Breaking News
March 22, 2019 - Alzheimer’s patients using antiepileptic drugs have twice the risk of pneumonia, study shows
March 22, 2019 - Skin diseases may be more prevalent than previously thought
March 22, 2019 - Overall rates of death from breast cancer are falling across the EU
March 22, 2019 - Novel plasmid could hold key to control of mosquito-borne illness
March 22, 2019 - Female Emergency Physicians Paid Less Than Males
March 22, 2019 - Estimated average glucose (eAG): MedlinePlus Medical Encyclopedia
March 22, 2019 - Experimental drug could be new option for type 2 diabetes
March 22, 2019 - Five Things To Know About The Electronic Health Records Mess
March 22, 2019 - TMJ disorders could be treated with tissue-engineered implants after successful animal study
March 22, 2019 - Team-based approach is key to successful care of pregnant women with heart failure
March 22, 2019 - Study identifies gene variant associated with accelerated cellular aging
March 21, 2019 - Salk scientists show how background noise from neurons can interrupt focused attention
March 21, 2019 - New class of drugs could help treat patients diagnosed with ovarian cancer
March 21, 2019 - Tecentriq Approved for Small Cell Lung Cancer
March 21, 2019 - Adipocyte glucocorticoid receptors play a role in developing steroid diabetes
March 21, 2019 - Climate change can affect nutrient content of crops, harming human health
March 21, 2019 - Podcast: KHN’s ‘What The Health’ Surprise! Fixing Surprise Medical Bills Is Harder Than it Looks
March 21, 2019 - Chemistry researchers patent new method for making anti-leukemia compounds
March 21, 2019 - UIC scientists identify hidden proteins in bacteria
March 21, 2019 - New Australian drug trial achieves remarkable results in patients with acute myeloid leukemia
March 21, 2019 - Females live longer when they have help raising offspring
March 21, 2019 - How did orthodontists sell orthodontics?
March 21, 2019 - In the Spotlight: From dietitian to physician assistant student
March 21, 2019 - The CRISPR Revolution: What You Need to Know
March 21, 2019 - FDA Chief Calls For Stricter Scrutiny Of Electronic Health Records
March 21, 2019 - Combined glucocorticoid and antioxidant therapy could benefit premature babies
March 21, 2019 - Low levels of certain eye proteins could serve as predictor for Alzheimer’s
March 21, 2019 - Post-traumatic holocaust survivors transmit negative views on aging to offspring
March 21, 2019 - City of Hope receives $7.5 million in grant awards to study cutaneous T cell lymphoma
March 21, 2019 - New video game-led training device helps stroke survivors regain arm mobility
March 21, 2019 - Compounds in coffee could slow prostate cancer growth
March 21, 2019 - New mobile DNA element in Wolbachia may contribute to improved disease control strategies
March 21, 2019 - Phase 2 Clinical Trial of Bermekimab Shows Potential New Standard of Care for Treatment of Hidradenitis Suppurativa, Including Significant Pain Reduction without Antibiotics
March 21, 2019 - More than one-third of patients risk major bleeding by doubling up on blood thinners
March 21, 2019 - A skeptical look at popular diets: Thumbs up for Mediterranean
March 21, 2019 - PTSD After Cardiac Arrest Predicts More Heart Trouble
March 21, 2019 - Role of immunological imprinting in elicitation of new antibodies
March 21, 2019 - Breast cancer relapse predictor tool may soon be a reality
March 21, 2019 - New computer program developed by TGen lights up cancer-causing genetic mutations
March 21, 2019 - FDA warns two breast implant makers for failure to comply with post-approval study requirements
March 21, 2019 - Butler Hospital receives COBRE grant to enhance research on neuropsychiatric illnesses
March 21, 2019 - Majority of osteoporosis clinical practice guidelines ignore patients’ voices
March 21, 2019 - Generic messages don’t help patients to lose weight
March 21, 2019 - Eisai and Imbrium Therapeutics Announce U.S. FDA Filing Acceptance of New Drug Application for Lemborexant for the Treatment of Insomnia
March 21, 2019 - Two-drug combos using popular calcium channel blocker show superiority in lowering BP
March 21, 2019 - First-in-human pilot study shows positive results for ‘bacteria-phobic’ catheter
March 21, 2019 - Itamar Medical launches next-generation WatchPAT system for home sleep apnea testing
March 21, 2019 - Study estimates health and economic impacts of healthy food prescriptions
March 21, 2019 - Detecting fungal disease in crops with multispectral imaging system
March 21, 2019 - MIT announces creation of the Alana Down Syndrome Center
March 21, 2019 - Next-generation LVAD device clinically superior, safer for heart failure patients
March 21, 2019 - Allergan Announces FDA Approval of Avycaz (ceftazidime and avibactam) for Pediatric Patients
March 21, 2019 - Mutations in noncoding genes could play big role in regulating cancer, study finds
March 21, 2019 - A medical student’s thoughts on Match Day
March 21, 2019 - Are eggs good or bad for you?
March 21, 2019 - New analysis reveals precision oncology insights for colorectal cancer
March 21, 2019 - Pollutants appear to weaken immune system and increase pathogen virulence
March 21, 2019 - Researchers develop and validate scale for rating severity of mononucleosis
March 21, 2019 - Scientists identify generation of key immune response in mice on introducing solid food
March 21, 2019 - New nanomaterial could restore internal structure of damaged bones
March 21, 2019 - Selective destruction of prostate tumor as effective as complete prostate removal
March 21, 2019 - 2011 to 2015 Saw Increase in Psychiatric ED Visits for Youth
March 21, 2019 - Tapeworm drug targets common vulnerability in tumor cells
March 21, 2019 - WVU researcher discovers higher suicide rate among Medicaid-insured youth
March 21, 2019 - Off the beaten path for global health residency
March 21, 2019 - European Parliament’s report calls on EU to develop policies to regulate endocrine-disrupting chemicals
March 21, 2019 - Women with undiagnosed diabetes in pregnancy more likely to experience stillbirths
March 21, 2019 - Fish consumption can help prevent asthma, study reveals
March 21, 2019 - Royal Holloway professors to lead new to research into curing Neurofibromatosis type 1
March 21, 2019 - NSF offers grant to improve treatment approaches for pelvic organ prolapse
March 21, 2019 - Your Apple Watch Might Help Spot a Dangerous Irregular Heartbeat
March 21, 2019 - Research team uncovers critical new clues about what goes awry in autistic brains
March 21, 2019 - From March Madness to medicine with help from mentors
March 21, 2019 - Mental health disorders among young adults may be on the increase
March 21, 2019 - New study examines smarter automatic defibrillator
March 21, 2019 - UC Riverside research shows how natural selection favors cheaters
March 21, 2019 - Mother’s diet during pregnancy can impact lung-specific genes of her offspring
March 21, 2019 - AeroForm Tissue Expanders makes breast reconstruction after mastectomy more comfortable
March 21, 2019 - New project focuses on creating more responsive, intuitive prosthetics
March 21, 2019 - New case study describes adolescent patient with rapid-onset schizophrenia and Bartonella infection
Costs of Medicare Diabetes Prevention Program may be higher than expected reimbursement

