Tuesday, April 3, 2012

The Mis-Understood Annual Wellness Visit

An article appears in today’s Sun Sentinel titled, “Few seniors go for Medicare wellness visits.” While the article points out that many seniors have not taken advantage of many of the new prevention benefits offered by Medicare, it also seems to reinforce this behavior. Specifically, it quotes a doctor from Miami who is not convinced that the Annual Wellness Visit has much intrinsic value. 

"I think it's nice that Medicare is offering an annual wellness visit. But it's not the same as an annual physical exam. It doesn't offer much more than recording some information," said Dr. Joel A. Danisi, director of clinical geriatrics at the University of Miami's Miller School of Medicine.

Danisi believes some doctors may view the wellness exam as duplicating what they already do for their older patients. "But I think it's perfectly reasonable for a patient to request one if they want it," he said.

I am truly shocked by his words. First of all, the annual physical exam is not a Medicare covered service. Doctors who perform it and bill Medicare are committing fraud. To suggest that all doctors routinely commit fraud is disconcerting. Second, a physical exam focuses on identifying problems that already have physical manifestations such as abnormal heart sounds, an enlarged liver and prostate, a lump in the breast, etc. This is completely different from the Annual Wellness Visit which focuses on assessing health risks, reviewing both prescription drugs and dietary supplements, and developing a five to year personalized prevention plan for the patient.

In response to Dr. Danisi’s comments, I wrote on the Sun Sentinel’s website the following:

Doctors who say that the Annual Wellness Visit doesn't provide much valuable information don't understand the value of primary prevention. Medicare's 100% paid for Annual Wellness Visit may be the only time your doctor ever truly focuses on your lifestyle and dietary supplement usage and tries to help you avoid diseases instead of just treating them once they develop. 
Don’t miss out on what is arguably the single greatest health benefit that Medicare has ever provided because it may disappear with the repeal of Obamacare. 

It's actually not very surprising that some doctors don't understand the value of primary prevention because medical schools spend very little time on such education and historically there has been no reimbursement available to doctors to practice it. Specific to geriatricians such as Dr. Danisi, they deal with the oldest patients who usually have a plethora of medical conditions and the last thing such doctors have time to typically focus on is health risk assessments of preventing new problems. I can't speak directly as to what compelled him to make such a statement other than to speculate that for the oldest patients he sees, he may feel that it is too late.  I believe that it is almost never too late to learn how to eat well, decrease stress. etc.

As someone who has taken care of Medicare patients for over 20 years, I believe that the Annual Wellness Visit is a game-changer for your health. For example, just yesterday, I saw a patient for such a visit. As is routine, we discussed his food choices. I asked him if he ate well. He said yes. I asked how much fruit he ate and he responded quite a bit. I then asked what fruit he ate and he responded that he ate mostly grapes, blueberries, and blackberries. I asked if he ate apples, bananas, citrus fruits, melons, etc. to which he responded no. While the fruits he is eating are full of nutrition, they lack several key nutrients found in some of the other fruits I’ve listed. As a result of our discussion, my patient committed to adding more types of fruits to his diet.

We also discussed his physical activity at length. It turns out that he is mostly practicing a sedentary lifestyle and we reviewed different ways that he can improve his physical fitness. These are but small examples of the value of the Annual Wellness Visit. It is the only time a doctor has to focus on the factors that can either prevent or lead to chronic disease.

Yesterday, I gave a lecture on the relationship between lifestyle and dementia to residents of a retirement community. It turns out that one of the attendees was 103. As I’ve written before, there are reasons beyond genetics why people live that long and one of them is they are curious people who take advantage of continuing opportunities to learn.  The Annual Wellness Visit is an opportunity to learn what it will take for you to stay healthy. If you want to stay sharp, keep learning and get your Annual Wellness Visit while it is still available.

Here's the link to the article:



  1. Medicare covers many screenings for people who are at high risk for certain diseases. During your Annual Wellness Visit template, you and your doctor will decide what tests and screenings you need

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