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Ninety-five percent of all elderly fee-for-service Medicare beneficiaries with Alzheimer's disease and other dementias have at least one other chronic condition, including congestive heart failure (28 percent), coronary heart disease (29 percent), diabetes (23 percent) and chronic obstructive pulmonary disease (COPD, 17 percent). The combination of Alzheimer's disease and other coexisting chronic conditions consistently increases Medicare costs and use of services. Total Medicare costs for this population are three times higher than the average for other Medicare fee-for-service beneficiaries ($13,207 versus $4,454 per beneficiary).
Costs for hospital care are 3.2 times higher than the average for other Medicare beneficiaries ($7,704 versus $2,204 per person). Home health care costs are 3.8 times higher than the average for other Medicare beneficiaries ($728 versus $190 per person). Physician visits are 1.3 times more than the average for other Medicare beneficiaries (14.4 versus 11.3 visits per person). Hospital stays are 3.4 times more than the average for other Medicare beneficiaries (1,091 versus 318 stays).
Medicare costs and service use for beneficiaries with Alzheimer’s
disease are higher because the program does not pay for
the chronic care management that could prevent expensive
but avoidable health care crises and excess disability.
Individuals with dementia need access to geriatric assessment
and ongoing care management to monitor their health status
and prevent the acute care crises that are currently driving
up Medicare costs.
Findings from research and demonstrations point to effective
methods of diagnosing, managing and treating Alzheimer’s
disease to maintain function among Medicare beneficiaries
with dementia. Comprehensive assessment and management of
individual needs, ongoing monitoring of health status, early
treatment of emerging problems and close collaboration among
physicians, family caregivers and the person with dementia
have proven to improve health status and reduce hospitalizations
for people with Alzheimer’s disease. These findings
from research and practice place new responsibilities on
clinicians to diagnose the disease earlier and begin management
and treatment.
The Alzheimer’s Association recommends that Congress
create a Medicare chronic care management benefit for high-cost
beneficiaries, specifically including beneficiaries with
dementia, that includes:
Payment to physicians and other professionals to coordinate patients' care with other practitioners and caregivers to ensure that people with dementia receive optimal care and to help their caregivers navigate the complex health and long-term care systems. A chronic care management benefit would be particularly useful in helping families manage the care of loved ones who have other chronic conditions such as diabetes and heart disease in addition to Alzheimer's. A chronic care management benefit could also connect beneficiaries to community services to reduce the number of emergency room visits and hospital stays. Reimbursement to physicians who spend time counseling family caregivers outside of office visits. Currently, Medicare will not reimburse for this service, diminishing the quality of communication between the caregiver and the physician, which can be detrimental to patient safety as well as caregiver confidence and well-being. A requirement that the Centers for Medicare & Medicaid Services (CMS) determine whether Health Savings Programs (formerly known as "chronic care pilot programs") are identifying beneficiaries with dementia and providing information, training and support to help family caregivers of beneficiaries with chronic conditions.
Next: Enhancing Existing Medicare Benefits
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Medicare costs and service use for beneficiaries with Alzheimer’s disease are higher because the program does not pay for the chronic care management that could prevent expensive but avoidable health care crises and excess disability.
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