Replay: Ask An Expert: Risks of Medicare Competitive Bidding

DPAC Ask An Expert: Dr. Gary Puckrien, PHD – Risk of Medicare Competitive Bidding



Dr. Gary Puckrein, Ph.D of the National Minority Quality Forum kicked off our new presentation series, Ask An Expert, with a closer look on the negative impact of Medicare’s Competitive Bidding Program for people with diabetes.

What did we learn? Increased deaths, increased hospitalizations, and increased costs.

If you missed the live presentation, we’ve got it archived so you can watch it by clicking here! 


Links & resources on Medicare Bidding

DPAC Blog Post on Bidding


Quality Diabetes Education

ACT NOW: Save lives and reduce cost with broader access to educators.

One policy step to reducing the burden of diabetes, improving health outcomes and lowering costs is improved access to diabetes education. Diabetes education can be enhanced by increasing the pool of providers and bringing the benefit in line with new recommendations on critical times for diabetes education. Ask your Congress Members to support Access to Quality Diabetes Education Act of 2015 (S. 1345 / HR 1726).

It is one policy step to reducing the burden of diabetes, improving health outcomes and lowering costs is improved access to diabetes education. Diabetes education can be enhanced by increasing the pool of providers and bringing the benefit in line with new recommendations on critical times for diabetes education

Diabetes self-management education (DSME) is reimbursable under Medicare. However, Certified Diabetes Educators are not recognized as a provider by the Centers for Medicare and Medicaid. Diabetes education is an underutilized benefit. There is evidence that diabetes education can save health care costs over time.

Living with successfully diabetes requires complex lifestyle changes, monitoring and in many cases medication. Education is key to making healthy changes. Encouraging referrals, more cost-effective providers and broader educational interventions at critical times can help change the lives of 30 million Americans with diabetes.

Sadly researchers at the American Diabetes Association’s (ADA) 2015 annual meeting in Boston reported that diabetes education underused. The ADA researchers said in a statement that “for people to learn the skills necessary to be effective self-managers, DSME is critical in laying the foundation with ongoing support to maintain gains made during education. Despite proven benefits and general acceptance, the numbers of patients who are referred to and receive DSME are disappointingly small.”

“It’s horrifying, what we’re not doing in education.” said David Marrero, Ph.D., ADA president of healthcare and education and professor of medicine at the Indiana University School of Medicine in Indianapolis.

The new recommendation identifies four critical times when a patient may need consultation with a diabetes educator:
* At diagnosis
* On an annual basis
* When new complicating factors influence self-management, such as a new health problem
* When there is a transition in care

Keep Care Settings Infection Free

ACT NOW: Write State Officials to Keep Care Settings Infection Free

Assisted blood glucose monitoring in long-term care facilities, clinic, and hospitals is sadly a primary source of blood-borne virus disease transmission. Between 1990 and 2008, there were 18 hepatitis B virus infection outbreaks in the United States that were associated with the improper use of blood glucose monitoring equipment. 147 people acquired hepatitis B. Six of those patients died.

Unfortunately, preventable outbreaks are still occurring due to breaches in infection control policies. Recently an outbreak of Hepatitis B was attributed to improper assisted blood glucose monitoring in Pennsylvania.

Each state has its own public health processes. Ask your Governor and state legislators to make sure your state public health offices are following CDC guidelines for infection control and enforcing the policies created to safeguard patients and healthcare personnel.

CDC recommended practices for preventing blood-borne pathogen transmission during glucose monitoring in healthcare settings include:

– Lancet/fingerstick devices should never be used for more than one person. (Single disposable lancet devices are recommended for assisted blood glucose monitoring.) The shared use or re-use of these devices is one of the common root causes of exposure and infection when multiple persons require blood glucose monitoring assistance.
– Whenever possible, blood glucose meters should not be shared.  If they must be shared, the device should be cleaned and disinfected after every use, per manufacturer’s instructions.  If the manufacturer does not specify how the device should be cleaned and disinfected then it should not be shared.
– Insulin pens and other medication cartridges and syringes are for single-patient-use only and should never be used for more than one person.
– Hand hygiene protocols must be consistently followed: gloves must be worn during assisted blood glucose monitoring and must be changed between patient contacts or touching a contaminated surface/open finger-stick wound, hand washing with soap and water or hands rubbed thoroughly with an alcohol-based hand rub must be completed immediately after removing gloves and before touching medical supplies intended for use by another person.
– Provide a full HBV vaccination series to all previously unvaccinated staff persons who may come in contact with blood during activities and to patients with diabetes.

