Comprehensive Evalutions of Patients with Alzheimer’s Disease or Related Dementias

Thanks to effective lobbying by the Alzheimer’s Foundation, Medicare agreed to pay for periodic, comprehensive assessment of patients suffering from some form of cognitive impairment (dementia).  Medicare started encouraging and paying for these cognitively-oriented evaluations in 2017, including for patients with even mild cognitive impairment.  There is no co-pay requirement.

These “multidimensional, cognition-focused assessments” require clinicians to evaluate, stage, and document many specific aspects of the patient’s condition, some of which tends to be overlooked in more “routine” examinations.  Together, these elements are designed to determine:

  • the patient’s degree of impairment, and changes that may occur over time;
  • the patient’s ability to make decisions, and manage his/her own affairs;
  • the patient’s dependency on caregivers;
  • the availability of effective caregiver support for the patient;
  • the safety of the patient’s environment;
  • the patient’s medication regimen;
  • the detailed care needs of the patient, in a written plan of care;
  • the presence of behavioral issues, if any;
  • and document the patient’s end-of-life preferences, and availability of appropriate legal documents

These assessments should be done periodically, to document any deterioration in the patient’s condition, including both cognitive and physical changes.  Medicare has not specified the appropriate frequency of these exams, except to indicate they should be done at least once a year.