What is included in a Medicare wellness physical assessment?

Components of Medicare Wellness Physical Assessment

The Medicare Annual Wellness Visit (AWV) includes a comprehensive health risk assessment, personalized prevention plan, and various standardized screenings but does not require a complete physical examination beyond blood pressure measurement. 1

Core Components of the Medicare Wellness Visit

Medical History Assessment

• Review of current and prior medical diagnoses, procedures, and surgeries 2
• Evaluation of comorbidities including cardiovascular, pulmonary, renal, metabolic, and musculoskeletal conditions 2
• Assessment of current symptoms related to chronic conditions 2
• Medication review including dosage, frequency, and adherence 2
• Vaccination status, particularly influenza vaccination history 2
• Cardiovascular risk profile assessment 2
• Identification of educational barriers and preferences 2

Limited Physical Examination

• Blood pressure measurement (required component) 3
• Assessment of vital signs 2
• Basic cardiovascular and pulmonary examination 2
• Evaluation of lower extremities for edema and arterial pulses 2
• Assessment of orthopedic and neuromuscular status 2
• Evaluation of cognitive function 2

Screening and Risk Assessments

• Health risk assessment questionnaires 4
• Depression screening (e.g., Patient Health Questionnaire-9) 2
• Cognitive impairment screening 2
• Fall risk assessment 4
• Functional ability assessment 4
• Sleep disorder screening (e.g., Epworth Sleepiness Scale, STOPBANG questionnaire) 2
• Physical activity assessment 2
• Nutritional assessment 2

Testing

• Resting 12-lead ECG (when indicated) 2
• Assessment of health-related quality of life using standardized questionnaires 2
• Selective laboratory testing based on risk factors 2
• Screening for abnormal blood glucose in adults aged 40-70 years with overweight or obesity 2

Prevention Planning and Documentation

Personalized Prevention Plan

• Development of a written treatment plan with prioritized goals 2
• Documentation of short-term and long-term strategies to reduce disease risk 2
• Creation of a follow-up plan reflecting progress toward goals 2
• Interactive communication of the plan with the patient and family members 2

Medication Management

• Ensuring appropriate medication regimens in coordination with primary care provider 2
• Identification of medications that may contribute to weight gain or other health issues 2

Implementation Considerations

Practical Aspects

• The visit should take less than 30 minutes to complete 5
• No comprehensive physical examination is required beyond blood pressure 3
• Standardized assessment tools are preferred by providers 1
• The visit should be tailored to meet the needs of a diverse population of older adults 4

Common Pitfalls

• Many eligible Medicare beneficiaries do not take advantage of this benefit 6
• The "one size fits all" approach may not adequately meet the wellness needs of diverse older adults 4
• Lack of standardized policies regarding AWV implementation across healthcare organizations 6
• Limited follow-up on identified issues can reduce the effectiveness of the visit 3

Potential Enhancements

• Some providers have explored adding ultrasound screening during Medicare Wellness visits, which has shown potential benefits with minimal negative outcomes 3
• Incorporating geriatric-focused approaches such as the 4Ms of an Age-Friendly Health System could improve AWV effectiveness 4
• Team-based care approaches may improve AWV implementation and follow-up 6

The Medicare Annual Wellness Visit represents an important opportunity for preventive care and health promotion for older adults, but its implementation varies widely across healthcare settings 1, 4.