David,
You are right, and I should have been more precise, and by using the Medicare example, I was trying to make the point and not very well, the Medicare annual wellness model reimbursed by Medicare with no out of pocket expense, will be similar to the newer model with the Coop/exchanges, I think.
I have material hanging up in the exam rooms and by my nurses station that explain what is involved in an annual exam and the difference between the f/u chronic management exam. Often time I will or my nurse will educate during intake, more so when I started this with medicare annual exams three years ago.
For those patients I sense resistance to this concept or have had issues/complaints about the annual tied in with a modifier, I offer to have them come in at two separate times to do just annual and the chronic exams, but most decline, because they see the waste of time involved in this.
My nurse, in house billers and I, have made an effort over the past 3 years educating about this process and that in essence during one exam I am doing two, the annual and chronic problem followup.
It takes awhile to adapt but most of my patients have, and I think all parties involved are reasonably satisfied with this approach.
