February 10, 2014

Medicare Really Harming Seniors with Diabetes

You knew this was likely to happen! Medicare's national mail-order program is ripe with problems and the Centers for Medicare and Medicaid Services (CMS) is not concerned except to defend their actions. All this started when the American Association of Diabetes Educators (AADE) did their homework and discovered that the regulations Congress specified are not being adhered to and in fact are being ignored.

Martha L. Rinker, JD, AADE's chief advocacy officer, told Medscape Medical News that despite CMS rules that forbid suppliers from pressuring patients to switch glucose-meter/test-strip brands and that allow physicians to write prescriptions for specific brands, the way the program is being conducted is leading many patients to switch anyway, with potentially negative consequences.”

Part of the problem is when a patient receives a meter they don't know how to use it will not be used. This defeats the purpose and results in waste. Ms. Rinker is also concerned about the accuracy of some of the low priced meters and test strips being foisted on Medicare beneficiaries.

Of course, some of the mail-order companies disagree and bring up the conflict of interest because some of the supporters of the AADE are also manufacturers. As expected, CMS is saying there is nothing out of order and that the agency has comprehensive monitoring in place. The CMS is not sending inspectors out, and they seem to be relying on the honesty of the suppliers.

"Although Congress clearly intended the 50% rule to ensure that beneficiaries would have access to the brands offered before the national mail-order program, CMS is failing to ensure that beneficiaries continue to have access to familiar test systems," the AADE report says.

Once the program was underway, CMS has not insured that the 50% rule has stayed in force. The AADE found in Medicare supplier directory that by the end of the first quarter of the mail-order program, only 5 suppliers were offering more than 50% of the testing systems that had been available prior to the competitive bidding program. On Medicare's website, the majority of suppliers were offering less than 50%, and in the AADE survey, no supplier offered more than 50%.

CMS said that requirement applied only at the time of bidding. Even though the legislation required that suppliers comply with the 'physician-authorization process' many are supposedly pushing beneficiary's to take substitutes. According to the CMS, failure to comply with all of these rules "constitutes a breach of contract and can result in termination of the supplier's contract." Apparently, CMS is not enforcing this requirement either.

CMS also states Medicare does not pay for convenience. It pays for medical necessity. This basically says they only care about cutting cost even if the Medicare patient is harmed. They will make their own rules, again, even if the Medicare patient is harmed.

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