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AAFP calls on CMS to simplify rules for prescribing diabetic supplies

The American Academy of Family Physicians is calling on CMS to simplify Medicare’s rules for prescribing diabetic supplies, describing the current system as “overly burdensome with little-to-no value added to the actual care” for patients.

In a letter to HHS Secretary Sylvia Burwell dated April 13, 2016, the chairman of the American Academy of Family Physicians (AAFP) characterized the documentation process required for prescribing diabetic supplies as “onerous” and overly time consuming.

“Family physicians simply want to be able to prescribe efficiently and effectively what their diabetic patients need to help manage their condition in a way that maintains their health,” Robert Wergin, MD, AAFP board chairman, wrote in the letter. “Unfortunately, the current Medicare rules surrounding prescription of diabetic supplies impede this goal and add no discernable value to the care of such patients.”

Wergin said for a physician to obtain glucose testing supplies from Medicare, they must write a detailed order including the patient’s name, description of the supplies, specific frequency of the testing — “as needed” or “PRN" orders are not accepted — length of the needed prescription, the physician’s signature, the date the order was signed and the prescription start date.

Documentation must also show proof of patient’s diagnosis and treatment by a physician; that the supplies are being ordered by the physician on record for treating said patient; certification that the patient or caregiver has been trained, or is scheduled to be trained, in the equipment’s use; certification that the patient or caregiver is capable of understanding the test results to properly manage their glucose; and show that the monitor is designed for home use.

If the prescription calls for testing supplies in quantities in excess of the monthly maximum, Medicare additionally requires half a dozen other documents, orders and certifications, according to Wergin.

“In practice, the documentation requirements are onerous to our members and consume valuable physician time that is not germane to the actual care of the patient,” Wergin wrote. “Clearly, the documentation requirements add administrative cost to both Medicare and the family physician and diminish the opportunity for better diabetic care. Family physicians’ time is better spent helping patients manage their diabetes, not providing additional paperwork to justify what the patient needs.”

While Wergin acknowledged that diabetic supplies are often the subject of Medicare claims processing errors, and that physicians must play a role in fraud prevention, he added that the current rules must, to a degree, be relaxed.

“Ideally, it should be acceptable for a physician to write for ‘diabetic supplies,’ which would encompass syringes, needles, test strips, lancets, glucose testing machine, etc., with only a need to provide a diagnosis and an indication such a prescription is good for the patient’s lifetime,” Wergin said. “… In recent years, CMS has shown a willingness to reconsider its current rules and to seek opportunities for simplification that benefit patients and providers without compromising the integrity of the Medicare program.”

The AAFP letter also urged the government to step in to prevent medical suppliers from directly soliciting patients regarding supplies they don’t need.

 It also warned of the risks involved with patients receiving unbranded or inaccurate glucose testing supplies from mail-order suppliers under the CMS competitive bidding process. – by Jason Laday

Additional reading:

http://www.aafp.org/news/government-medicine/20160418diabeticsupplies.html