What are the recommended components of a Medicare annual wellness visit for a 65-year-old female?

Medicare Annual Wellness Visit Components for a 65-Year-Old Female

The Medicare Annual Wellness Visit (AWV) for a 65-year-old female should include comprehensive screening for chronic conditions, preventive services, and personalized health planning, with special attention to age-appropriate screenings for women.

Core Medical Assessment Components

• Medical history review including family history of autoimmune disorders, complications, and common comorbidities such as obesity, obstructive sleep apnea, and non-alcoholic fatty liver disease 1
• Medication review including assessment of medication-taking behavior, potential rationing of medications, medication intolerance, and side effects 1
• Physical measurements including height, weight, BMI calculation, and blood pressure determination 1
• Cognitive assessment using validated screening tools such as the Mini-Cog test, which has a sensitivity of 76% and specificity of 89% for identifying possible dementia 1
• Depression screening using validated tools such as the Patient Health Questionnaire-2 (PHQ-2) or Patient Health Questionnaire-9 (PHQ-9) 1
• Functional assessment to evaluate activities of daily living and mobility, particularly important for patients 65 years and older 1

Preventive Screenings

• Cervical cancer screening with cervical cytology (Pap smear) every 3 years, or for women aged 30-65 years, screening with a combination of cytology and HPV testing every 5 years 1
• Clinical breast examination which should be performed annually for women aged >19 years according to ACOG recommendations 1
• Mammography screening should be performed biennially for women aged 50-74 years 1
• Lipid profile including total, LDL, and HDL cholesterol and triglycerides if not performed within the past year 1
• Diabetes screening with A1C testing if not available within the past 3 months 1
• Bone health assessment including calcium, vitamin D, and phosphorous levels when appropriate 1

Social and Behavioral Assessment

• Social determinants of health assessment including food security, housing stability, transportation access, financial security, and community safety 1
• Tobacco, alcohol, and substance use screening with appropriate counseling 1
• Physical activity and sleep behaviors assessment, including screening for obstructive sleep apnea 1
• Eating patterns and weight history review 1

Personalized Prevention Planning

• Health risk assessment to guide further screening and evaluation, which is a formal requirement of the AWV 2
• Personalized prevention plan development based on identified risk factors and health needs 1
• Referrals to health education and prevention counseling services as needed based on screening results 1
• Advance care planning discussions including identifying surrogate decision makers 1

Special Considerations for 65-Year-Old Women

• BRCA risk assessment by asking about family history suggestive of increased risk for deleterious mutations in BRCA1 or BRCA2 genes, with referral for genetic counseling if risk factors are identified 1
• Counseling about risk-reducing medications for women at increased risk for breast cancer 1
• Osteoporosis screening which is particularly important for postmenopausal women 1

Implementation Considerations

• Allocate adequate time for the visit to ensure all required components are addressed 2
• Utilize a team-based approach with different team members performing different parts of the evaluation for efficiency 2
• Ensure proper documentation of all required elements to support appropriate billing 2
• Consider group Medicare wellness visits as a potential efficient approach for delivering high-value preventive care, though additional study is needed to compare effectiveness with standard care 3

Common Pitfalls to Avoid

• Avoid substituting brief physical examinations for the comprehensive preventive services required by Medicare 4
• Don't neglect mental health screening, which is a critical component of the wellness visit 1
• Avoid focusing solely on physical health while neglecting behavioral and social aspects of health 1
• Don't overlook the opportunity to address preventive services gaps, as AWVs increase the rates at which older adults receive recommended preventive care 2, 5