February 17, 2014

Why Is Optimal Diabetes Care Not Cost Effective?

This article in Diabetes-in-Control is perplexing in several ways. A study was performed to determine the obstacles to providing care and potential solutions to overcoming these obstacles. Yet the study could not recommend concrete solutions and how completely to resolve the cost ineffectiveness – only maybes.

Then in researching even farther, I discovered that the study was reported in March of 2012 and listed even more groups than are listed is the Diabetes-in-Control (DiC) article. The DiC says the roadblock to providing care is the cost. This is the reimbursement clinicians receive for providing optimal diabetes care. As a result, diabetes care is often limited, incomplete, or totally lacking. However, the original study found that providers considered patient adherence as the main roadblock to optimal diabetes care. The following is one of many charts from the survey.

This link is to the PDF file with the study details. The Diabetes Working Group, a collection of professional organizations and individuals, created an internet based survey to determine the demographics and practice patterns of diabetes care providers. Although they say that the survey was sent to members of five organizations, only four are listed by the DiC article.
The cost it took to provide care for these patients and reimbursement amounts was calculated using the average number of patients seen per week (as provided in the survey) multiplied by the average number of patients seen in a year based on national estimates. The results were unanimous in showing that provided costs exceeded reimbursements for all patient scenarios. The cost of treating adult patients would exceed reimbursement by over $750,000/year and pediatric patients by $471,000/year. Providers would require a 19% increase in overall reimbursement just to break even.”

The survey, conducted by the Endocrine Society, was the largest of its kind. The recommendations are based on three barriers health care providers thought. These were patient adherence, time with patients, and cost reimbursement. The following are some recommendations of the Diabetes Working Group -

In terms of payment reform, the working group recommended:

  • Appropriate reimbursement for providers meeting standards of care in treating their patients by paying adequately for all services delivered.
  • Testing and implementing payment models that reward providers for supplying optimal care to patients with diabetes.

The group also made the following recommendations to improve care management:
  • Increase use of shared decision-making opportunities with patients in the office setting to maximize patient engagement in self-management of diabetes.
  • Fully leverage existing health information technology tools to assist patients in diabetes self-management and track performance.
  • Create strong provider teams and share roles and expectations with patients.

Given the high and growing prevalence of diabetes, the chronic nature of the disease, lack of success in achieving desired patient outcomes, and the high cost of treating complications resulting from poor diabetes control, the barriers to providing optimal diabetes care must be brought to the forefront of the national health care discussion,” the working group wrote in the paper.”

I can only say that the Diabetes-in-Control article is not a proper reflection of the study
and the conclusions of the Diabetes Working Group.

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