What is the Current Value Equation for Dementia Diagnosis and Management: Variation in Costs Across Practice Types

Objective: To describe current practice patterns and time-driven-activity-based costs (TDABC) in different primary care practice (PCP) settings for diagnosis, referral, and first-year management of patients with dementia.Background: Three changes are poised to have a big effect on how dementia is diagnosed and managed with PCPs playing a central role: 1) Affordable Care Act which focuses on paying for preventive annual wellness visits with a cognitive screen, 2) the movement from fee-for-service to bundled care, and 3) incentives for physician practices to promote value through TDABC and outcome measurements.Design/Methods: We interviewed physicians in three PCP settings [group practice, independent practice association/accountable care organization (IPA/ACO), and medical home] about their practice patterns and amount of time spent in diagnosing and managing their dementia patients. We tracked the first year care-cycle from the wellness visit through consultation to determine average practice costs. We compared utilization and time-based national costs by practice type and identified areas of practice variationResults: The capacity cost rate varied from $0.29 to $2.68 per minute. The available clinical minutes varied from 73,000 to 113,000 annually across practices and personnel types. The total annual PCP time per dementia patient averaged 288 minutes for ACO/IPA physicians, and 89 minutes for group practice physicians with care time costs of $625 and $202, respectively. Total costs including medications, consultations, diagnostic labs, and neuroimaging was $2,395 and $6,292 per patient, respectively.Conclusions: PCPs are consistent in diagnosing and managing patients with dementia but vary in costs using time-base rather than claims-based costing. These variations are due mostly to costs related to patients receiving drug treatment, timing and frequency of neurological consultations, and proportion of active versus stable dementia patients. A significant amount of physician time is related to administrative tasks required for patients to receive insurance coverage for home care needs. Disclosure: Dr. Wilson has received research support from Quest Diagnostics. Dr. Bonasera has received research support from the Intel Corporation. Dr. Davis has nothing to disclose. Dr. Balsamo has nothing to disclose. Dr. Kassan has nothing to disclose. Dr. Stallone has nothing to disclose. Dr. Harry has nothing to disclose. Dr. Kurzweil has nothing to disclose. Dr. Higgins has received personal compensation for activities with Quest Diagnostics. Dr. Rankin has research support from Quest Diagnostics. Dr. Warsh has nothing to disclose. Dr. Kaplan has nothing to disclose.