Wellness Reviews
Wellness Reviews are a two-edged sword. Required too frequently, they annoy the patients. Required too infrequently, they could deter effective treatment. I have heard comments from patients such as "The doctor should know what's wrong - I've been coming long enough", etc. Perhaps it would help if the doctor would say at the beginning of each 12-visit treatment cycle something like "We can follow this treatment plan for 12 visits and re-evaluate how your condition is changing through your next wellness review". That way, the patient would be expecting some follow-up paperwork. It might go more smoothly if the patient is aware up front. Perhaps we could use the idea of patient involvement in their overall treatment regiment as a selling point emphasizing that the doctor is really listening to each patient. Note: the question on the Wellness Review that begins - "On (this date), we developed a treatment plan of "..... is not productive, as most patients have no idea when the treatment plan started or how many visits it entailed. This would be better provided for the patient, possibly by the WC before giving the form to the patient, but I have no idea where to get this information either.
I see what your saying...if we communicated the need for periodic follow up as part of our routine, people would not balk at it so much.
Should we add communication about that to the first visit even to set that expectation nearly on?
I think that wellness reviews would be less frustrating to the patients if we did them every 4-6 months instead of every 12 weeks on paper. The Doctors still have to due the exams in the computer for notes on each visits either way so if there is something new or worsening the doctor can decide to have them fill out the review earlier and to have a paper trail of the changes but for the maintenance/ routine visits it frustrates a lot of the patients when they don't have anything changing from before or just the feeling of always having to make extra time when they come for an in and out visit to have the same forms to fill 4+ times a year.
Another idea is to change the Wellness review questions that are on there to be shorter but still to the point as a lot of the patients have been coming for years and don't remember there dates of starting, treatment plans or initial complaints.
I think that questions 2-5 on the wellness review would be a good shortened version and what most people fill out currently.
Quote from wcbrendaburgess@gmail.com on April 12, 2025, 5:57 pmWellness Reviews are a two-edged sword. Required too frequently, they annoy the patients. Required too infrequently, they could deter effective treatment. I have heard comments from patients such as "The doctor should know what's wrong - I've been coming long enough", etc. Perhaps it would help if the doctor would say at the beginning of each 12-visit treatment cycle something like "We can follow this treatment plan for 12 visits and re-evaluate how your condition is changing through your next wellness review". That way, the patient would be expecting some follow-up paperwork. It might go more smoothly if the patient is aware up front. Perhaps we could use the idea of patient involvement in their overall treatment regiment as a selling point emphasizing that the doctor is really listening to each patient. Note: the question on the Wellness Review that begins - "On (this date), we developed a treatment plan of "..... is not productive, as most patients have no idea when the treatment plan started or how many visits it entailed. This would be better provided for the patient, possibly by the WC before giving the form to the patient, but I have no idea where to get this information either.
Brenda, I love the idea of the doctor's preemptive conversation with the patients. As far as the date on the forms goes, that is something the WC should provide prior to giving the form to the patient. The date would be the date of their last Wellness Review or the date they last updated their forms. So a quick glance at the documents will give you that date. As far as the frequency goes, if the patient is on a WP then it would be 1 visit per week. If they are on a package or Flex it might be 2 visits per month.
Is the wellness review even necessary if we are properly documenting and updating the patients' condition in back office on the days of the re-examination. I mean the review isn't really protecting us if we are not really doing an exam, putting in the findings, and updating the goals and what not. For example, who cares what their wellness review states if we fail to check BP over 2 years of care and then the patient has a stroke. It asks about new injuries or complaints, but that's something I ask patients almost every visit. Updating the subjective, which is what the wellness review is asking, is something that we already do. Am I right?
Dr. Mike,
Do you think they should get a new brief exam with vitals and everything at the end of every 12 week treatment plan?
I've been researching myself assisted with ChatGPT and looking at Medicare's and NCBOCE's guidelines and apparently even for a wellness patients with no new trauma, injury, complaints, or change in health history, reexams should occur every 90 days or at 12 visits. Which is why axis won't let us push a care plan beyond 12 weeks. I guess my point is that wellness review shouldn't be looked at as a replacement for the reexam and if the paperwork is upsetting patients, then realistically we could handle taking care of that subjective portion during the reexam itself. I do think a brief exam would be fine. I also just checked on BP specifically in a wellness setting. Apparently "acceptable standard of care" is at least one check per year. So I would suggest vitals be done on the days the patient is hit with the annual reexamination form.
I would agree with Miss Brenda, I think preparing the PT with clear communication on how the treatment plan works and how when they come to the end of the plan we will reassess with a short exam would eliminate a lot of frustration for the PT. I think right now they just see us throwing more paper at them. I also think it would be helpful to create a way to digitally bypass PT's having to re-enter all of their info when it's time for their annual paperwork, and just re-sign the IC and a quick survey "any updates to home address, hospitalizations, surgeries, etc" and if "no" is selected, they only need to sign off on that.
I do not think it is a bad idea to do the first wellness review at 1 month. I feel that it is easier for them to remember how they felt and to show them the improvement that has been accomplished in that time frame. For long standing wellness patients, some that I have seen for the last couple of years, I think every 6 months is sufficient. Since we are not necessarily treating BP, I don't think it is something that needs to be assessed other than once a year, or as a short history at a re-exam necessitates that measurement.
I appreciate everyone's feedback. I think 12 weeks may be overkill for sure, especially when people skip several of those weeks. By the same token, to Dr. Mike's point....the board requirement is 12 weeks or 90 days, and they expect that to actually be a new exam, and history....every 90 days. With our 6 question wellness review, we are not asking much. While 6 months between may be most amenable to patients, I am afraid stretching it out that far would be a failure on our part to meet the minimum standards expected by the board. I will remind you all that several years ago, the board requested and reviewed the documentation from every Joint clinic in the state, and as a result of us NOT doing wellness reviews at that time at all....twenty something (21 or 22) docs all got a mark on their license, and had to complete a documentation course in order to keep their licenses. The decision we make needs to be adequate to prevent that from happening again.