The Effect of Medicare Annual Wellness Visits on Breast Cancer Screening and Diagnosis

Abstract

Objective: The Medicare Annual Wellness Visit (AWV)—a prevention-focused annual check-up—has been available to beneficiaries with Part B coverage since 2011. The objective of this study was to estimate the effect of Medicare AWVs on breast cancer screening and diagnosis. Data Sources and Study Setting: The National Cancer Institute’s Surveillance, Epidemiology, and End Results cancer registry data linked to Medicare claims (SEER-Medicare), HRSA’s Area Health Resources Files, the FDA’s Mammography Facilities database, and CMS “Mapping Medicare Disparities” utilization data from 2013 to 2015. Study Design: Using an instrumental variables approach, we estimated the effect of AWV utilization on breast cancer screening and diagnosis, using county Welcome to Medicare Visit (WMV) rates as the instrument. Data Collection/Extraction Methods: 66,088 person-year observations from 49,769 unique female beneficiaries. Principal Findings: For every 1-percentage point increase in county WMV rate, the probability of AWV increased by 1.7 percentage points. Having an AWV was associated with a 22.4-percentage point increase in the probability of receiving a screening mammogram within 6 months (P<0.001). There was no statistically significant increase in the probability of breast cancer diagnosis (overall or early stage) within 6 months of an AWV. Findings were robust to multiple model specifications. Conclusions: Performing routine cancer screening is an evidence-based practice for diagnosing earlier-stage, more treatable cancers. The AWV effectively increases breast cancer screening and may lead to more timely screening. Continued investment in Annual Wellness Visits supports breast cancer screening completion by women who are most likely to benefit, thus reducing the risk of overscreening and overdiagnosis.