What did you

say? ABC or
AWV?
Communication and
Medicare Annual
Wellness Visits

Bradley Carqueville, PharmD

Jordan Clark, PharmD
Objectives

Identify potential barriers to communication with the geriatric population

Develop approaches to successful communication with geriatric patients

Describe components of a Medicare Annual Wellness Visit (AWV)

Evaluate interventions and opportunities for pharmacist-led AWVs

Apply communication strategies to patient cases

Effective
Communication
With Geriatric
Patients

Bradley Carqueville, PharmD

PGY2 Ambulatory Care
Community Health Network
BCarqueville2@ecommunity.com
Communication

Communication is an overall complex process

As patients age, they may develop impaired senses, slowed

processing of information, memory loss, and emotional distress

These barriers limit health literacy

• Leads to increased healthcare usage, poor health outcomes, and greater

potential for medication errors
Communication Considerations

Hearing Vision Perceptions

Hearing Considerations
Hearing Impaired Patients

One in three patients over 65, and nearly half of all patients
over 75 years of age have some level of difficulty with hearing
• Common causes include loud noises, earwax buildup,
medications, and genetics
Many patients will have hearing aids to assist with hearing
conversations, television, radio, and other common noises

Background noise or multiple people talking can result in a

significant impact on the ability to concentrate
Tactics for Assisting the Hearing
Impaired
Sit face to face
Talk slowly, clearly, loudly
Limit background noise
Don’t chew gum or eat while speaking
Supplement with visual aids
Vision Considerations
Visually Impaired Patients

Patients will complain of blurred vision, visual field loss,

difficulty reading, and more

Common causes: macular degeneration, glaucoma,

cataracts, and diabetic retinopathy

Limits ability to provide written instructions, provide

visual education and demonstrations
Tactics for Assisting the Visually
Impaired

Diagrams Color
Font Size
Font Size
& charts Choice
Visual Impairment Cases

89 year old male presenting to your pharmacy with

concerns about being able to take his medications as
prescribed due to his limited vision

• He is taking 56 units of Basaglar daily

Insulin • He cannot see the numbers on the pen, so he turns
the dial to what “feels” like the right amount

• Has his own set-up for remembering to take his pills,

12 prescription but notices that he forgets if he took some of his
bottles meds by the time he gets to the end
 Perception
Considerations
Generational Gaps

Properly addressing patients

Use of technology
• May be lacking basic knowledge of hardware/software operations
• May not own a computer
• May have a distaste for or a discomfort with technology and the
internet

Telephone encounters
Cognitive Difficulties

Reduced processing of information

• Difficulties in vision or hearing can compound this when patients have
to work harder to make up for the loss of other senses
• Repetition and summarization

Confusion/Dementia
• Orienting/re-orienting the patient
• Consider sticking to yes or no questions rather than open ended
questions
• Avoid interrupting but may lightly help if patient searching for a word
Caregivers

Understand the caregiver’s role – especially from the

patient’s perspective
• Legal authority on decision making
• Including the patient in healthcare decisions

Address the patient directly, not the caregiver

Check with patient if they want caregiver present when

discussing sensitive subjects
Tips & Tricks
 Distraction-
free
environment

Plain
Teach-back
language
Making
Face to face
communication
conversations
effective
Frequently Frequently
summarize! summarize

Provide
written
instructions
Summary

Need to optimize communication to provide effective

care for our elderly population

Be aware of, and take into consideration the different

barriers that limit communications with patients

Bridge the generational gap and address perceptions of

care on both sides
Medicare
Annual
Wellness Visits

Jordan Clark, PharmD

PGY2 Ambulatory Care
Community Health Network
JAchenbach@ecommunity.com
Medicare Annual Wellness Visits

– Developed through the Affordable Care Act of 2010

– Focus of patient’s wellness and preventive screening services
– Covered service
– Original Medicare
– Medicare Advantage
– Covered by Medicare Part B:
– Part B for over 12 months
– Not received an AWV in the past 12 months
“a physician, qualified non-physician practitioner,
medical professional (including a health educator,
PharmDor
registered dietitian, nutrition professional,
other licensed practitioner), or team of such
medical professionals who are working under the
direct supervision of a physician.”
Medical and family history

List of providers

Review allergies and medications Visit

Health risk assessment
Components

Screenings

• Hearing impairment
• Risk of falling
• Cognitive impairment
• Depression

Preventative health
Review allergies and medications

Think Pair Share

Health risk assessment
Demographic data

Self-assessment of health status

Psychosocial risks

Behavioral risks

Activities of Daily Living (ADLs), including but not limited to: dressing,
bathing, and walking

Instrumental ADLs, including but not limited to: shopping, housekeeping,

managing own medications, and handling finances
Fall Risk
Cognitive Impairment Screening
Depression Screening
Preventative Health Assessment

Age-appropriate preventive services Medicare covers

Recommendations from the United States Preventive

Services Task Force (USPSTF) and the Advisory
Committee on Immunization Practices (ACIP)
Preventative Health Assessment

Example Screenings Candidates

Bone Mas Women determined by their physician or qualified
Measurements non-physician practitioner (NPP) to be estrogen
deficient and at clinical risk for osteoporosis
Colorectal Cancer Aged 50 and older who are at normal risk of
Screening developing colorectal cancer
Screening Aged 40 and older: Annually
Mammography
Hepatitis C Virus High risk for HCV infection
(HCV) Screening Born between 1945 and 1965
Health Advice

Fall Physical
Nutrition
prevention activity

Tobacco-use
Weight loss Resources
cessation
Billing

G0438 G0439
AWV initial AWV subsequent

Personal prevention Personal prevention

plan of service plan of service
 Value of Pharmacist-led Visits
At least comparable to those provided by providers
• Higher rates of health advice, vaccination recommendations, and
screenings
3-month study evaluating 300 patient AWV records
• Average of 5.4 interventions, made 272 referrals, ordered 183 diabetes
and lipid screenings, offered 370 vaccinations, and made 24 medication
and dosage changes
Similar reimbursement compared to providers
• ~$100 average for subsequent AWV visit

Physician and patient satisfaction

Patient Case

– MM is a 68 yoF
– PMHx: HTN, HLD, COPD, MI 5 yrs ago
– Medications: albuterol inhaled PRN, aspirin 81 mg po daily, atorvastatin 40
mg po daily, Breo Ellipta 100-25 inhaled daily, carvedilol 25 mg po BID,
lisinopril 20 mg po daily
– Screenings:
– Mammogram 2017
– DEXA 2017
– Immunizations: influenza 2017, pneumonia series completed 2016, Tdap
2016
 Possible Interventions

Inhaler
Medication Signs/sx
Specialists technique,
monitoring bleeding
adherence

DEXA results-
Mammogram Colonoscopy Flu, Shingrix
CaVitD?
Activity Time!
What did you
say? ABC or
AWV?
Communication and
Medicare Annual
Wellness Visits

Bradley Carqueville, PharmD

Jordan Clark, PharmD