TORONTO -- The Medicare annual wellness visit, which was mandated under the Affordable Care Act and includes an assessment of cognitive impairment, is underused, researchers reported here.
In an analysis of electronic health records (EHR) from Allina Health System in Minneapolis, only about 30% of its eligible Medicare population had an annual wellness visit in 2015, reported Pamela Mink, PhD, MPH, of Allina Health, and colleagues at the Alzheimer's Association International Conference.
They also found that the patient groups who would benefit most from cognitive screening were less likely to go for an annual check-up.
"We found, not surprisingly, that the demographic groups with higher rates of dementia that have been observed in epidemiologic studies also have worse Mini-Cog scores, and these are the same patients who are less likely to have an annual wellness visit, which is an opportunity to detect cognitive impairment," Mink said during a press briefing. "This suggests an opportunity for further outreach and improvement among these groups, as well as overall."
The Medicare "annual wellness visit" began in early 2011 as part of the Obama administration's healthcare reform. It gives physicians an opportunity to check patients' height, weight, and blood pressure, to review their medical history, and to establish a list of current medications. It also requires an assessment of cognition in order for physicians to be reimbursed.
However, it has been nationally underutilized, used in only 11% of Medicare Part B enrollees in 2013, Mink said, adding that it was also underutilized at her health center in Minneapolis.
Mink's group assessed 5 years' worth of EHR data from the 90 clinics -- including 61 primary care centers and 13 hospitals -- in their health system, which totaled more than 4 million visits in 2015, to create a picture of an early-adopter experience. They used the Mini-Cog to assess cognitive impairment.
Overall, the use of the annual wellness visit rose from 20% of eligible patients in 2011 to about 30% in 2015, Mink reported.
About 53,000 of the 118,000 eligible patients had an annual wellness visit over the entire 5 years of the study, totaling about 45% of the entire population that did take advantage of the Medicare visit. About a quarter (27.4%) had two or more visits, Mink said.
They also found that 6% of patients had Mini-Cog scores that put them in the category of cognitive impairment being likely, suggesting that these patients may benefit from interventions.
In further analyses, the researchers found that patients who had at least one annual wellness visit were more likely to be female, to be white or Asian, to be age 70 to 74, or to live within the region's metropolitan areas.
By contrast, those with Mini-Cog scores associated with possible cognitive decline were more likely to be male, African American or Hispanic, or in the older age groups, which are exactly the groups that could benefit from early cognitive screening, Mink said.
She added that her health system will be looking into ways to get more patients to have their annual wellness visit, and to continue to use their research to "share lessons learned about annual wellness visit uptake and to contribute to the knowledge base to inform policy."
William Thies, PhD, senior scientist at the Alzheimer's Association, said physicians can choose whichever cognitive screening device they prefer for the cognitive assessment in the annual wellness visit. The Mini-Cog, he said, is a good choice because it offers convenience and fewer time constraints, two things important to busy practices today.
He added, however, that more primary care physicians should be doing cognitive screening on a wider basis.
"The reality is that most Alzheimer's will be treated in the primary care setting," he told MedPage Today. "There's just too much of it for the manpower distribution."
Mink and co-authors disclosed no relevant relationships with industry.
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