Physical exam vs annual wellness visit: the differences explained

Can you tell the difference between an annual physical and an annual wellness visit (AWV)?

Question: Can you tell me the difference between an annual physical and an annual wellness visit (AWV)?

Answer: Although both types of exams have prevention in mind, there are many differences between them.

An annual physical exam is a more thorough examination than an annual Medicare wellness visit. A typical annual medical exam is a “hands-on” type visit, including a physical exam and any blood work or lab tests that may be part of the exam or necessary for the patient’s chronic stable conditions.

Alternatively, the AWV is a “hands-off” risk assessment. The purpose of the AWV is to identify gaps in care, improve the quality of care delivered by a provider, and help paint a picture of a patient’s current health status in order to create a reference for future care.

What is included in a physical exam?

An annual physical exam is an assessment of your body’s health. The main purpose is to look for health problems.

During the exam, your doctor uses their senses – primarily sight, touch, and hearing – to assess how your body is performing. Based on what he learns, your doctor may ask you to take tests to discover or rule out possible health problems.

The list below shows some of the things a doctor may do during a physical exam.

Visually check the patient’s entire body for signs of existing health problems:

  • Examination of the patient’s eyes, ears, nose and throat to detect any problems
  • Listen to the patient’s heart and lungs for irregular sounds
  • Test motor function and reflexes
  • Perform pelvic and rectal exams
  • Measure height, weight and blood pressure

Submit or order urine and blood samples for laboratory tests, screening purposes and for ongoing chronic illnesses

Generally, Medicare does not cover an annual medical exam. The exam and any tests ordered by your doctor are separate services, and you may have costs associated with each depending on your health insurance plan.

What is included in a Medicare wellness visit?

A Medicare AWV, also called a wellness exam, is an assessment of the patient’s general health and well-being. The primary focus is prevention – either to develop or update the patient’s personalized prevention plan. Medicare covers an AWV once every 12 months (11 full months must have passed since your last visit), and patients are eligible for this benefit after having had Part B for at least 12 months.

During the exam, a doctor or PPA (usually a primary care provider) combines information from the visit with the patient’s medical record to assess your risk of common preventable health problems such as heart disease, cancer, and heart disease. type 2 diabetes. Based on what they learn, your doctor creates your personal prevention plan with a checklist of the screenings you need to undergo.

The list below shows what needs to be done during a wellness exam.

Review your health risk assessment (questions you answer about your health)

  • Confirm the patient’s medical and family history
  • Record current medications (including prescriptions and over-the-counter medications) and providers
  • Measure and document the patient’s height, weight and blood pressure
  • Look for signs of memory loss, dementia, frailty, depression, stress, pain and fatigue
  • Consider behavioral risks, including smoking, physical activity, nutrition, oral health, alcohol use, sexual health, motor vehicles (i.e. wearing the seat belt) and home safety
  • Assess activities of daily living (ADL)
  • Document patient health risk factors and treatment options, including referrals to education and counseling programs
  • Provide personalized health advice
  • Develop a screening schedule (like a checklist) for preventive services recommended for you
  • Review potential risk factors for opioid use disorder (OUD)
  • Screen for potential substance use disorders (SUDs)
  • Advance care planning (eg, living will, power of attorney for health care), if the patient chooses to

Medicare Part B covers one annual wellness visit and many preventative screenings with no copayments or deductibles. However, you may have to pay part of the cost of some recommended tests or services.

Renee Dowling is a compliance auditor for Sansum Clinic, LLC, in Santa Barbara, California.

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