The Impact of Mandated Cognitive Assessments on Alzheimer’s Disease and Related Dementias Diagnosis Rates

Tuesday, June 25, 2019: 3:30 PM
Tyler - Mezzanine Level (Marriott Wardman Park Hotel)

Presenter: Johanna Thunell

Discussant: Edward C. Norton

Although there is no disease modifying treatment for Alzheimer’s disease, an early and accurate diagnosis allows clinicians to promptly detect reversible causes of memory loss, inform pharmacologic treatment options that for some, may delay cognitive decline, and to inform about clinical trial opportunities. It also allows patients to communicate medical, legal, financial, living, and end-of-life desires, and access medical and other support services. Early diagnosis may identify deficits sooner, inform disease progression over time, and assist in developing and evaluating new drugs aimed at delaying onset or stopping dementia before irreversible brain damage. Barriers to diagnosis include low public awareness of early symptoms, stigma and misconceptions about the disease leading to delays in seeking medical assistance or reluctance to communicate with health care providers. Provider-related barriers include low recognition of cognitive impairment and/or insufficient training in dementia diagnosis, and reimbursement issues.

The new annual wellness visit (AWV) benefit available to Medicare Part B beneficiaries may reduce some of these barriers to dementia diagnosis. The Patient Protection and Affordable Care Act of 2010 mandated an AWV that, along with checks of blood pressure, weight, medical history and other routine services, included for the first time, a cognitive screen at each visit. Prior to the AWV, Medicare reimbursed for specific procedures, such as vaccinations, colonoscopies, pelvic exams, and lipid tests and a “Welcome to Medicare” visit which provided a one-time initial visit with a primary care physician in the first 12 months after enrollment.

In this study, we ask what was the effect of the introduction of the AWV benefit on Alzheimer’s disease and related dementias (ADRD) diagnoses rates, average age at diagnosis and geographic dispersion of diagnoses? We use the 100% sample of Medicare claims data and regression discontinuity in time (RDiT) approach to estimate the impact of the legislation enactment. Preliminary analyses show immediate and increasing take-up in both the AWV and the initial “Welcome to Medicare” visits after the policy went into effect. The total number of preventative exams claims went from about 2,500 to 27,000 immediately after the policy took effect and continued to grow in subsequent months, representing substantial take-up. We also observe an increase in ADRD incidence in the months immediately following ACA effective date, from about 14,000 claims in December 2010 to about 16,000 in January 2011.