Lindsborg clinic sees quick success boosting Medicare Wellness Visits

The Family Health Care Clinic team includes Karna Peterson (back row, fifth from right) and Julie Worcester (back row fourth from left), who led the push to increase Annual Wellness Visits among the clinic's Medicare patients.Annual Wellness Visits are a regular opportunity for Medicare patients and their physicians to give special attention to personalized prevention plan. Needed screenings are performed or scheduled, risk factors and treatment options are addressed, and diet, home safety, and available community resources can be discussed, among other things.

“It’s a time to give guidance or encouragement on important aspects of wellness that a provider and patient may not have time to discuss in a typical office visit,” said Karna Peterson, Clinic Manager at Family Health Care Clinic, which is part of Lindsborg Community Hospital.

Family Health Care Clinic (FHCC) was already exceeding the national average for percentage of patients getting Annual Wellness Visits (or AWVs), but they wanted to do better.

“We were seeing a lot of patients who weren’t taking advantage of all the screenings that they were eligible for, and the Annual Wellness Visit is a dedicated time to make sure that recommendations were done,” said Peterson. “I feel like it’s our duty as health care providers to help patients understand their benefits and the health care they have access to and can benefit from.”

By incorporating the AWV into regularly scheduled patient appointments, they administered significantly more wellness visits. They now build this in before the patient sees their provider and will communicate any findings as recommendations during the visit with their primary care provider.

They did this by scheduling a nurse visit prior to the patient’s yearly physical exam with the primary care provider. By building in this process, patients can discuss any recommendations and findings with their primary care provider.

The clinic sees 2,240 Medicare patients. Prior to this intervention, in 2018, 21% of the clinic’s Medicare patients were receiving the AWV. The national average is 19%.

After the intervention—from January 2019 through May 2019—they were able to complete 602 Annual Wellness Visits resulting in a 27% AWV rate in the first five months of the year.

“Now we are doing more bone density scans, mammography, and an uptick in colonoscopies,” Peterson said. “Two patients received a low-dose CT scan resulted in some findings—we feel that those would likely not have been caught otherwise.”

• One patient (66-year-old female) had a recent lung biopsy due to the findings of the low-dose CT. This patient now been diagnosed with a primary adenocarcinoma of the lung. She was asymptomatic at the AWV and had the low-dose CT done because of meeting smoking status/history screening criteria in the AWV.
• Another patient (71-year-old male) had a low dose CT of the lungs and it picked up hepatic lesions that were recommended by the radiologist for further imaging.

Patients have praised this new scheduling approach—some have even begun requesting the AWV. The nursing and medical assistant staff have also expressed satisfaction with the new approach to scheduling AWVs, as reflected by a few of their comments:

• “I enjoy doing the AWVs because the interaction I have with the patients allows me to make a positive impact on their lives.”
• “It’s satisfying to do AWV’s with patients because I get to help them improve their health by informing them of all preventative services, they may be eligible for and getting those ordered.”
• “My favorite thing about AWVs is being able to interact with the patients on a more personal level. This type of visit allows me to listen if they need to talk or give them a chuckle if they needed a laugh.”
• “I wish patients were more informed of the benefits the AWVs have on their health and know that FHCC does AWV as part of a regular office visit now, which takes a lot less of their time but still gets results.”

Self-Management Education

FHCC has also made significant strides in assisting patients in better managing chronic conditions. They have implemented several of the Self-Management Education (SME) programs aimed at empowering patients in their care through knowledge, support, and guidance. In order to create a sustainable program, they’ve used mostly volunteers as program educators—retired local coaches, teachers, and community leaders. Using volunteers ensures that leaders are passionate about helping patients and ready to serve the community in this way. The volunteers are also doing outreach—using traditional approaches as well as social media—for these programs and other clinic initiatives. Most of the patients participating in the program have been self-referred.

The program educators have found satisfaction in being able to help patients better understand the disease they are managing, to support them in their efforts, and to offer guidance for taking steps for further improving their health outcomes. In the words of one volunteer, Cynthia Woodard:

“I enjoy teaching SME classes because I have the privilege of sharing a whole ‘toolbox’ of methods that empower people to care for their chronic condition instead of letting the chronic condition control the patient. Working in conjunction with the patient’s medical health care team, these classes can lessen pain and fatigue while improving the quality of life for anyone dealing with a chronic health condition.”

Weight Management program

The journal American Family Physician recommends using Therapeutic Lifestyle Change (TLC) techniques when attempting to help patients make behavioral adjustments. FHCC has incorporated this into their Medically Supervised Weight Management program with the intent to promote health and prevent chronic disease. Time is always an issue for primary care providers to properly address weight management during regular visits, so the clinic uses physician assistants to oversee the program.

The physician assistants use chronic disease protocols in helping patients with weight management. They work with the same patient for two years, which they have found yields more sustained improvement and true behavioral change.

The physician assistants work in collaboration with the patient’s primary care provider to monitor their progress and provide support. Together they have been able to decrease participants’ medications associated with chronic disease and they have experienced both lower overall A1c and blood pressures as well as fewer medications.

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