Structural brain imaging substantially underused in Medicare population
Structural brain imaging is substantially underused among the Medicare population, presenting opportunity for radiology providers, according to new research.
Clinical guidelines from multiple organizations recommend such scans to help assess newly detected cognitive impairment. However, robust contemporary data on whether these exams are routinely performed remain limited, experts write Sept. 15 in JACR.
University of Southern California researchers aimed to better understand the treatment landscape, analyzing 100% of data from both traditional Medicare and Advantage plans, spanning 2020 to 2022. Overall rates of structural imaging within one year of diagnosis were about 57%, with about 46% of scans conducted via MRI, the study found.
About 66% of beneficiaries with an initial diagnosis of dementia were scanned, compared to 51% for those with mild cognitive impairment.
“To our knowledge, this is the first study to examine the use of structural brain imaging in the full Medicare population newly diagnosed with MCI or dementia,” lead author Soeren Mattke, MD, director of the USC Brain Health Observatory, and co-authors concluded. “We found substantial underuse of this guideline-recommended diagnostic procedure across the entire cohort. Gaps in care were even more pronounced in Medicare Advantage enrollees and dually eligible beneficiaries, a highly socioeconomically vulnerable group.”
The study sample included a total of nearly 1.1 million community-dwelling Medicare beneficiaries between the ages of 65 and 84. Those eligible were newly diagnosed with cognitive impairment in 2021. Of them, about 34% were assessed as having mild cognitive impairment and 66% with dementia. Researchers sought to pinpoint receipt of any structural brain imaging via MRI or CT within 365 days before or after the diagnosis.
Rates were higher for non-dual-eligible beneficiaries compared to those who qualify for both Medicare and Medicaid. This held true in both traditional Medicare (61% vs. 58%) and for members of Medicare Advantage plans (54% vs. 53%). The initial scan was performed with MRI in about 29% of cases, with lower rates in duals and Medicare advantage.
“These findings highlight the need for sustained efforts to improve adherence to clinical guidelines and ensure equitable access to recommended diagnostic evaluations for all patients with newly diagnosed cognitive impairment,” the authors charged.
Read more, including potential study limitations, in the Journal of the American College of Radiology.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.