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Annual Wellness Visits (AWV) with primary care providers is a Medicare benefit to help patients prevent or manage health care concerns/issues.  Currently, this Medicare provided benefit has no co-pay to the patient. 

Wellness visits include a health risk assessment that can help identify high-risk behaviors, and make recommendations for preventive screenings and referrals.  A physical examination is different from a wellness visit in that it is a hands on annual exam.  Medicare does not cover routine physical exams.

Guidelines to check:

History - Conduct patient history and medication list by requesting this information in advance so that documentation is completed and can be discussed when a patient enters the wellness visit.

Screen patient for depression, their safety and functional ability.  Depression screening and functional ability assessment, along with the safety screening, may be able to be managed by trained support staff in advance of the patient visit.

Cognitive assessment of patient with input from caregivers or family members who may be present during the wellness visit. Gathering impressions from the staff who obtained the patient history or performed other elements of the encounter could also be beneficial. Documentation should include evidence of assessment, such as notations of the patient's general appearance, affect, speech, memory and motor skills.

Screen for hearing and vision loss.

The wellness visit also includes checking height, weight, body mass index and blood pressure.  It is a good time to check a patient’s physical activity level and last exam date, recommend preventive screenings and check for known medical conditions.  By identifying patient behavioral risks and problems through their medical history and screenings, the AWV can be an opportunity to discuss interventions and order further screenings.  Discussion can also include education on advance care directives.

For more information go to ACP tools for wellness visits.  Billing codes for initial AWV is G0438, subsequent AWV G0439, diagnosis code V70.0.

 

Contributed by: The Physician Alliance, one of Michigan’s largest physician organizations serving more than 2,200 physicians in southeast Michigan.

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

Sources:  American College of Physicians, American Academy of Family Physicians, The Centers for Medicare and Medicaid Services (CMS)

Onychomycosis (fungal nails) affects at least 10% of the world’s adult population. It is difficult to treat and has a high rate of reinfection. Foot Healthcare Associates practice strives to cure fungal toenails and significantly reduce reinfection and is the first in Michigan to be able to offer Lunula Laser treatment for fungal toenails.

This new and exciting treatment is a proven noninvasive treatment for onychomycosis. The Lunula Laser has gone through extensive research which has been published in reputable medical journals. There is no discomfort, downtime or side effects associated with this laser treatment.  It uses low-level laser light to treat fungus and usually requires four 12-minute sessions to the affected area.  

Before Lunula Laser              After Lunula Laser                   

In an 18-month study of 323 patients, 99% of patients reported full clearance of their fungal infections after four treatments.  In another study that evaluated 168 toes which had fungal involvement of 81.15% of the nail, it was revealed that the disease was reduced to only 31.32% within the nail after one treatment.

At the end of the study, 63.58% of the nail plate had no fungus remaining in it. An additional study, which was FDA directed, evaluated 105 toes and reported an average clear nail of 73.79% and 79.75% at post-procedure months 3 and 6, respectively. Also, there was not a single adverse event.

Contributed by:  Dr. Barnett at FOOT HEALTHCARE ASSOCIATES with locations in Southfield, Novi, and Livonia, Michigan. New diagnostic and treatment technologies are offered for all foot and ankle conditions.

References:

  1. www.Lunula.com
  2. Robert Sullivan1 and Deirdre O’Flynn.Erchonia Laser Therapy in the Treatment of Onychomycosis.  Podiatry Review. Vol. 71(2):6-9.
  3. Scher RK, Tavakkol A, Sigurgeirsson B, et al. Onychomycosis: diagnosis and definition of cure. Journal of American Academy of Dermatology. 2007;56:939-944.

One reason why winters are so tough on arthritis is that people get less exercise. A lot less. A study of arthritis sufferers in Chicago, a place that knows something about winter, found that they were a third less active in November than they were in June. Essentially, they were spending three more hours a day just sitting around as the days grew shorter and temperatures dropped. And winter hadn't even officially begun.

Exercise eases arthritis pain. It increases strength and flexibility, reduces joint pain, and helps combat fatigue. And clearly the study subjects weren't getting much in November. Cold temperatures and rainfall (but not snowfall) all contributed to this decline. But the greatest factor was the lack of daylight hours later in the year.

The study tracked 241 Chicagoans with arthritis for three years by using accelerometer readings, which measure a person's energy expenditure.

Most of the participants were over 60. All had been diagnosed with knee osteoarthritis or rheumatoid arthritis. Over a three year period, they wore an accelerometer up to six days a week, at three to six-month intervals. Their energy expenditure readings were compared to Chicago's daily weather conditions and the amount of daily sunlight over the three-year period.

Many of the participants would get their exercise from a brisk walk, an idea that was much less appealing during the cold Chicago winter.

The researchers blame part of the decline on a lack of indoor exercise facilities for the urban elderly. Just as cities have food deserts, they also have exercise deserts and the lack of convenient places to exercise grows during the year's colder months. Looking at Chicago specifically, the researchers note that there's a great deal of money spent on outdoor activities for younger and healthier people in the summer but little spent on indoor activities for the elderly in the winter, an inequality they'd like to see addressed.

Does cold weather itself aggravate arthritis? Studies have given conflicting results. Some suggest that cold, damp weather aggravates arthritis while others have found no such link. The current consensus is that the cold makes some people's arthritis worse but not everybody's.

The tendency to get less active and hibernate during the winter isn't just an issue for arthritis sufferers, it seems to affect everyone. And the human body wasn't meant to sit around. Long periods of sitting produce many ill effects. Everybody needs to be aware of and cope with this.

One way is to keep more active indoors. Indoor malls can serve as a replacement site for outdoor walks when the weather gets chilly. And joining a swimming, yoga or dancing class will also keep you active. Exercise doesn't have to be boring. Anything that keeps you moving works.

There's also good reason to spend time outdoors. When going outside, dressing warmly is the key. Dressing in layers traps body heat and helps keep you warm. And since most heat is lost from the extremities, you need to pay special attention to your head, hands and feet. This means a hat, gloves or mittens, and warm shoes with good traction.

Marilyn Monroe beat the summer heat in The Seven Year Itch by keeping her undies in the icebox. You can take the chill off of winter by putting your clothes in the dryer for a few minutes before going outside. This warms them up and make sure you start out nice and toasty. In fact it might even make you want to go outside to cool off.

An article detailing the study appears in the September 2011 issue of the Journal of Physical Activity and Health.

 

  Contributed by: Dr. Jeff Carroll, DO is a board certified orthopedic surgeon and professor of orthopedic surgery. He practices at Movement Orthopedics, located at

 43475 Dalcoma Drive, Suite 160 Clinton Township, MI  48038.

 

 

This blog is for informational purposes only and should not be considered medical advice. Please consult your doctor for more information or if you have a medical concern.

 

 

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