title: Comparison of Pharmacist and Physician Managed Annual Medicare Wellness Services.
abstract: BACKGROUND
  Medicare Annual Wellness Visits (AWV) are a benefit provided for Medicare beneficiaries to increase focus on wellness and preventive measures. Pharmacists can conduct AWVs, which offers a potential avenue for outpatient revenue generation.
  
  
  METHODS
  To compare a composite of interventions and screenings and revenue generated by a pharmacist with those made by a physician during a subsequent AWV. A report generated through the electronic health record was used to determine AWVs conducted by a pharmacist or 3 participating physicians from December 2013 to March 2016, including revenue generated. Through electronic chart review, documentation was accessed to quantify and categorize the number and types of referrals, health advice, laboratory tests, procedures, vaccinations, and screenings that were recommended during each patient's AWV.
  
  
  METHODS
  The pharmacist performed 19 subsequent visits, and the 3 physicians performed 89 subsequent visits. Overall, the composite of interventions and screenings was significantly higher in the pharmacist group than the physician group (P = 0.03). More interventions were made in the areas of health advice (P = 0.020), vaccine recommendations (P = 0.009), and screenings in the pharmacist group (P < 0.001). The physicians ordered significantly more laboratory tests per visit (P < 0.001). The pharmacist was reimbursed on average $105 per visit versus $99 per visit for the physicians.
  
  
  CONCLUSIONS
  Pharmacist-provided AWVs are at least comparable to those provided by physicians and offer an additional access point for valuable services for Medicare beneficiaries.
  
  
  BACKGROUND
  There was no financial contribution to this study. Riche reports participation in the Speaker's Bureau for Merck and the Speaker's Bureau and Advisory Board for Novo Nordisk. The authors have no other conflicts of interest to report pertinent to this research. This data has not been previously published in any other location. Richie, Sewell, Malinowski, Jackson, and Fleming were involved in study design and manuscript preparation/approval. Jackson was involved in data collection, and Richie and Sewell were involved in data collection and data analysis. Sewell and Richie had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
authors.affiliation: 1 The University of Mississippi School of Pharmacy, Jackson.
authors.forename: Mary Jean
authors.initials: MJ
authors.lastname: Sewell
authors.affiliation: 2 The University of Mississippi School of Pharmacy, and The University of Mississippi School of Medicine, Jackson.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Riche
authors.affiliation: 1 The University of Mississippi School of Pharmacy, Jackson.
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Fleming
authors.affiliation: 1 The University of Mississippi School of Pharmacy, Jackson.
authors.forename: Scott S
authors.initials: SS
authors.lastname: Malinowski
authors.affiliation: 3 The University of Mississippi School of Medicine, Jackson.
authors.forename: R Terry
authors.initials: RT
authors.lastname: Jackson
mesh_terms: D015331:Cohort Studies; D005260:Female; D006296:Health Services / Q000191:economics*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D010595:Pharmacists / Q000191:economics*; D010808:Physical Examination / Q000191:economics* / Q000379:methods; D010819:Physician's Role; D010820:Physicians / Q000191:economics*; D024382:Professional Role; D012017:Referral and Consultation / Q000191:economics; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology