Medicare’s Annual Wellness Visit and Diagnoses of Dementias and Cognitive Impairment

Abstract

Introduction

Early detection of Alzheimer’s disease and related dementias allows clinicians and patients to prepare for future needs and identify treatment options. Medicare’s Annual Wellness Visit (AWV) requires detection of cognitive impairment and may increase dementia diagnosis. We estimated the relationship between AWV receipt and incident dementia.

Methods

Using a retrospective cohort of Medicare Fee-For-Service (FFS) beneficiaries enrolled for at least 3 years from 2009 to 2016 and two-stage least squares, we quantified the relationship between AWV and incident diagnosis of cognitive impairment/dementia, and by race/ethnicity. The county-level change in percent of beneficiaries receiving AWVs was used as an instrumental variable to account for unobserved factors associated with individuals’ AWV receipt and diagnosis. Sample included 3,333,617 beneficiaries ages 67 years and older, without dementia at the beginning of the study.

Results

Beneficiaries included 2,713,573 White, 251,958 Black, 196,845 Hispanic, 95,719 Asian, 11,727 American Indian/Alaska Native, and 63,795 of other race/ethnicity. Using ordinary least squares, dementia incidence was -0.79 percentage points (95% CI -0.81 to -0.76) lower for persons receiving an AWV compared to no AWV. Using instrumental variables reversed the direction of the effect: AWV receipt increased dementia diagnoses by 0.47 percentage points (95% CI 0.14 to 0.80), 15% over baseline. AWVs increased diagnoses 2.0 percentage points (95% CI 0.05 to 3.94) among Blacks, 0.40 percentage points (95% CI 0.05 to 0.75) among Whites, but est were imprecise for Hispanics and Asians.

Discussion

Increasing AWV take-up and supporting physicians’ performance of cognitive assessment may further improve dementia detection in the population and among groups at higher risk of undiagnosed dementia.

The full study can be viewed at Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring.

Thunell, J. A., Jacobson, M., Joe, E. B., & Zissimopoulos, J. M. (2022). Medicare’s Annual Wellness Visit and diagnoses of dementias and cognitive impairment. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring14(1), e12357.

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