Collaboration Details

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Title of Collaborative Activity:

Detection of Cognitive Impairment: The Search for an Evidence-Based Screening Tool

Description of Collaborative Activity:

In January 2011, a New Requirement in the Medicare Annual Wellness Visit is for an Evidence-Based Screening Tool for the Detection of Cognitive Impairment. This new requirement was included in Public Law 111 - 148, the Patient Protection and Affordable Care Act as an additional element under Sec. 4103: Medicare Coverage of Annual Wellness Visit Providing a Personalized Prevention Plan. The Centers for Medicaid and Medicare Services (CMS) noted that in their solicitation for public comments before implementing the new regulation, the definition of cognitive impairment in the statute “was vague and commenters suggested adding a standardized screening tool.” The law only stipulates that providers assess an individual’s cognitive function by “direct observation, with due consideration of information obtained by way of patient report, concerns raised by family members, friends, caretakers, or others.” Most providers routinely use these methods during outpatient visits to assess general well-being and function, but are not always effective in specifically detecting cognitive impairment. Other concerns with this subjective method include false positive findings and questionable, expensive neurological workups. CMS and others, therefore, have identified the need for some standardized instrument or set of tools that could be used by providers. Since the annual wellness visit is scheduled for 45 minutes and has other required elements, the tool would need to be short, with no associated cost, easy to administer, sensitive to change over time, and normed for use in the Medicare beneficiary population. The National Institute on Aging (NIA) at the National Institutes of Health completed a comprehensive review of over 140 published cognitive screening tools to determine the level of evidence to support an instrument or set of instruments that could be used by providers. The review included the critical components identified by CMS as well as other psychometric properties. On October 31, 2011, NIA presented its findings to a large group of researchers, providers, federal policy staff, and other stakeholders for evaluation. Based on the questions raised and input provided by this group, NIA is continuing to add to the information on each tool and will provide additional information as it becomes available.

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