Saturday, December 11, 2010

Medicare Mandate for Cognitive Screening

An assessment of cognitive impairment will be a mandatory part of the annual wellness visit for Medicare beneficiaries beginning January, 2011, as part of passage of comprehensive health care reform legislation known as the Patient Protection and Affordable Care Act.
In the midst of the most significant demographic transformation in decades with the first wave of baby boomers beginning to turn 65 next year, assessment for cognitive impairment detection is essential as millions of Americans advance to an age when they are at greater risk for developing Alzheimer's and other dementias. (Source: Alzheimer's Association)

How did this one slip past the “death panel” crowd? Many persons over the age of 65 will doubtless be surprised when their general practitioner asks them to name as many animals as they can in a minute or to count backwards by nines. No doubt some will find it obtrusive or threatening. One hopes that when this becomes widely known it does not become yet one more excuse to put off the annual wellness visit with the physician.

Early detection of dementia is certainly a desirable thing. It can motivate lifestyle changes (exercise, nutrition, etc.), inspire participation in memory clinics or creative expression groups, and help individuals and those in their social support network plan for how they will address future changes. But this new provision also raises a host of questions:

How much instruction are front-line medical providers receiving in how to administer these cognitive assessments? What assessment tools will they use?

Beyond making a notation in the medical record, are these providers equipped to discuss options with their patients who show symptoms of memory loss or cognitive decline? Will they provide them with ongoing support and guidance? Or will they simply send them home with a booklet?

What is the threshold at which the front-line provider will refer the patient for more comprehensive evaluation? Who establishes this threshold? Will it be universal or individual (and therefore subjective)?

Are there enough practitioners equipped to do these more comprehensive evaluations to accept what is likely to be a huge increase in referrals?

Are there sufficient community-based resources to offer support, guidance and programs to those diagnosed, their families and their friends? How will these essential resources be funded?

This new, mandatory provision of Medicare is not on many people’s screens yet. It soon will be. It will no doubt quickly expose how limited and underfunded our network of resources for those experiencing progressive memory loss presently is. One dares to hope that it will inspire us to begin to address this critical need.


  1. John,

    You have posed a good set of questions on Medicare cognitive screening. My sense is primary care physicians will slowly begin to grapple with the problem of with how they are going to administer tens of thousands of cognitive screening tests starting this year.

    Some information that may be helpful to your readers:

    Christian Elliott

  2. Are patients required to submit to this cognitive screening test?