Is AI Coming to the Medicare Annual Wellness Visit?

The Centers for Medicare & Medicaid Services (CMS) is contemplating a shift in the Medicare annual wellness visit (AWV) towards a more AI-driven approach. This idea emerged in CMS's recent proposal for physician payment rules, though the impact of AWVs on patient outcomes remains inconclusive. While some studies suggest AWV increases preventive service usage, others find no significant association with improved screening, care utilization, or spending.

Given the mixed findings, CMS seeks to determine if AI tools could transform the AWV from a one-time assessment into a continuous, data-driven preventive care function. These potential AI tools range from pre-visit beneficiary information collection to identifying high-risk individuals and suggesting follow-up steps for clinicians.

Stephanie Carlton, CMS's deputy administrator and chief clinical AI officer, emphasized the potential for AI to fill a gap in AWV adoption. For the AWV to remain relevant, it must move beyond a physician-centric model to become a more continuous, beneficiary-specific preventive care function. However, CMS's proposed rule still mandates that the AWV be conducted by a physician or a team supervised by one.

The American Academy of Family Physicians (AAFP) cautiously supports the potential use of AI in AWVs. They believe AI tools can enhance AWVs by aiding in patient identification, summarizing health information, pinpointing gaps in preventive care, supporting documentation, and facilitating follow-up. However, the AAFP warns against models that could weaken the continuity and accountability of care, such as allowing third-party technology vendors to independently provide preventive care services.

They fear such models could lead to fragmented records, duplicated services, and compromised patient outcomes. The AAFP urges CMS to ensure any technology-enabled AWV strengthens, rather than undermines, the patient's established primary care team.