Role of PCPs in diagnosing dementia in traditional Medicare and Medicare Advantage

Abstract

INTRODUCTION

This paper quantifies how incident dementia diagnosis rates vary for similar beneficiaries in traditional Medicare (TM) and Medicare Advantage (MA) seen by the same primary care provider (PCP).

METHODS

This cohort analysis used 2016 to 2018 data for Medicare beneficiaries. Using a propensity score-matched sample of beneficiaries with similar likelihood of MA enrollment, we estimated linear probability models with PCP fixed effects of incident dementia diagnosis in 2017 for beneficiaries in MA relative to beneficiaries in TM.

RESULTS

Among a matched sample of 15,410,030 beneficiaries, accounting for both provider and patient characteristics, the incident dementia diagnosis rate was 0.11 percentage points lower for MA beneficiaries compared to TM beneficiaries attributed to the same PCP. MA patients were less likely to be seen by dementia specialists.

DISCUSSION

Differences in system-level factors such as access to dementia specialists is a contributing factor to differences in diagnosis rates in MA and TM.

Highlights

• In this study, we quantify how incident dementia diagnosis rates vary for similar beneficiaries in TM and MA seen by the same PCP.
• To investigate the role of insurance design on dementia diagnosis, we examined differences in diagnosis rates for TM and MA beneficiaries seen by the same PCP.
• Among a matched sample of TM and MA beneficiaries with assigned PCPs in 2017, incident dementia diagnosis rates were 0.11 percentage points lower for MA beneficiaries compared to TM beneficiaries seen by the same PCP.
• MA patients were less likely to be seen by dementia specialists compared to TM beneficiaries seen by the same PCP.