Please make sure that the public health departments in our state are diligent in making sure these and other safety steps outlined by CDC are implemented, practiced, and enforced. These infections are preventable with your help.

We Need A Hearing on Diabetes

ACT NOW: to ask Congress for a Hearing on Diabetes.

In the five years since the last hearing on diabetes held in Congress, the number of Americans diagnosed with prediabetes has increased to 86 million, the cost of diabetes care in the U.S. has exploded to $322 billion annually, and without Congressional leadership, this epidemic will wreak financial havoc on our healthcare system.

A new hearing is needed to focus on the current untenable and unstable financial path caused by unbridled diabetes costs and explore potential legislative resolutions. There are existing bills in Congress offering savings measures to stem this epidemic with diabetes prevention programs. See our scorecard for details. There is no better time to investigate and take action.

Untangle Federal Agencies

ACT NOW: To Ask Congress members to sponsor the National Diabetes Clinical Care Commission Act

Here is why:

Diabetes is a significant problem for our nation. It touches the lives of thirty million Americans. Living well with diabetes requires individuals to make healthy changes to the status quo.

The government needs to make a healthy change too. Diabetes consumes one in three Medicare dollars. Beyond Medicare, the government has responded to diabetes with efforts by more than three dozen different federal agencies. Those of us living with diabetes know these agencies can be a tangle of crossed responsibility that is a missed opportunity for communication and collaboration. Helping Americans live well with diabetes will require the government to change the status quo of agencies working alone, to a coordinated national response.

The new commission that H.R.1192 creates will focus on diabetes activities and help the federal government to better address the disease, in a fiscally responsible and effective manner. The act is budget neutral, and prior experience suggest this commission can have a significant positive impact on care. The journal “Diabetes Care,” June 1994 highlights the success of the National Diabetes Advisory Board, including the pivotal Diabetes Control and Complications Trial (DCCT) that has defined modern diabetes care.

The coming years promise new device and medication innovations that can be as pivotal as DCCT. Coordinating the federal response to these innovations will help millions of Americans.

ACT NOW: Ask your elected officials to sponsor the National Diabetes Clinical Care Commission Act.

Continuous Glucose Monitoring Enhances Quality Care

ACT NOW: Ask for Medicare Coverage for CGM

Access to quality diabetes care products through private insurance and Medicare is critical to living successfully with diabetes and minimizing costly complications. Join other DPAC Patient Voices in calling for access Continuous Glucose Monitoring (CGM) and coverage processes that provide patients with the tools they need.

The cornerstone of diabetes self-management is making timely changes to manage blood glucose levels. To do that, people need access to quality blood glucose testing supplies, medications, and devices.

Medicare CGM Access Act of 2015 (S804/HR1427) are bipartisan companion bills were introduced by Senators Collins and Shaheen and Representatives Reed, DeGette and Whitfield.

Continuous Glucose Monitoring is life-saving 21-century technology that can help prevent costly hospitalization of American seniors with diabetes. CGM can save lives – and money; the average cost of an emergency room visit and subsequent hospital admission for a low blood sugar is $17,000. Medicare should join the vast majority of private insurance providers in making CGM accessible by Medicare patients. Seniors with diabetes should not lose this powerful tool when they join Medicare.

The ‘Medicare CGM Access Act of 2015’ would resolve this coverage oversight by Medicare and help pave the way for coverage of the next generation of CGM-related technologies, such as Artificial Pancreas (AP) systems.

We believe that well-controlled diabetes is the leading cause of nothing. The high cost of diabetes complications can be minimized through the immediate investment in safe and accurate tools of good care.

We believe that all patients, regardless of age or socioeconomic status, should have access to devices, including continuous glucose monitors (CGM) that can prevent immediate and long-term diabetes complications.

ACT NOW to ask your members of Congress to co-sponsor the Medicare CGM Access Act of 2015, or if one of your elected officials already has co-sponsored the bill, send them a thank you. (Don’t worry,  we’ll do the work to find out if your members of Congress have co-sponsored or not!)

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