I do not understand the American
Diabetes Association (ADA). This article on the Diabetes Care
section, covers many of the points that should have been covered, but
I am in doubt about the enthusiasm and sincerity even being part of
the 2014 Guidelines.
The point of self-management education
(inpatient and/or outpatient) is delivered by an interdisciplinary
team and this will help people with diabetes adjust their daily
regimen to improve glycemic management. Diabetes self-management
education teaches individuals with diabetes to assess the interplay
among medical nutrition therapy, physical activity,
emotional/physical stress, and medications.
Today, self-management education is
understood to be such a critical part of diabetes care that medical
treatment of diabetes without systematic self-management education is
regarded as inadequate. The weakness of today is doctors that will
not support education, support needed testing supplies, and the lack
of certified diabetes educators to assist in education.
The following is quoted, “Numerous
studies have demonstrated that self-management education leads to
reductions in the costs associated with all types of diabetes.
Participants in self-management education programs have been found to
have decreased lower-extremity amputation rates, reduced medication
costs, and fewer emergency room visits and hospitalizations.”
“To achieve optimal glycemic
control, thus achieving long-term reduction in health care costs,
individuals with diabetes must have access to the integral components
of diabetes care, such as health care visits, diabetes supplies,
self-management education, and diabetes medications. As such,
insurers must reimburse for diabetes-related medical treatment as
well as for self-management education programs that have met accepted
standards, such as the American Diabetes Association's National
Standards for Diabetes Self-Management Education and Support.
Furthermore, third-party payers must also reimburse for medications
and supplies related to the daily care of diabetes. These same
standards should also apply to organizations that purchase health
care benefits for their members or employees, as well as managed care
organizations that provide services to participants.”
“It is recognized that the use of
formularies, prior authorization, competitive bidding, and related
provisions can manage provider practices and costs to the potential
benefit of payors and patients. Social Security Act Title XIX,
section 1927, states that excluded medications should not have “a
significant clinically meaningful therapeutic advantage in terms of
safety, effectiveness or clinical outcomes of such treatment of such
population.” A variety of laws, regulations, and executive orders
also provide guidance on the use of such controls to oversee the
purchase and use of durable medical equipment and single-use medical
supplies associated with the management of diabetes.”
The last paragraph has me wondering if
they are telling payors (insurance providers) to do what they want
when it comes to diabetes. I know many of the current people on
Medicare are attempting to opt out of the mail order supply sources and
returning to local pharmacies for their diabetes supplies. This has
meant an increase in costs the patient is required to shoulder, but
some patients are unwilling to accept the second rate and unreliable
testing supplies they were required to use under the mail order
business.
The following is quoted because
Medicare is totally ignoring this and could care less about what the
Medicare patient is doing to manage their diabetes. “Though it
can seem appropriate for controls to restrict certain items in
chronic disease management, particularly with a complex disorder such
as diabetes, it should be recognized that adherence is a major
barrier to achieving targets. Any controls should take into account
the huge mental and physical burden that intensive disease management
exerts upon patients with diabetes. Protections should ensure that
patients with diabetes can readily comply with therapy in the widely
variable circumstances encountered in daily life. These protections
should guarantee access to an acceptable range and all classes of
antidiabetic medications, equipment, and supplies. Furthermore, fair
and reasonable appeals processes should ensure that diabetic patients
and their medical care practitioners can obtain medications,
equipment, and supplies that are not contained within existent
controls.”
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