The Intersection of FFS and VBC Medicine: AWV APV APPE

08/17/22 | Featured

by Jonathan Hart, MD MBA

As the introduction of this series explained, there are activities a physician or provider can perform in the office that benefit the patient and the practice regardless of one’s stance in fee-for-service (FFS) or value-based care (VBC) practice models. This intersection carries even more importance when one considers that, even in many successful VBC organizations, physician compensation still lags in the FFS and production world. The activities to be discussed can motivate the front-line doc from a production perspective while benefiting the organization from a VBC perspective.

AWV, APV & APPE

The first activities we’ll explore will be the combinations of Annual Wellness visit for Medicare (AWV), Annual Preventive Visits for commercial plans (APV), and Annual Preventive Physical Exams for Medicare advantage plans (APPE).

From the FFS perspective all these yearly patient evaluations add revenue at a relatively higher rate than a typical office visit. A Medicare AWV generates the same work RVU rate as a moderate level visit, 99214, at 1.92. A well-planned and executed AWV can move quickly in an office setting. Since much of the data-gathering can be done by ancillary staff in the office, the amount of time needed by the physician or provider to get the same information from and benefit to the patient can be less than with a 99214.

Additionally, when coded properly, regular office visits can often be billed at the same time as an AWV. This is helpful when a regular office visit gets converted to an AWV (a function of a well-oiled daily huddle by the office staff). The benefits of the AWV can be realized, and the patient can get their acute need met.

Annual wellness/preventative visits are well-known in the VBC world as the foundation of medical management. Organizations mature in the VBC space recognize the multi-pronged value-producing activities of a well-performed AWV/APV.

Through an effective AWV/APV, a practice can: 

  • Appropriately document a patient’s burden of illness
  • Identify patients with chronic conditions
  • Verify that medications are reconciled
  • Attend to necessary, applicable HEDIS measures.

 

HEDIS Measures

 

The NCQA developed HEDIS measures as a way of measuring quality in medicine. While this definition of quality can be a source of philosophical argument, the bottom-line is this: HEDIS measure closure can lead to improved patient care. We’ll go into more detail on HEDIS in the next blog. The short story is that screening and preventative HEDIS measures can help avoid acute and chronic health issues or catch them early when the conditions are more impactable. Likewise, meeting the goals for management of chronic conditions like hypertension or diabetes leads to improved patient health, well-being, and outcomes – and savings in the cost of care. As a bonus, in many VBC contracts, closure of HEDIS measures can lead to quality bonus revenue from plans or open the gates to shared savings.

Annual Preventive Physical Exams (APPE), augment the findings of an AWV/APV utilizing a well-established tool in the physician’s toolbox – patient examination. A well-done exam can uncover early signs of chronic conditions and their poor control or discover other issues in need of addressing, such as suspicious skin lesions. The same benefits as outlined above apply. These exams are covered by most Medicare Advantage Plans, generating FFS revenue in addition to the VBC benefits.

When done well, these activities benefit patients, physicians, practices, and payers for a quadruple win. Patients fare better, physicians are more “productive”, and entities on the hook for health care costs benefit. Next up … HEDIS.