be Well with Skagit Regional Health.

I'm your host, Jaime Lewis. Dr. Celerian, welcome to the program.

Alexa Celerian, DO: Thank you. It's good to be here.

Host: Let's start with a basic question. What is a Medicare annual wellness visit?

Alexa Celerian, DO: So a Medicare annual wellness visit is a yearly exam that you typically do with your primary care provider. Often it focuses on maintaining your health, preventing future illnesses. When we think about going to a doctor, we usually think about going there when we feel sick, when we have a particular health concern.

During those types of regular clinic visits, your doctor usually doesn't have a lot of time to go over preventative care. The Medicare annual wellness visit allows for providers to see the overall health status of their patients. Evaluate for things like physical functioning so that we can make sure we create a plan moving forward.

Host: You already mentioned that it's a primary care physician that performs these visits. Is that correct?

Alexa Celerian, DO: That is correct. Yeah, usually done by your primary care provider, so whether it be your doctor, physician assistants, nurse practitioners. Often it's best to do these visits with the health professional that you see regularly, the people who know you best. The intake part usually is done by the medical assistants or the nurses.

This includes checking things like your height and weight, the vision screening and the hearing screening, the memory screen, going over your medications, assessing for anxiety, depression and fall risk. Those are done by usually the medical assistants or the nursing staff, and they report these to the provider so that we can go over them during your visit.

Host: What can a patient generally expect from this visit?

Alexa Celerian, DO: We talked briefly about kind of the initial part of the visit, just to dive a little bit more in detail on what to expect. The vision screen is similar to what you would do when you see the eye doctor. We use an eye chart to see if there's any concerns about your vision, at which point we have the opportunity to be able to send a referral to an eye specialist if we think that's warranted.

The memory screen, we talked briefly about that too. It's a two part test. It's called the mini cog. It involves memorizing and recalling a three list of unrelated words. And then we ask patients to draw a clock. Oftentimes we ask patients to fill out a form called a health risk assessment. It goes over various aspects of your overall health. For instance, we talk about the psychosocial risk. So anxiety and depression, loneliness and pain. We go over behavioral risks such as tobacco use, recreational drug use, physical activity, alcohol consumption. We talk about safety, so safety at home, safety when driving a motor vehicle.

And another important part is also going over activities of daily living, such as being able to dress yourself, feed yourself, bathe, toilet and just to see if there's any physical limitations, that increase your risk of falling that we need to address. After these, we typically want to go over your medical history, family histories, your current medications and any medication changes, and then probably the more important part is the preventative care.

Things like age appropriate vaccines, so making sure you're up-to-date on those vaccines. We also go over cancer screenings. So those are guided by the United States Preventative Task Force. This includes things like breast cancer screening, lung cancer screening, prostate cancer screening, colon cancer, cervical cancer.

Those are screenings that we would typically do. And we screen for abdominal aortic aneurysms and talk about things like the bone density scan. And at this time, we can order those age appropriate screenings that are needed. Another important part of the Medicare wellness is the advanced care planning.

So, things like healthcare directives, your power of attorney, the living will that goes over the patient's wishes. Those are also important things that we discuss and oftentimes if one doesn't have that, then we provide them with information, so that they can fill those out. If you do have one of those already, oftentimes we ask for a copy so that we can file it into your medical records, you know, in case if you're ever in the hospital, then they have access to it also.

And then there's a form called a POLST form. It stands for Physicians Orders for Life Sustaining Treatment. It talks about whether or not you would want resuscitation, and so we often go over that, and fill those out if appropriate. Overall, the main goal is to make sure we have a personalized prevention plan, assess your health risk and encourage patients to make healthy life choices.

Host: That's an incredibly broad and comprehensive intake that you do, on each of these annual visits. What advice do you have for patients to come prepared to go through a Medicare annual exam?

Alexa Celerian, DO: Probably an important thing is, oftentimes before your appointment, we send the health risk assessment questionnaire, via mail or electronically. If you're able to fill this out in advance, that's helpful. It helps make sure that we have a thorough understanding of your health history so that we can review it, prior to the visit.

And it also sometimes can serve as a reminder of questions that you might want to ask or raise during your appointment. It's also helpful to have your medication list, your doses of medications. Some patients bring their medications to the visit, and that's also appropriate. And then if you've had any new procedures in the past year, any new surgeries or any new medical conditions that you were diagnosed with, it's helpful for us to have this information. So that, we have an overall, understanding of your health history.

Host: It sounds really similar to, say, an annual physical, and I'm wondering, what is the difference between an annual wellness visit and an annual physical?

Alexa Celerian, DO: Yeah, it's a good question. You know, the terminology can be a little bit confusing. So, an annual wellness exam focuses on maintaining your health and preventing future illnesses. It does not, however, include a physical exam, that's done by your doctor. So, the doctor, when you go in for your annual wellness visit, doesn't necessarily have to examine you, so they don't listen to your heart and lungs, that you would typically do for a physical exam. If one has a specific complaint or if you wanted to discuss a health concern with your doctor, for instance, you, if your knee hurts, you know, that would not be part of the annual wellness visit. Some providers are happy to address that during the visit, but often it's billed as a separate, encounter as, as like a regular clinic visit. Other providers will ask you to schedule a separate appointment to address those acute health concerns that are not part of the wellness exam.

Host: How can I go about scheduling my visit?

Alexa Celerian, DO: You can schedule your visit by calling your primary care provider's office. Some clinics have the ability to schedule online through the electronic portal and that's also a reasonable approach.

Host: And are these visits covered by a patient's Medicare plan?

Alexa Celerian, DO: Yeah, the annual wellness visits are covered by the Medicare Part B plan. So for the first 12 months of being on that plan, you can schedule what we call a Welcome to Medicare visit. So that's your initial wellness visit. And that establishes that foundation of your medical care, your health care.

The Welcome to Medicare visit is a little bit more comprehensive and often includes an option to do like a baseline EKG, so a heart rhythm strip, so that we have a baseline for you. And then in order for the annual wellness visits to be covered by Medicare, you just want to make sure that they're at least a year apart from the last time you had an annual wellness visit.

You know, the things often people ask, you know, what are the things that are not covered by the annual wellness visit? As mentioned previously, the physical exam is not something we typically do during these visits. If we were diagnosing new illnesses that you haven't been diagnosed with in the past, that's not something that's covered.

And then doing diagnostic tests like X-rays, ultrasounds or blood work that are not considered preventative are not part of that visit. And overall, although they're not mandatory, we usually encourage patients to do these visits once a year. Scheduling an annual doctor's visit to assess your health is just as important when you're feeling fine as it is when you're feeling sick or under the weather.

It's just about making sure you're getting all the screenings and vaccines you need to stay on top of your health.

Host: Excellent. Well, Dr. Celerian, thank you so much for sharing your expertise with us today.

Alexa Celerian, DO: Thank you.

Host: That was Dr. Alexa Celerian, a board certified internal medicine physician at Skagit Regional Health. To schedule your Medicare annual wellness visit or learn more about the services offered at Skagit Regional Health, visit SkagitRegionalHealth.org. If you found this podcast helpful, please share it on your social media channels.

And don't forget to check out our full library of health focused episodes. Thank you for listening.