Op-Ed

With a deluge of Alzheimer’s patients coming, Medicare must step up, pay more for treatment | Opinion

More than 5.5 million Americans, most of them 65 or older, currently have dementia caused by Alzheimer’s.
More than 5.5 million Americans, most of them 65 or older, currently have dementia caused by Alzheimer’s. Getty Images

An experimental blood test could be 88 percent accurate in predicting Alzheimer’s disease, according to research presented at the recent Alzheimer’s Association International Conference. As the science around Alzheimer’s advances, we need to ensure that Medicare advances with it.

Currently, more than 5.5 million Americans, most of them 65 or older, have dementia caused by Alzheimer’s. This number will continue to rise as the population ages. According to the U.S. Census Bureau, older adults will outnumber children by 2035. And it’s these individuals — patients and their family members — who bear the brunt of treatment and care costs.

A new study published in the Journal of Managed Care and Specialty Pharmacy found that Medicare spending on Alzheimer’s disease is surprisingly low. The study examined almost 340,000 Medicare beneficiaries and found that in the last year of life, Medicare spent $1,300 less on patients with Alzheimer’s disease than other beneficiaries. The lower costs were often due to avoiding complex care, such as chemotherapy for cancer, for loved ones with advanced dementia.

But lower Medicare costs do not mean low overall care costs. Alzheimer’s patients and their families pay a substantial amount in out-of-pocket costs for care. A 2015 study in the Annals of Internal Medicine found that average out-of-pocket spending for patients with dementia was 81 percent higher than spending for patients without dementia.

Most people with Alzheimer’s disease have Medicare, but patients often need Medicaid to fill in the coverage gaps. Medicaid covers services that Medicare does not, such as long-term care in nursing homes, assisted living and at-home care. According to the Kaiser Family Foundation, a quarter of adults with dementia living in the community are covered by Medicaid over the course of a year.

Another shortcoming of the status quo is that as many as half of dementia cases are missed in the primary-care setting. Many people are first diagnosed with Alzheimer’s disease during a hospital stay for an unrelated issue, as opposed to by their primary-care provider. In 2017, the Centers for Medicare & Medicaid Services created a diagnostic code to help doctors better recognize dementia, which allows for earlier care and planning. But, according to an Alzheimer’s Association analysis, out of a projected 910,000 new cases of Alzheimer’s disease in 2017, the code was used for only 20,000 Medicare beneficiaries. The experimental blood test could help in this regard, but only if Medicare elects to cover its costs.

Clearly, more effort is needed to coordinate Medicare and Medicaid services as they relate to Alzheimer’s disease and dementia. As a first step, CMS’ Medicare-Medicaid Coordination Office was created to allow states to develop models that integrate medical, long-term and behavioral health services while delivering savings. Its pilot program involves 12 states where enrollees reported a 20 percent reduction in hospitalizations.

Medicare is mandated to pay for care that is “reasonable and necessary for the diagnosis or treatment of illness or injury.” CMS should explore what Medicare is doing, and not doing, for seniors with dementia. Our nation’s older adults pay into this program over the course of their lifetimes with their blood, sweat and tears, and they deserve nothing less back from their government.

Susan Peschin is president and CEO of the Alliance for Aging Research in Washington.

InsideSources.com

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