Identifying barriers to implementation of the medicare annual wellness visit for patients of a rural federally qualified health center

Abstract

As the population ages, the Medicare Annual Wellness Visit provides an opportunity to address determinants of health and improve quality of life. It is designed to help practitioners provide evidence-based health promotion, disease prevention, and wellness recommendations to Medicare beneficiaries. While barriers to its use have been described in the literature, there is a lack of studies describing why underutilization of the Medicare benefit is worse in rural compared to non-rural areas. This study used the Human Factors Conceptual Framework to Map-Assess-Recognize-Conclude (HF-MARC) as a conceptual framework to identify barriers of Medicare Annual Wellness Visit use at two nurse-led rural Federally Qualified Health Centers in Midwest United States. Data were collected through a survey, two interviews, and review of organizational documents. After integrating the data, results revealed that socioeconomic barriers, inefficient data collection processes, marginally acceptable data collection tools, organizational policies, and rural recruitment and retention challenges may play a role in the low utilization of the Medicare benefit at the studied rural clinics. Similar rural practices should focus on improving workflow to deliver a level of benefit to patients which exceeds the opportunity costs they incur by attending the visit. Policymakers should fund public health initiatives which promote healthy aging.