Medicare Data shows extremely low use of screening for abdominal aortic aneurysm, a potentially fatal condition
Researchers find patients, physicians forego simple ultrasound screening despite Medicare coverage for those at highest risk
BOSTON (April 29) ─ Few people on Medicare are taking advantage of a potentially life-saving benefit to detect a weakening in the wall of the aorta, the body’s main blood vessel, suggests a new study from Tufts Medical Center.
After analyzing Medicare claims data, the researchers found that less than 1 percent of eligible men and women a year were being screened for abdominal aortic aneurysm (AAA).
Since January 2007, legislation has provided a free, one-time ultrasound screening to qualified Medicare beneficiaries. People eligible to be screened for AAA include men who have smoked at least 100 cigarettes during their lifetime as well as men and women with a family history of AAA.
“There’s a missed opportunity to improve health when people who meet the risk factor criteria for AAA are not targeted for screening by their doctors as part of their Medicare benefits,” said lead author Natalia Olchanski, M.S., project director at the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center.
The findings, which were published online in the Journal of General Internal Medicine, show that AAA screening is greatly underutilized. The analysis examined Medicare claims data collected between 2005 and 2009, two years before and after Medicare introduced AAA screening as a covered benefit for at-risk people when they first enrolled at age 65, as part of the SAAAVE (Screening Abdominal Aortic Aneurysm Very Efficiently) Act of 2007.
A person with AAA often has no symptoms of the condition. But over time, a weakened area of the aorta begins to bulge outward increasing its risk of rupturing, which could be fatal. If a bulging aorta is detected early by ultrasound screening, a small aneurysm may only require close monitoring by a physician. A larger or rapidly growing aneurysm may need treatment to surgically repair the aorta.
In addition to evaluating AAA screening rates, the researchers also created a simulation model to estimate how higher utilization rates of the screening could influence health.
The model projected that increasing the use of AAA screening to 80 percent of the Medicare-eligible population could have a significant impact on health and substantially increase life expectancy among screened individuals. The data showed an average gain of 131 life years per 1,000 people screened.
“We suspect that screening rates may currently be low because of a lack of awareness among physicians of the Medicare benefit as well as limited public awareness of AAA as a health concern for people over 60,” Olchanski said.
Currently older men with a history of smoking are eligible for AAA screening, but the study also estimated that if the screening benefit were expanded to include older women who have smoked, it could potentially save lives and increase life expectancy in this group as well.
The research was conducted at the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center. It was funded by Medtronic, Inc.
Olchanski, N, Winn, A, Cohen, JT, Neumann, PJ. Abdominal Aortic Aneurysm Screening: How Many Life Years Lost from Underuse of the Medicare Screening Benefit? J. Gen. Intern Med. 2014: Online First.
About Tufts Medical Center and Floating Hospital for Children
Tufts Medical Center is an exceptional, not-for-profit, 415-bed academic medical center that is home to both a full-service hospital for adults and Floating Hospital for Children. Conveniently located in downtown Boston, the Medical Center is the principal teaching hospital for Tufts University School of Medicine. Floating Hospital for Children is the full-service children's hospital of Tufts Medical Center and the principal pediatric teaching hospital of Tufts University School of Medicine. Tufts Medical Center is affiliated with the New England Quality Care Alliance, a network of more than 1,800 physicians throughout Eastern Massachusetts. For more information, please visit www.tuftsmedicalcenter.org.
Media Contact: Julie Jette