Medicare’s Annual Wellness and “Welcome to Medicare” Visits Should Include Opioid Use Review

Last Updated: Oct 2, 2018

doctor-elderly-coupleOpioid misuse and overdose among the senior population is a growing concern in Pennsylvania and the nation:

  • This month, the federal Agency for Healthcare Research and Quality released a report showing that, for adults age 65 and older, opioid-related emergency department visits more than doubled between 2010 and 2015.
  • The Pennsylvania Health Cost Containment Council shared data showing that the hospitalization rate for Pennsylvanians age 55 and older admitted for heroin overdose increased nearly 36 percent between 2016 and 2017.

Given that some Medicare beneficiaries have or may be at risk for Opioid Use Disorder (OUD), the Centers for Medicare and Medicaid Services (CMS) has issued guidance emphasizing the importance of reviewing opioid use for certain Medicare preventative benefits.

Physicians and practices who offer eligible Medicare patients the Initial Preventive Physician Examination (also know as the “Welcome to Medicare” visit) or the Annual Wellness Visit (AWV) should include a review of opioid use, including OUD, when reviewing a patient’s medical and family/social history. CMS says that if a patient is using opioids, the clinician should assess the benefit from other, non-opioid pain therapies instead, even if the patient does not have OUD but is possibly at risk.

For subsequent AWVs, clinicians should continue to include an opioid use review when updating medical and family history.

For further details on opioid use review for the AWV and Welcome to Medicare visit, read CMS’ MLN Matters article here.

PAMED’S Annual Wellness Visit Toolkit

Pennsylvania Medical Society (PAMED) members have free access to our Annual Wellness Visit Toolkit, a comprehensive resource to assist in carrying out wellness visits, and to meet the Centers for Medicare and Medicaid Services' (CMS') documentation requirements. This toolkit aims to simplify the components of wellness visits and provide physicians with the tools to comply with the documentation requirements.

The toolkit has been updated as of September 2018 to reflect CMS’ guidance on review of opioid use.

Get the Toolkit 

In this toolkit you will find helpful forms, each with related instructions for their use. The toolkit will download as a ZIP file, which contains a PDF document and many of the forms as customizable Microsoft Word documents.

Questions? Please contact PAMED's Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.


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