Between 2018 and last year, use of cognitive assessment and care plan services tripled, but few Medicare beneficiaries who qualify received the service, according to a recent study by the Government Accountability Office (GAO).
The GAO study found that, at most, 2.4% of Medicare beneficiaries with a diagnosis of Alzheimer’s disease or a related disorder received this service. The number of Medicare beneficiaries living with cognitive impairment is expected to increase as the U.S. population ages and skews older.
The Centers for Medicare & Medicaid Services (CMS) started covering cognitive assessments and related care planning in 2017.
Under Medicare guidelines, providers can deliver the cognitive assessment service to patients showing signs of, or already diagnosed with, a cognitive impairment, the GAO report stated. The service involves a cognitive assessment that includes a detailed patient history and a written care plan based on information from the assessment.
In the time frame of the study, GAO found that certain providers including neurologists, nurse practitioners, internists, family physicians, and geriatricians delivered over 80% of services, mostly in urban areas.
The reasons behind why so few Medicare beneficiaries received cognitive assessment services are multi-faceted. Providers faced challenges of the intensive time needed to conduct assessments – typically requiring at least 60 minutes – coupled with billing limitations preventing providers from working in teams to collaborate during the visit. Providers also said a key challenge was the limited training for primary care providers.
In terms of challenges for beneficiaries, advocacy groups noted that access challenges centered on the stigma associated with being diagnosed with cognitive impairment coupled with the lack of awareness of the service through Medicare.
The report also highlighted past research on racial and ethnic disparities in dementia care that showed Black and Hispanic adults have a higher prevalence of dementia and that Black, Hispanic and Asian adults have a lower likelihood of receiving a timely diagnosis or comprehensive evaluation when compared to white adults. The research originated from the Journal of Alzheimer’s Disease and JAMA Neurology.
To combat those myriad challenges, CMS and the Department of Health and Human Services (HHS) conducted an outreach effort that targeted 1.4 million providers eligible to deliver the cognitive assessment services. On the consumer side, CMS and HHS added a description of the services to the Medicare.gov website and the Medicare and You handbook, the study noted.
This public awareness effort comes as more than 10 million Americans aged 65 and older deal with cognitive impairment characterized by memory loss, confusion and difficulty performing daily tasks, according to the Alzheimer’s Association’s 2023 Alzheimer’s Disease Facts and Figures publication.
Even as few Medicare beneficiaries are receiving cognitive assessments, concerns are also mounting related to access to memory care. Supply constraints and financing challenges make new memory care development tough to pencil out, with current operators in the space angling to increase occupancy due to the demand spike.
Only time will tell how operators pivot to meet this growing demand. Across the senior living industry, more operators have considered ramping up the expansion of memory care offerings to accommodate for the demographic shifts in the near future, with examples including Sonida Senior Living, Discovery Senior Living, the Aspenwood Company, Strive Senior Living and more.
As the U.S. population continues to age, addressing the memory care gap and ensuring access to cognitive assessment services for Medicare beneficiaries with Alzheimer’s and related disorders becomes critical. The GAO report sheds light on the challenges faced by providers and beneficiaries in obtaining these services, including limited training, billing limitations, stigma, and disparities in dementia care. Efforts by CMS and HHS to increase awareness and outreach are steps in the right direction, but further action is needed to bridge the gap and provide comprehensive care for those impacted by cognitive impairment.
