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Advisory Council April 2019 Meeting Presentation: Medicare Dementia Care Planning

Monday, April 29, 2019

Printer Friendly Version in PDF Format (6 PDF pages)


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

Medicare Advantage
(41% of MA population)
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)

Frequency of Use of G0505

Fee-for-Service Medicare Advantage
Pie Chart: 1 visit (92.2%) Pie Chart: 1 visit (99.0%)

Use of G0505 by Sex

Fee-for-Service Medicare Advantage
Pie Chart: Female (60.4%), Male (39.6%). Pie Chart: Female (58.2%), Male (41.8%).

Use of G0505 by Race/Ethnicity (FFS)

Pie chart: White (79.9%), Black (9.6%), Hispanic (5.8%), Asian/Pacific Islander (2.7%), American Indian (0.2%), Other/Unknown (1.8%).

Age of Beneficiaries Using G0505

Bar Chart: Under 65--Fee-for-Service (6.9%), Medicare Advantage (5.3%); 65-74--Fee-for-Service (26.7%), Medicare Advantage (34.5%); 75-84--Fee-for-Service (37.7%), Medicare Advantage (40.5%); 85+--Fee-for-Service (28.7%), Medicare Advantage (19.7%).

Unique # of Providers Who Bill for G0505

Medicare Advantage
(41% of MA population)

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

State Map: Utilization rate less than 100 per 100,000 FFS beneficiaries--Alabama, Georgia, Kentucky, New Mexico, Ohio, Utah; Utilization Rate more than 10 per 100,000--Arkansas, Delaware, Iowa, Maine, Massachusetts, Minnesota, West Virginia, Wisconsin; Utilization rate equals 0--Montana, New Hampshire, North Dakota, Rhode Island, South Dakota, Vermont.

Use of G0505 by Month

Line Chart.

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?