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AADE: Telehealth should be included in Medicare Diabetes Prevention Program
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The American Association of Diabetes Educators outlined several recommendations for a CMS proposal to include the Medicare Diabetes Prevention Program in the 2018 Medicare Physician Fee Schedule, including the addition of telehealth and other online platforms as a covered service that is interchangeable with in-person delivery.
In public comments issued this week, AADE also suggested revisions to Medicare Diabetes Prevention Program (MDPP) payment policies and the addition of a process that could test any program changes to improve beneficiary access, increase goal attainment and potentially reduce costs.
“Medicare opened the door to virtual programs to supplement missed classes, and although limited, we appreciate this move toward virtual,” Leslie Kolb, RN, BSN, MBA, vice president of science and practice for the AADE, told Endocrine Today. “AADE feels that virtual programming should be implemented with this new benefit. This is a bold move for Medicare, but technology is an important component for the future of health care. Virtual programs allow a choice for Medicare beneficiaries and increase access, particularly in vulnerable populations.”
Under a cooperative agreement with the CDC, AADE is one of six organizations designated to scale and sustain the National Diabetes Prevention Program.
In the comments, AADE noted that allowing access to a virtual MDPP supplier would give beneficiaries, many of whom are older adults who travel to warmer climates in the winter, the ability to keep the same provider and achieve greater results.
“When you specifically look at the Medicare Diabetes Prevention Program, there is already a precedent set for telehealth coverage, as both diabetes self-management training and medical nutrition therapy are currently covered via telehealth,” Kolb said. “To that end, clinical staff at a distant facility could oversee an in-person weigh in, and the collected weights would be entered as the ‘in-person’ weights. AADE feels this is especially important as an interchangeable option to in-person, to address rural and seasonal populations and reduce participants from ‘switching’ programs or not completing their MDPP program.”
‘Costs may be a barrier’
AADE also raised concern that the MDPP’s distribution of payments over the course of a program do not align with the burden and risk incurred upfront by MDPP suppliers, Kolb said.
“For example, most program costs (eg, administrative costs, staffing, beneficiary engagement, marketing, materials, recruitment, etc) are incurred up front in the initial 6 months,” Kolb said. “These costs are incurred whether or not a participant meets the weight-loss criteria. MDPP sites, as proposed by Medicare, would be faced with covering the initial overhead expenses without timely reimbursement. As a result, these costs may be a barrier for entities to become an MDPP supplier.”
AADE is recommending that Medicare consider shifting a portion of the payments to align with the actual costs incurred between the attendance payments and/or the payments based on weight loss, Kolb said. Additionally, AADE recommends decreasing the payment for 5% weight loss from $160 to $100, with the $60 distributed to the core sessions attended by beneficiaries, and removing the payment for 9% weight loss completely, instead distributing that remaining $25 payment toward the attendance of sessions in months 7 to 12. AADE also “highly recommends” removing the various payments for participants in months 7 through 12 that depend on whether participants achieve 5% weight loss.
“As AADE has seen with Diabetes Self-Management Training services, access is poor, and if we are to expand and sustain this new benefit, the system will need to be set up to realistically support MDPP programs up front,” Kolb said. “With 84 million people at risk for type 2 diabetes, developing quality programs should be a priority.”
Expanding access
In its recommendations, AADE is also suggesting the MDPP “one-per-lifetime” limit be removed for participants who experience a major life event. The limitation, Kolb said, could deny a participant coverage they need at the time they need it.
“Life happens, and participants should not be denied this benefit because they started the program before a major event occurred in their life,” Kolb said. “For example, a newly diagnosed health condition, major surgery, a change in medications, a permanent change in residence or a catastrophic event may reduce the ability to participate in physical activity.”
The deadline for CMS to accept comments on the proposed rule was Sept. 11, and the agency said it will respond to comments in a final rule. – by Regina Schaffer
Reference:
AADE. 2018 Proposed physician fee schedule released. Available at: www.diabeteseducator.org/cms-comment.
Disclosure: Kolb reports no relevant financial disclosures.