A USC Schaeffer Institute health economist is urging Medicare leaders to make cognitive screening routine at annual wellness visits, followed by an FDA-approved blood test for amyloid — and, if indicated, a brain scan — to identify Alzheimer’s Disease (AD) earlier, when treatment and planning options are better. Fewer than one-third of Medicare patients who attend a wellness visit report receiving a formal cognitive screening, despite Medicare requiring it.

The move

• Make cognitive assessment a standardized, brief, routine part of every Medicare annual wellness visit — and actually deliver it at scale.

• When screening raises concern, use FDA-approved blood tests (cleared last year) that can indicate amyloid plaques, a hallmark of AD.

• Use abnormal blood results to trigger next-step workup (neurologic evaluation and brain imaging) to confirm diagnosis and guide care.

Why it Matters for Care

• Earlier detection can redirect patients to reversible causes of cognitive symptoms (e.g., sleep apnea, thyroid disease, vitamin deficiencies, medication side effects) before labeling dementia.

• For confirmed early AD, patients may be eligible for newer amyloid-targeting therapies that have shown meaningful slowing of disease — with the greatest impact when started earlier.

• Clinicians can shift counseling from reassurance-only to actionable planning: safety, finances, advance care planning, caregiver support, and timing of major life goals.

Between the Lines

• The bottleneck isn’t science — it’s implementation: primary care time constraints, lack of standardized tools, and weak reimbursement for cognitive assessment.

• Medicare’s requirement has limited bite because of lingering clinical and cultural beliefs that diagnosis isn’t worthwhile without a cure — even as treatment options and trial pipelines expand.

• The author argues Medicare should add a new code and pay more for brief standardized screening, and even offer modest reimbursement for clinical trial referrals to accelerate enrollment (138 AD drugs are in trials).

What to Watch

• Whether CMS moves to standardize and enforce cognitive screening in the annual wellness visit — including new billing codes or higher payment.

• How quickly FDA-cleared blood tests for amyloid are adopted in primary care workflows, and whether payers align coverage with a “screen → blood test → scan” pathway.

• Guideline updates and quality measures that could push systems to treat cognitive screening more like cancer or cardiovascular screening.

• Policy momentum around dementia’s economic burden: estimated total societal cost around $800B; modeling cited suggests a five-year delay in onset could cut prevalence by 41% and total costs by 40% by 2050.

Source: RealClearHealth