Introduction

Ninety-five percent of Medicare beneficiaries with Alzheimer's disease have one or more other chronic conditions, such as coronary heart disease, congestive heart failure, diabetes and chronic obstructive pulmonary disease.

It is the combination of dementia and these other conditions that triple the number of hospital stays, and triple Medicare costs for both hospital and home health care.

People with dementia have frequent medical crises that could be prevented; with impaired memory and judgment, they cannot manage their own care. They cannot follow routine physician orders or medication regimes on their own; they cannot identify early signs of infection or illness. Their caregivers — whether family members or paid personal care aides — are overburdened and untrained in the requisite health care skills.

So beneficiaries with dementia get very sick, repeatedly. They end up in the hospital, get put back together, and sent home or to the nursing home to await the next crisis. And Medicare pays the bill.

Congress can make a significant impact through relatively modest Medicare improvements that introduce concepts of chronic care into the basic benefit package. This includes payment for geriatric assessment and a defined chronic care management benefit.

Our position

The Alzheimer's Association calls on Congress to modernize Medicare to meet the health needs of all beneficiaries with Alzheimer's disease by adding a chronic care benefit to Medicare, including payment for geriatric assessment.

What we are doing

The Alzheimer's Association advocates for improved Medicare coverage for care of chronic conditions, and works with members of Congress on this issue. Findings from research and demonstrations point to effective ways to diagnose, manage and treat Alzheimer's disease; maintain function; and prevent health care crises and excess disability. These findings place new responsibilities on clinicians to diagnose the disease earlier and begin management and treatment. However, Medicare does not pay clinicians for this type of care management and treatment.

Senator Blanche Lambert Lincoln (AR) and Representative Gene Green (TX) introduced the Geriatric Care Act of 2003 (HR 102/ S 387) with support by the Alzheimer's Association. A number of provisions in this bill would provide better coverage for people with Alzheimer's disease and other chronic conditions. The Geriatric Care Act of 2003 would improve access to geriatric care by extending Medicare coverage to geriatric assessment and care coordination.

The legislation authorizes Medicare to cover these essential services by paying geriatricians and others to manage medications effectively, work with other health care providers as a team and provide necessary support for caregivers. The Geriatric Care Act would also help increase the number of residents in geriatric training programs, by allowing for additional geriatric training slots in hospitals. The bill also contains incentives to train academic geriatricians who teach geriatrics to primary care and specialty physicians-in-training.