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By John M. Bigler One of the most dreaded possibilities for older persons and their families is the onset of Alzheimer's disease. The disorder causes loss of memory, changes in personality and behavior, and a decline in cognitive ability. Ten percent of people over 65 years old and nearly half of those over 85 years have Alzheimer's disease. There are currently about four million people in this country with Alzheimer's disease, and 50,000 living on Long Island. Fourteen million of the people born into the baby boom generation will be afflicted. These numbers should give an idea of the staggering amount of resources that will be necessary to provide the care and treatment for these people.
During the past year, the Bush administration authorized coverage by Medicare for the treatment of Alzheimer's disease. This change was made last year and is still to be implemented with health-care providers. Until now, Alzheimer's patients have been ineligible for Medicare coverage of psychological services, hospice care and other treatments. Medicare didn't cover treatment for Alzheimer's disease in the past because experts believed that the patient's health couldn't be improved by any available treatment.
In the past, many claims were automatically denied on the assumption that any treatment that could be provided would be futile because people with Alzheimer's disease were incapable of achieving any improvement in their medical condition. New studies show that people with Alzheimer's often can benefit from psychotherapy, physical and occupational therapy and other services. Until this change in rules for Medicare coverage, a patient diagnosed with Alzheimer's disease could be prevented from receiving Medicare coverage for other unrelated conditions, such as a broken leg or a stroke. If a diagnosis of Alzheimer's disease was evident anywhere on the claim, Medicare tended to deny coverage for all services provided.
With Alzheimer's disease, as with any other illness, health-care providers submitting claims for payment from Medicare must show that the services they provide to the patient are medically necessary. The new policy prohibits Medicare carriers that review claims for benefits from denying those claims simply because a person has Alzheimer's disease.
The government has decided to change its policy because doctors and psychologists now are often able to diagnose Alzheimer's disease in its early stages when patients are most likely to derive significant benefits from treatment and therapy. While there's no cure for Alzheimer's, staving off its worst effects can prolong a relatively normal life and save money. Although the new rules for approval of benefits will likely result in a greater cost to the Medicare program, some of this cost could be offset by savings elsewhere in Medicare and Medicaid, because the newly authorized services will enable patients to live longer on their own, with greater ability to function.
Under the new policy, Medicare will pay for more therapy and outpatient services. With the assistance provided by these services, people with Alzheimer's will be able to live at home longer and avoid institutionalization. These services would keep people out of nursing homes, avoiding costs that would otherwise be borne by the government and by patients or their families. In the long run, this will cost the government less than denying potentially beneficial treatment and then paying for long-term nursing home care.
Reprinted with permission of the Suffolk Times © 2002
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New research shows that psychotherapy, physical and occupational therapy and other services can improve the condition of Alzheimer's patients. The new policy means that Medicare beneficiaries no longer can be denied reimbursement for the costs of mental health services, hospice care or home health care just because they have Alzheimer's disease.