Diabetes advocates are pressing for a bill that would compel Medicare to cover CGM technology. They cite a study in The American Journal of Managed Care, which found it costs $17,564 every time a person with diabetes goes to the emergency department with hypoglycemia.
A 2011 study published in The American Journal of Managed Care makes the case: every incident of hypoglycemia that results in a trip to the emergency department costs $17,564, and many of these episodes could be avoided.
That’s what the JDRF, the American Diabetes Association, a host of other advocacy groups, and a bipartisan roster of sponsors in Congress have argued this year, as they work to pass the Medicare CGM Access Act of 2014. The bill is vying for attention in the lame duck Congress before the new session begins in January.
The act addresses a problem that grows each year as more persons with type 1 diabetes mellitus (T1DM) live longer, fuller lives, thanks to improvements in technology. Most commercial insurance plans long ago approved coverage for continuous glucose monitors, or CGM technology, which give patients the ability to monitor their blood sugar in real time, allowing for finely tuned adjustments to insulin intake and the prevention of episodes of hypoglycemia or hyperglycemia.
Yet Medicare has generally deemed the devices unnecessary. This means that T1DM patients who have spent years with their diabetes in control are suddenly unable to afford CGM technology, and must rely instead on far less precise finger-stick measurements, which may not capture rapidly rising or falling blood sugar levels. As described by Mike Hoskins on the well-regarded website DiabetesMine, Medicare has classified CGM devices as “precautionary,” making them supplemental, rather than medically critical technology.
According to the JDRF, persons over the age of 80 were 2.5 times as likely to visit the emergency department for an insulin-related hypoglycemia event, and nearly 5 times as likely to be admitted, compared with patients between the ages of 45 and 64. With accountable care organizations (ACOs) in an era of reimbursements based on quality care measurements that include both health measurements in diabetes and how well its hospitals perform in preventing rapid readmissions, it would seem that more than just T1DM patients themselves have a stake in getting Medicare to cover CGM.
Diabetes advocates have ramped up their push for passage of the bill as the end of the session nears. While the bill has Republican sponsorship in both the House and the Senate, any change in leadership brings uncertainty. Medicare coverage for CGM technology is seen as important not only for today’s seniors, but also for future patients who might someday seek coverage for emerging technology, such as the artificial pancreas.
Two other bills in the current session of Congress that would affect persons with diabetes are:
National Diabetes Clinical Care Commission Act. This legislation seeks better coordination among the 37 separate federal agencies that have some role in the prevention and treatment of diabetes.
Access to Quality Diabetes Education Act. The legislation seeks to increase access to diabetes self-management training by designating credentialed diabetes educators as certified providers for purposes of outpatient DSMT services under Medicare Part B. Supporters claim the bill is budget-neutral because it will be offset by savings.
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