What screenings and interventions are recommended for a Medicare annual wellness exam?

Medicare Annual Wellness Visit Screening Components

The Medicare Annual Wellness Visit should include comprehensive assessment of physical measurements, cognitive and mental health screening, functional status evaluation, cardiovascular and diabetes risk assessment, age-appropriate cancer screenings, and personalized prevention planning with advance care directives. 1

Required Core Assessments

Physical Measurements and Vital Signs

• Height, weight, BMI calculation, and blood pressure determination must be performed at every visit 1
• Blood pressure screening is essential for cardiovascular risk assessment in this population 2

Cognitive and Mental Health Screening

• Cognitive assessment using the Mini-Cog test (sensitivity 76%, specificity 89% for dementia) is required 1
• Depression screening with PHQ-2 or PHQ-9 must be completed 1
• Mental health screening is a critical component that should never be neglected 1

Functional Assessment

• Evaluation of activities of daily living and mobility is particularly important for patients ≥65 years 1, 3
• Functional performance assessment helps identify early decline and intervention opportunities 3

Medical History Review

Comprehensive History Components

• Medical history including family history of autoimmune disorders, complications, and common comorbidities (obesity, obstructive sleep apnea, non-alcoholic fatty liver disease) 1
• Medication review assessing medication-taking behavior, potential rationing, intolerance, and side effects 1
• This medication reconciliation is essential given polypharmacy risks in older adults 1

Laboratory and Metabolic Screening

Cardiovascular Risk Assessment

• Lipid profile (total, LDL, HDL cholesterol and triglycerides) if not done within the past year 1, 3
• Annual lipid screening is recommended for cardiovascular disease prevention 2

Diabetes Screening

• A1C testing if not available within the past 3 months 1, 3
• Diabetes screening is a core component of chronic disease prevention 2

Additional Metabolic Testing

• Bone health assessment including calcium, vitamin D, and phosphorous levels when appropriate 1
• Thyroid-stimulating hormone (TSH) testing is particularly important for older women 3

Cancer Screening (Age and Gender-Specific)

For Women Age 65

• Cervical cancer screening with Pap smear every 3 years, or cytology plus HPV testing every 5 years for ages 30-65 1
• Clinical breast examination annually 1
• Mammography biennially for women aged 50-74 years 1
• BRCA risk assessment by evaluating family history, with referral for genetic counseling if risk factors identified 1

Colorectal Cancer Screening

• Fecal occult blood testing annually for individuals >50 years 2
• Flexible sigmoidoscopy every 4 years, or every 2 years if high risk 2
• Colonoscopy every 2 years if high risk for colon cancer 2
• Barium enema may substitute for sigmoidoscopy or colonoscopy when deemed advisable 2

For Men Age 65

• Annual digital rectal examination and prostate-specific antigen test 2

Additional Screening

• Annual dermatologic examination of previously irradiated fields or for high-risk patients 2

Social Determinants and Behavioral Health

Social Risk Assessment

• Assessment of food security, housing stability, transportation access, financial security, and community safety 1
• Social determinants significantly impact health outcomes and must be addressed 1

Substance Use Screening

• Tobacco, alcohol, and substance use screening with appropriate counseling 1
• This screening is essential for cardiovascular disease and cancer prevention 2

Lifestyle Assessment

• Physical activity and sleep behaviors assessment, including obstructive sleep apnea screening 1
• Eating patterns and weight history review 1
• Physical activity promotion is a core recommendation for chronic disease prevention 2

Personalized Prevention Planning

Prevention Plan Development

• Personalized prevention plan based on identified risk factors and health needs 1, 3
• Referrals to health education and prevention counseling services based on screening results 1, 3
• The prevention plan should address tobacco avoidance, physical activity, BMI maintenance <25 kg/m², and nutritionally balanced diet 2

Advance Care Planning

• Advance care planning discussions including identifying surrogate decision makers 1
• This is a required component that addresses end-of-life preferences 4

Special Considerations for Older Adults

Bone Health

• Osteoporosis screening is particularly important for postmenopausal women 1
• Bone densitometry for postmenopausal women and men ≥50 years 3

Infection Prevention

• For patients with history of splenic irradiation or splenectomy: pneumococcal, meningococcal, and Haemophilus influenzae revaccinations every 5-7 years 2

Vascular Screening

• Abdominal ultrasonography once for men aged 65-75 years who have ever smoked 3

Common Pitfalls to Avoid

• Never substitute brief physical examinations for the comprehensive preventive services required by Medicare 1
• Do not neglect mental health screening—it is a critical component 1, 5
• Avoid focusing solely on physical health while neglecting behavioral and social aspects 1, 5
• The traditional annual physical examination has little empirical evidence of value; the AWV must focus on prevention and screening 2
• Ensure adequate time allocation and team-based approach for efficient completion of all required elements 4, 6