Underuse of Medicare Annual Wellness Visits Impedes Cognitive Impairment Detection

Recent research presented at AAIC 2016 in Toronto revealed that underuse of Medicare Annual Wellness Visits (AWV) represents missed opportunities to screen for early signs of cognitive impairment and to promote cognitive health. Because assessment of cognitive health is a mandatory part of Medicare wellness visits, researchers are urging providers to encourage patient participation. 

“The Medicare annual wellness visit can be implemented on a broad scale and sustained over time in health systems, and offers a regular opportunity to establish a baseline measurement and identify changes that may indicate Alzheimer’s or another dementia,” presenting author Pamela Mink, PhD, MPH, of Allina Health in Minneapolis, said in a press release. “Unfortunately, even in our study, the people most vulnerable to dementia are skipping the annual wellness visit, while healthier people show higher usage.” 

The researchers noted that, in 2013, only 11% of Medicare Part B enrollees had an AWV, suggesting that its value as an opportunity for early detection of cognitive impairment may be limited. Mink and colleagues studied data from electronic health records of 105,387 ambulatory patients aged older than 65 years with at least one outpatient Medicare claim in the prior 12 months. Mini-Cog scores were analyzed and compared to AWV participation in order to determine the potential impact of well visits.

Study results showed that 44.2% of study participants had at least one AWV during the study period. Further, annual increases were noted, with 22.2% in 2011 vs. 31.1% in 2014. The prevalence of AWV participation was increased among women, white patients, Asian patients, non-Hispanic patients, and those aged 70 to 74 years (P < .01). 

The researchers found that positive Mini-Cog scores were more common among contrasting demographics, including men, black patients, Hispanic patients, and those in older age ranges (P < .01). Demographic groups with higher rates of dementia were less likely to have participated in an AWV. 

Mink and colleagues wrote that these findings identify opportunities for further improvement. “Our ongoing research will examine how providers can use the data in subsequent clinical care,” Mink said. — David Costill