Billing for Comprehensive Dementia Care Services Among Traditional Medicare Beneficiaries: Implications for the
GUIDE
Model
Yucheng Hou, Aanand D. Naik, Karen E. Joynt Maddox, Kenton J. Johnston ABSTRACT
Background
The guiding an improved dementia experience (GUIDE) model is a nationwide payment model launched in 2024 to test monthly dementia care management payment as a tool to improve care and outcomes for Medicare fee‐for‐service beneficiaries with dementia and their caregivers. GUIDE requires participating practices to provide comprehensive dementia services, including care assessment and coordination, caregiver support, and respite services. This study assessed baseline billing patterns for GUIDE‐required services among eligible physician group practices prior to GUIDE implementation.
Methods
Using 2022 Medicare clinician and practice data, we identified a national sample of eligible physician group practices for GUIDE, defined as having at least one dementia‐proficient clinician. Among eligible practices, we examined the variation in their billing patterns for GUIDE‐required services under the Medicare fee‐for‐service fee schedule. We identified and decomposed practice‐level factors predictive of billing for any GUIDE services and assessed the association between these factors and service volume.
Results
Among 4737 eligible practices, 60% billed for GUIDE‐required services; however, these services were substantially underused by dementia‐proficient clinicians. Practices billing for more required services under fee‐for‐service were larger, more likely to participate in other risk‐based payment models, such as accountable care organizations, but had smaller dementia caseload shares and served patients with lower overall clinical risks.
Conclusions
Before GUIDE implementation, billing for required services varied substantially across eligible practices and was underused by dementia‐proficient clinicians. These baseline differences may help explain early participation patterns and inform future evaluations of whether GUIDE incentives build capacity for delivering comprehensive dementia care.