In recent years, the Medicare annual wellness visit (AWV) has emerged as a pivotal opportunity to provide preventive health care to older adults. These visits, designed to focus on prevention rather than acute medical complaints, aim to improve long-term health outcomes by facilitating screenings, vaccinations, and health risk assessments. However, in practice, these wellness visits often encounter significant obstacles, primarily when patients present new or ongoing medical issues during the appointment. This common scenario frequently disrupts intended prevention-focused workflows, leading to incomplete wellness visit capture and lower compliance with screening guidelines. A novel approach, tested over nine months in a family medicine department encompassing five clinics, has demonstrated promising strategies to address these ingrained challenges effectively.
The central idea of the study was to merge Medicare annual wellness visits with problem-based medical consultations into a single, extended patient encounter. Unlike traditional shorter appointments dedicated exclusively to wellness visits, these combined sessions allowed patients to address both preventive screening needs and active medical concerns with their regular, familiar physicians. This integration was supported by Medicare’s billing allowances, which permit simultaneous coding for both visit types, thereby incentivizing co-delivery within one appointment. By scheduling 40-minute combined visits rather than the usual shorter slots assigned for wellness checks, healthcare providers aimed to reduce fragmentation and improve patient engagement.
Data collected over the intervention period were compared with baseline metrics from the preceding nine months to evaluate changes in wellness visit completion, appointment no-show rates, and the frequency of ordered screenings and diagnostic tests. The patient cohort consisted of individuals aged 65 and older, on Medicare, seeking care at one of the participating family medicine clinics. The multidisciplinary team tracked monthly outcomes, enabling detailed trend analysis and evaluation of process improvements attributable to the scheduling alteration.
The results were striking: the completion rate for Medicare wellness visits surged from a mere 8.4 percent before the intervention to an impressive 50.8 percent after nine months of implementing combined visits. This sixfold increase underscores the efficacy of integrating problem-based care with preventive services in encouraging patients to fulfill their annual wellness appointments. Such a dramatic rise reflects multiple factors, including increased appointment availability, enhanced patient-provider continuity, and the accommodation of patients’ broader healthcare needs within a single encounter.
No-show rates also experienced a notable decline when visits were combined. Specifically, the no-show rate for the mixed wellness and problem-based visits was measured at 11.9 percent, significantly lower than the 19.6 percent observed for visits scheduled solely as annual wellness checks. This reduction in missed appointments not only improves clinical efficiency and utilization of healthcare resources but also enhances the likelihood of early disease detection and intervention through more consistent patient engagement. The lower no-show rates likely reflect patients’ greater perceived value in combined visits, which address both preventive and symptomatic concerns without requiring additional clinic visits.
A further insight from the data revealed the critical role of continuity of care. Patients who had their annual wellness visits conducted by their regular physician exhibited fewer no-shows compared to those assigned to different clinicians. The established therapeutic relationship seemingly fosters greater trust and accountability, encouraging patients to adhere to recommended visit schedules. This finding emphasizes the importance of maintaining patient-provider continuity, especially in the context of preventive care where long-term monitoring is essential.
Closely associated with increased visit completion were improvements in clinical screening measures. The quality improvement project documented enhanced ordering rates for an array of preventive screenings and diagnostic tests, spanning several major domains. These included mental health screens such as depression assessments, evaluations for falls risk and pain management, and comprehensive cancer screenings for breast, cervical, colorectal, and lung cancers. Additionally, laboratory assessments, including glycated hemoglobin (A1c) for diabetes control, urine microalbumin for renal function, hepatitis C and HIV testing, as well as pneumococcal vaccination ordering, all increased substantially. These broadened screening initiatives collectively contribute to closing long-standing gaps in care delivery for older adult populations.
From a systems perspective, the adoption of combined visits represents an innovative process redesign that aligns clinical workflow efficiency with patient-centered care. Allowing longer appointment times recognizes the complex, multifaceted needs of older patients, particularly those with multiple chronic conditions. Such a model facilitates comprehensive care discussions without the constraint of switching between separate visit types, thereby reducing administrative burden for providers. Medicare’s flexible billing regulations, which authorize coding for both wellness and problem-based services in a single encounter, break down previous financial disincentives and support sustainable practice change.
These findings have broad implications for health policy and clinical practice, particularly within primary care disciplines where annual wellness visits have untapped potential to enhance population health outcomes. The successful implementation across multiple family medicine clinics suggests scalability and adaptability in diverse practice settings. By minimizing patient no-shows and enhancing adherence to preventive screening protocols, this approach promises not only to improve individual patient health trajectories but also to reduce downstream healthcare costs associated with delayed diagnosis and treatment.
Clinicians and healthcare administrators should also consider the relational dimensions underscored by the study. The preferential outcomes linked to continuity of care highlight a compelling case for models that strengthen ongoing patient-physician relationships, which may further maximize engagement with preventive services. In tandem with technological solutions such as electronic health record prompts or patient reminders, scheduling combined visits could serve as a powerful lever to advance Medicare wellness visit utilization.
While additional research is warranted to assess long-term clinical outcomes and economic impacts, the current evidence positions combined Medicare wellness and problem-based visits as a pragmatic and patient-centered strategy to address prevalent barriers in preventive healthcare for older adults. Future initiatives may also explore integration with emerging telemedicine platforms, potentially diversifying access and maintaining high-quality interactions. Overall, this quality improvement endeavor exemplifies a successful merger of policy, clinical workflow innovation, and patient engagement to significantly elevate preventive care delivery in aging populations.
In conclusion, targeted redesign of appointment scheduling that permits the combined delivery of Medicare annual wellness visits and problem-based consultations holds substantial promise for enhancing healthcare quality metrics. The approach effectively increases the uptake of critical preventive services while lowering no-show rates and maintaining compliance with current Medicare billing frameworks. By leveraging continuity of care and expanded visit duration, healthcare systems can better address the complex health needs of older adults and substantially close existing screening and preventive care gaps. This represents a scalable, evidence-based framework poised to influence primary care practices nationally and globally.
Subject of Research: Optimization of Medicare annual wellness visits through combined scheduling with problem-based care to reduce no-show rates and improve preventive screening adherence.
Article Title: Combining Medicare Wellness Visits With Problem-Based Visits Reduces No-Show Rates and Closes Screening Gaps
News Publication Date: 22-Sep-2025
Web References: https://www.annfammed.org/content/23/5/441
Keywords: Family medicine, Diseases and disorders, Depression, Health and medicine, Cancer screening