Costs of Medicare Diabetes Prevention Program may be higher than expected reimbursement

image_pdfDownload PDFimage_print

For some healthcare providers – especially those serving racial/ethnic minority and low-income patients – the costs of delivering a new Medicare Diabetes Prevention Program (MDPP) may be much higher than the expected reimbursement, reports a study in the November issue of Medical Care. The journal is published in the Lippincott portfolio by @WKHealth.

Payments may cover as little as one-fifth of the costs of delivering recommended diabetes prevention services in “safety-net” healthcare settings, according to the brief report by Natalie D. Ritchie, PhD, of Denver Health and Hospital Authority and R. Mark Gritz, PhD, of University of Colorado School of Medicine. “While many MDPP suppliers are needed to reach all Medicare beneficiaries with prediabetes, insufficient reimbursement may be a deterrent,” the researchers write.

Analysis Suggests $661 Gap Between MDPP Costs and Payments

The MDPP is an innovative program to prevent diabetes in Medicare beneficiaries. A previous report on the National Diabetes Prevention Program suggested that educational and coaching sessions over one year reduce the risk of developing type 2 diabetes in older adults at high risk. The MDPP targets older adults meeting criteria for “prediabetes” – estimated to be present in about 48 percent of US seniors.

Under a “pay-for-performance” scheme announced last year, healthcare providers will be reimbursed for MDPP services based on patients’ attendance and weight loss. The program targets a five percent reduction in body weight, which can delay or prevent type 2 diabetes. But there are concerns about whether reimbursements will cover the costs of MDPP services – particularly in minority and low-income populations, who have a disparately high risk of diabetes.

Drs. Ritchie and Gritz analyzed the costs of and expected reimbursement for providing MDPP services to 213 Medicare beneficiaries with prediabetes or other diabetes risk factors in Denver’s safety-net healthcare system. Most patients were of minority race/ethnicity (41 percent Hispanic, 32 percent black) and classified as low-income (about 70 percent).

Average projected reimbursement was about $139 per patient, based on coverage rules issued by the Centers for Medicare and Medicaid Services. Consistent with previous studies, outcomes of the MDPP intervention were not as good in this group of largely minority, low-income Medicare beneficiaries. Average weight loss was just under two percent, which may still be beneficial for reducing diabetes risk. Less than five percent of participants met all milestones (attendance and weight loss) needed to reach the maximum payment of $470 for a full year of services.

By comparison, the costs of delivering the program were estimated at $800 per patient. Subtracting the average payment of $139, there was a $661 gap between the costs of the program and the expected payments. Expenses for coaching staff accounted for a little over half of the costs of providing MDPP services. “Even if program delivery costs were reduced and Medicare beneficiaries performed better in the future, it appears that an unsustainable funding gap might likely remain,” commented Dr. Ritchie.

Preventing diabetes is a major priority for improving health and reducing healthcare costs in older Americans. The introduction of the MDPP offers an “unprecedented opportunity to provide lifestyle intervention to Medicare beneficiaries with prediabetes,” the researchers believe.

Their study adds to concerns that reimbursement provided by Medicare will fall short of covering the costs for providing MDPP services – especially for healthcare providers serving diverse, underserved patient populations. The payment gap could limit access to recommended diabetes prevention services and contribute to widening health disparities.

Drs. Ritchie and Gritz present an analysis suggesting that reimbursing the full beneficiary cost of $800 per patient would pay for itself within the first year due to healthcare expenditures avoided – and bring an even larger return on investment in subsequent years. The authors conclude: “The high economic and societal costs of diabetes and the importance of reducing health disparities suggest that financially sustainable payments are necessary to ensure benefit access, while yielding cost-savings for Medicare.”​

Source:

http://home.lww.com/news.entry.html/2018/10/15/costs_of_medicaredi-V3wp.html

Tagged with:

About author

Related Articles