ORIGINAL RESEARCH
Brandon H. Hidaka, MD, PhD; Rachael C. Passmore, DO; Karen M. Fischer, MPH; Dominika A. Jegen, MD; Robert J. Stroebel, MD; David R. Rushlow, MD; Tom D. Thacher, MD
Corresponding Author: Rachael C. Passmore, DO; Mayo Clinic College of Medicine and Science.
Email: Passmore.Rachael@mayo.edu
DOI: 10.3122/jabfm.2026.260198R1
Keywords: Cohort Studies, Cost-Effectiveness, Emergency Medicine, Health Care Costs, Health Services Accessibility, Hospitalization, Hospitals, Medicare, Preventive Health Services, Retrospective Studies
Dates: Submitted: 5/12/2026; Revised: 8/14/2026; Accepted: 8/31/2026
Status: In Press.
PURPOSE: Determine if completion of an initial Medicare Annual Wellness Visit (AWV) impacts the rate of hospitalization, Emergency Department (ED) use, and overall cost of care.
METHODS: We conducted a retrospective pre–post cohort study of 39,572 Medicare beneficiaries aged 65 years or older who completed an initial AWV within a large multidisciplinary healthcare system. Rates of hospitalization, emergency department (ED) use, and total cost of care were compared during the 12 months before and after the initial AWV. Costs were analyzed using standardized z-scores to assess within-patient relative change.
RESULTS: The rate of hospitalization increased from 5.1% in the year before the AWV to 6.7% in the year after (p<0.001), and ED utilization increased from 14.9% to 17.4% (p<0.001). Total cost of care also increased following the AWV (p<0.001). Utilization was highest in the first 3 months after the visit, with significantly greater rates of hospitalization and ED use compared to later time periods.
CONCLUSIONS: Initial Medicare AWVs were associated with increased short-term healthcare utilization and costs, particularly in the first 3 months following the visit. These findings are most consistent with increased access to care following Medicare enrollment, identification of previously unrecognized conditions, and age-related risk rather than a causal effect of the AWV itself.