During a wellness visit, the doctor measures the patient's height, weight, body mass and blood pressure — and perhaps listens to his heart through his clothes. The rest is a discussion of the patient's medical and family history, any physical or mental impairments, and risk factors for potential diseases such as diabetes and depression. The doctor also establishes a schedule for future care, and may refer the patient for other tests and screenings, many of which are now free under Medicare. (See a full list of services covered by the wellness visit.)
In other words, it provides a snapshot of the patient's current health, as a baseline for future yearly visits, and is intended as a preventive service, a way of catching potentially serious health issues early.
"The fact that Medicare is now recognizing the importance of these types of services and is willing to pay for them is a big step forward. That cannot be overstated," says Ejnes. "A lot of times, the counseling that occurs is more important than the poking and prodding. You're talking about weight, smoking, exercise, screening for depression. But it's not what we would normally consider a physical. Hence the resistance we're seeing from physicians offering this service and perhaps a sense of dissatisfaction when the patient leaves and realizes that what they got wasn't what they thought they'd be getting."
Among doctors in general, there is no agreement of what should be done in an annual physical — and some regard it as unnecessary, with no good evidence to show that otherwise healthy patients derive any benefit from it, but even they concede that most patients like it.
Physicians also have varying opinions on Medicare's wellness visit. Some welcome it as a long overdue opportunity to spend 45 minutes talking with healthy patients to help them stay healthy — or perhaps detect, during the conversation, some sign of an issue that merits investigation.
Research has shown that most doctors don't talk to their patients about weight loss or diet, but when they do take time to discuss it, people often act on it. In one study, patients who were obese and advised by their doctors to lose weight were three times more likely to try to lose weight than obese people who didn't receive such advice.