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Many people are dissatisfied with a new interim Medicare policy. The policy was considered to be a breakthrough for Medicare patients because for the first time it will cover patients who are not being treated with insulin injections. Prior to July 1, 1998, these patients were not covered by Medicare for their diabetes testing supplies.
For a patient who is not currently being treated with insulin injections, there will be 50 test strips covered every two months, and 100 lancets covered every four months. For the patient who is taking insulin, up to 100 test strips and 100 lancets will be covered every month by Medicare, and more are available if the treating physician justifies the need for additional strips.
Under the new interim policy published by the Durable Equipment Regional Carriers (DMERC), a non-insulin-using patient will receive 25 test strips per month. If the patient wishes to receive anything beyond the 25 strips per month, however, they must produce a log. The log will keep a record of their glucose readings, and document proof that the non-insulin-using patient does, in fact, require additional supplies. The treating physician must also maintain a copy of this log.
Kim Hanchette, MEd, CDE, at the Diabetes Treatment Center in Raleigh, North Carolina is pleased with the direction of the new policy.
"We're very happy that Medicare is finally saying that all patients with diabetes should monitor, and that they will cover these supplies," stated Hanchette. "Now everybody with diabetes can benefit from these blood sugar monitors."
Although Hanchette is pleased with Medicare's efforts to reach out to the entire diabetes community, she feels that the supply of test strips and blood glucose monitors is too limited. Several other people and organizations in the diabetes community are downright indignant toward the interim policy. The American Association of Diabetes Educators (AADE) is just one of them.
"The AADE opposes this new policy because the frequency limit of 50 strips every two months for non-insulin-using diabetes patients is too low to be considered a reasonable quality of care," stated David Holtzman, who is the director of government affairs with the AADE. "Under the new proposed standards of 50 test strips every two months, non-insulin-treated Medicare beneficiaries with diabetes would be limited to testing their blood glucose levels once a day for 25 days in any given month. The AADE, and other organizations, feel that the rules and regulations associated with obtaining additional supplies set up barriers for frequent testing. Mark Libratore, who is president of Liberty Medical Supply in Palm City, Florida, believes that a new policy should promote frequency testing instead of discouraging it.
"The Association of Clinical Endocrinologists states that all patients with diabetes should test their blood glucose levels at least twice a day," said Libratore. "There's no literature anywhere that says a non-insulin-using patient should test his glucose only 25 times per month."
David Holtzman echoes the same sentiment.
"They're actually making it more difficult to get additional blood glucose monitoring strips than it is to get a Class 2 narcotic," stated Holtzman.
Jeff Meese, who is the president of Preferred RX of Ohio, says that he was one of the experimental patients in the Diabetes Control and Complications Trial which ended about five years ago. The DCCT was a federally funded study projected to last ten years, and designed to prove whether or not tight control of blood sugars would reduce the long-term complications associated with diabetes. Meese pointed out that the study actually ended two years early because the results between the two testing groups was so dramatic, and it was proven that multiple blood testing could reduce long-term complications.
"When I read that Medicare is now saying that 25 blood tests a month is adequate, that just flies in the face of that study," stated Meese. "I mean, one arm of the government is saying 'yes, multiple blood testing is good,' while the another arm is saying 'you don't need to test that often.'"
Meese points out that there probably does need to be some restrictions on the number of strips a non-insulin using patient receives, but 25 is too few.
"The number of strips that a non-insulin-using patient can get on a monthly basis should be based on the physician's orders, not an arbitrary number of tests picked by the Health Care Financing Administration (HCFA)," stated Meese. "The restrictions being implemented on October 1st will stop patients with diabetes from doing the blood testing they need, and will ultimately cost Medicare substantially more in medical costs."
The AADE points out that the process of obtaining additional testing strips will be a hardship for physicians, suppliers and non-insulin-using patients.
Libratore goes on to say that keeping the log could create a bureaucratic spaghetti mess. In order to receive the additional supplies, a doctor could wind up photocopying 25 pages of the patient's log book, with the supplier doing the same thing.
"If we make all these copies, there will be no trees left in America!" stated Libratore. "Because the burden to maintain the log is placed on the patient, they (the patient) could lose the incentive to test frequently."
The DMERC did not want to respond to the criticisms of the organizations, but did offer information on the steps they are taking before the policy goes into implementation.
"People should understand that we did publish this as an 'interim' policy," stated Adrian M. Oleck, MD, and medical director for DMERC Region B.
Oleck stressed that before the DMERC can make any changes to the policy, they have to receive input. Input in the diabetes community, however, has been less than favorable.
The Congressional Diabetes Caucus (CDC), a bipartisan group of 150 members of Congress dedicated to improving the lives of Americans with diabetes, recently sent a letter to Secretary of Health Donna Shalala. In the letter, they mentioned that the DMERC is "undermining the HCFA's program memorandum from July which stated that 'a physician should determine the appropriate level of blood-testing strips for people with diabetes.'" The CDC went on to say, "if the interim policy goes into effect, it will prevent physicians from effectively treating people with diabetes solely because of the inaction or sufficient inaction of their patients with respect to a written log book."
Dr. Adrian Oleck of DMERC, Region B says that they have been reviewing all of the feedback.
"We sent the policy out for comments in July of this year, and have received several comments," said Oleck. "As we usually do with all of our policies, we will look at these comments, analyze them, and decide whether any changes need to be made ."
Libratore mentions that people can either call their representatives at the U.S. Capitol Switchboard (202-224-3121), or the American Diabetes Association (888-342-2383) if they have any comments or questions regarding the policy.
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