Three steps to improve preventive service utilization during the COVID-19 pandemic

Patients are deferring routine office visits for chronic disease management and preventive services out of concern for their safety during COVID-19. But these visits are important, especially for patients with conditions that require close monitoring, or those who are due for immunizations.

Many clinics are addressing the needs of their patients with chronic disease by performing routine outpatient office visits (codes 99201 – 99215) via video or telephone visits, because most payers are now covering these at telehealth reimbursement rates. With Medicare reimbursing for annual wellness visits (G0438 and G04349) via video or telephone, Medicare and Medicare Advantage patients are receiving the care they need.

But what about preventive visits for patients on Medicaid or commercial insurance? Here are three steps practices can take to improve preventive service delivery to these patients during the pandemic.

1. Use technology to stay connected to patients.

Most payers have adopted Medicare’s telehealth list for coverage. However, Medicare does not cover routine preventive visits (9938X and 9939X), so it was not included on the telehealth coverage list. Therefore, most commercial plans failed to include it in their medical policies for telehealth coverage. Consequently, some physicians are avoiding performing preventive visits (9938X and 9939X) via video or phone. With patients afraid to come in for in-person office visits, and physicians reluctant to schedule video visits that might not be reimbursed, preventive services are decreasing.

All practices should reach out to their local payers to find out if they cover these preventive visits via telehealth and develop internal guidance for meeting the visit requirements for the plans that do. For plans that do not, practices can still use video or telephone visits to discuss immunization status and outline for patients the precautions they’re taking to make it safer for patients to come in for vaccinations and other preventive services.

2. Look for built-in opportunities to address preventive care.

The Centers for Disease Control and Prevention recently issued guidance that highlights the importance of assessing the immunization status of patients at each encounter during the pandemic to avoid missed opportunities for vaccination.¹ If a patient comes to the office for an acute condition, offer any needed vaccinations and preventive screenings. If billing a routine office visit (99201 – 99215), make sure to add the correct diagnosis to the visit for the service provided (e.g., Z23, “Encounter for immunization,” when providing a vaccination, or Z13.6, “Encounter for cardiovascular disease screening,” when ordering a screening lipid panel). If patients have video visits scheduled for chronic disease management, check and see if they are overdue for vaccines and screenings and let them know if they are.

Clinics should also review their patient charts for missed wellness visits or overdue vaccinations and reach out to those patients to either schedule in-person visits or offer any alternative approach available in the clinic.

3. Offer revised in-person services.

Many pediatric clinics have long used the approach of establishing one waiting room (or section of a waiting room) for sick patients and a separate one for healthy patients, which could be an option for a family medicine clinic as well. If your clinic does not have enough space, another option is to designate certain “healthy” exam rooms where nonsymptomatic patients can immediately be roomed upon arrival. 

Other ways clinics can offer in-person services with less risk of COVID-19 transmission include the following:

• Curbside visits,
• Drive-through immunization clinics,
• Designated “safe” lab locations to reduce exposure risk when routine labs are needed,
• Designated “safe” imaging locations to reduce exposure risk when routine imaging is needed.

If your clinic or organization does not have internal testing sites, partner with area locations for them to become designated safe sites.

Having an organized approach to preventive visits can help avoid the decline in preventive services during a pandemic.

— Vinita Magoon, DO, JD, MBA, MPH, CMQ, Baylor Scott & White Health, Temple, Texas

1. Vaccination Guidance During a Pandemic. Centers for Disease Control and Prevention. June 9, 2020. Accessed July 22, 2020. https://www.cdc.gov/vaccines/pandemic-guidance/index.html