Monday, April 29, 2019
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Dementia Care Planning in Medicare: Use of the Care Planning Code
Matthew Baumgart
Vice President of Health Policy
Alzheimer's Impact Movement
Alzheimer's Association
Unique # of Beneficiaries Using G0505
Fee-for-Service |
18,669 |
Medicare Advantage
(41% of MA population) |
2,857 |
Code Use In Context |
65+ Estimated Prevalence of Alzheimer's, 2017
(2017 Alzheimer's Disease Facts and Figures) |
5.3 million |
FFS with Diagnosed ADRD, 2017 (all ages)
(CMS, Chronic Conditions Warehouse) |
3.7 million |
65+ Estimated Incidence of Alzheimer's, 2011
(Rajan, et al. 2019) |
910,051 |
Frequency of Use of G0505
Fee-for-Service |
Medicare Advantage |
![Pie Chart: 1 visit (92.2%)](/sites/default/files/private/images-site-pages/261356/Mtg32-Slidefig6a1.jpg) |
![Pie Chart: 1 visit (99.0%)](/sites/default/files/private/images-site-pages/261356/Mtg32-Slidefig6a2.jpg) |
Use of G0505 by Sex
Fee-for-Service |
Medicare Advantage |
![Pie Chart: Female (60.4%), Male (39.6%).](/sites/default/files/private/images-site-pages/261356/Mtg32-Slidefig6a3.jpg) |
![Pie Chart: Female (58.2%), Male (41.8%).](/sites/default/files/private/images-site-pages/261356/Mtg32-Slidefig6a4.jpg) |
Use of G0505 by Race/Ethnicity (FFS)
Age of Beneficiaries Using G0505
Unique # of Providers Who Bill for G0505
Fee-for-Service |
1,208 |
Medicare Advantage
(41% of MA population) |
539 |
Top 5 Providers Who Bill for G0505
Fee-for-Service |
Medicare Advantage |
51% |
1. Internal Medicine |
1. Family Practice |
65% |
2. Neurology |
2. Internal Medicine |
3. Family Practice |
3. Neurology |
4. Nurse Practitioner |
4. Psychiatry |
5. Geriatric Medicine |
5. Geriatric Medicine |
Top 5 Primary Diagnoses for Visit
Fee-for-Service |
Medicare Advantage |
1. Dementia (unspecified) |
1. General Medical Exam |
2. Mild Cognitive Impairment |
2. Mild Cognitive Impairment |
3. Alzheimer's Disease |
3. Alzheimer's Disease |
4. Other Amnesia |
4. Dementia (unspecified) |
5. Hypertension |
5. Other Amnesia |
High & Low Performing FFS States
Use of G0505 by Month
Possible Future Questions
- How many who receive care planning are newly-diagnosed? (For under 65, how many are newly-eligible for Medicare?)
- What subsequent services do those with care planning receive?
- In 2018, how many received an updated care plan?
- Do those who receive care planning have fewer hospitalizations and ER visits?