Open Forum

Hello colleagues,

I'm interested in gathering insights from organizations that have explored alternative workflows to support Annual Wellness Visits (AWVs), particularly in the setting of ongoing RN shortages impacting access to RN-led AWVs.

In our organization, LPNs are not permitted to independently complete AWVs, as this falls outside of their scope within our care model. As a result, we are exploring whether certain AWV-related activities could be incorporated as an extension of pre-visit planning to better support providers and improve patient access.

Specifically, has anyone implemented or evaluated workflows where LPNs support completion of AWV-related components, such as:

• Administering the Health Risk Assessment (HRA) (in-person or telephonically, potentially in advance of the visit)
• Coordinating necessary labs, screenings, or preventive services
• Identifying care gaps and preparing AWV documentation elements for provider review
• Preparing for a follow-up provider visit, during which the provider reviews, finalizes, and submits AWV documentation and charges

From my understanding, CMS does not provide fully prescriptive guidance on the timing of HRA completion, and in this model the LPN would not be conducting an independent AWV or "assessment". Rather, these activities would be performed as part of pre-visit planning, with the provider remaining responsible for the encounter, review, documentation, and billing.

I recognize there may be professional, regulatory, operational, and billing considerations with this approach, and I'm interested in learning:

• Has your organization attempted a similar model?
• How were responsibilities divided between nursing staff and providers?
• What barriers (clinical, compliance, operational, or cultural) did you encounter?
• Were there successful approaches to pre-visit HRA completion by LPNs (e.g., telephonic outreach 1–2 weeks prior)?
• What impact, if any, did this have on patient access, provider burden, care team efficiency, or AWV completion rates?

Our goal is to improve access to preventive care while maintaining compliance, supporting care team efficiency, and ensuring providers have the information needed to complete high-quality AWVs.

I appreciate any experiences or insights you are willing to share.

Thank you in advance.

Naomi Ramshur, RN, BSN, MBA

Director of Provider & Practice Engagement (PPE)

Office: 757-339-4629 Mobile: 757-339-4629

Email: nxramshu@sentara.com

1330 Sentara Park 4^th floor Virginia Beach, VA 23464

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