Veterans with Dual Coverage Under Scrutiny

Being a veteran, this article creates resentment in me. It is as always; blame the veteran for having served the country and find ways to deny medical supplies where possible. It is bad enough that the Centers for Medicare and Medicaid Services (CMS) and the Veterans Affairs severely limit testing supplies, but now the veterans that are taking advantage of both are being put under the scope.

The researchers who are reporting this are determined to put these veterans in a bad light and prevent them from gaining the upper hand in diabetes management. Their reasoning is cost must be limited. They cite the costs of self-monitoring of blood glucose in the United States as being substantial. Medicare contractors paid more than $1.2 billion for test strips and/or lancets in 2007, and the VA, where use and cost are lower, approximately $50 million per year is spent on test strips alone.

Both Medicare and the VA, however, place restrictions on the number of test strips used per a specific time period based on the patient's diagnosis and treatment regimen. The researchers are upset with the veterans using both systems for obtaining test strips, and thereby side-stepping each system's attempts to discourage overuse.

The researchers defined overuse of test strips as more than one strip per day, or more than 365 strips per year, for those taking no diabetes medications, oral diabetes medications only or long-acting insulin without short-acting insulin. For those taking short-acting insulin, overuse was defined as more than four strips per day, or more than 1,460 strips per year.

The researchers showed their bias because a few of the oral medications do cause hypoglycemia and the users need more test strips. Data from 363,996 veterans aged at least 65 years with diabetes who used the VA health care system who received strips in 2009 were included.

A total of 260,688 veterans (71.6%) with diabetes received strips from the VA only, 82,826 (22.8% from Medicare only and 20,482 (5.6%) from both the VA and Medicare, according to the data. The researchers found that those receiving strips from the VA and Medicare received more strips (median, 600), as compared with Medicare only (median, 400) and VA only (median, 200; P<.001).

The researchers could not do the work necessary to confirm information as evidenced by this statement, “Odds for overuse also appeared to be considerably greater for those receiving coverage from both the VA and Medicare versus the VA only.”

“Patterns remained similar, the researchers noted, even when more conservative thresholds of overuse were employed.”

Then the researchers make this statement, “These findings illustrate the profound importance of understanding dual health system care and are emblematic of waste and inefficiency that must be addressed.” The researchers apparently did not confirm that there was actual waste, but concluded that there was waste and blame the veterans for trying to manage diabetes more effectively.