Annual Wellness Visits Question Title * 1. Your name, city/state & email are required so that I can send the results of this survey to every participant. The others in this box just help me. Name: * Company: Address: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: * Question Title * 2. My practice is the following specialty or specialties (mark each that apply) Family Practice Internal Medicine General Practice Geriatric Medicine Pediatric Medicine General Surgery Cardiology Urology Radiology Otolaryngology Pulmonary Endocrinology Nephrology Osteopathic Medicine Ophthalmology Chiropractic Osteopathic Medicine Sports Medicine Orthopedics Nuclear Medicine Urgent Care Hospitalist Billing Service Durable Medical Equipment Neurology Specialty Surgery (Cardio, Neuro, Vascular, etc) Other Question Title * 3. How many practitioners do you have in your practice? 1 2 3 4 5 6 7 8 9 More than 9 Question Title * 4. What percentage of patients do you see that are on Medicare? it's ok to guess 0% to 10% 11% to 20% 21 % to 30% 31% to 40% 41% to 50% 51% to 60% 61% to 70% 71% to 80% 81% to 90% 91% to 100% More than half Probably 3/4 of our patients Question Title * 5. Do you currently perform Welcome to Medicare Visits (IPPE) visits (CPT Code G0402) on patients? Yes No I have no idea Not applicable to my specialty Question Title * 6. Do you currently perform Annual Wellness Visits on Medicare Patients (Codes G0438 & G0439)? Yes No I have no idea Not applicable to my specialty Question Title * 7. if the previous answer was yes - when did you start performing AWVs to Medicare patients? 2011 2012 Not applicable - as we do not perform them Question Title * 8. If you perform AWVs, who in your office sees the patient as part of the Annual Wellness Visit? Nurse or M.A. only Physician and Nurse/M.A. Question Title * 9. Were you aware that this visit does not NECESSITATE the physician seeing the patient? I knew that HUH? I had no idea - I thought the doctor had to be the one doing it I don't care and I'm wondering why I'm doing this stupid survey Question Title * 10. One of the Requirements in 2012 for the AWV is that you get a Health Risk Assessment on the Patient. Do you presently get one? No - I didn't know that change took place No - I know they require it - but we don't do it because - uh - I don't know why Yes - We have the patient complete a form prior to us taking them back into the exam room Yes - We have the patient complete a form in the exam room Yes - We complete the form for the patient I still don't know why I'm taking this survey - how do I get out of here? Question Title * 11. Part of the AWV requires you "Detect Cognitive Impairment". How do you "detect" it during your AWV? We have the patient draw a little clock, answer questions and do what we call an MMSE that was given to us by someone We have the patient draw a little clock, answer a few questions and I don't know why we do that We have the patient sit in front of a computer and take a computerized test like the CANS-MCI that you promote We don't have do any kind of written or computer form to detect cognitive impairment, so we may be in trouble if we ever get audited - help me please. I'm still here - why can't I get out of this survey? Someone call 911 quick. Question Title * 12. Thank you for completing this survey. If you would like Don to contact you or if you have any questions on the AWV (which Don DOES recommend you perform on EVERY Medicare patient once a year), please indicate so in the box below. The AWV is very profitable and more importantly, your physicians will be graded on the percentage of patients they perform this test on, in the future. This is part of the AHRQ and PPACA and we encourage you to perform them with the computerized cognitive tests that Don promotes as that almost doubles the amount you are paid - while really helping your patients. Done