This was the question burning in people’s mind and passionately talked about yesterday and today at the General Sessions of the AACE/ACE Consensus Conference on Glucose Monitoring, an event to bring together in Washington, DC all relevant stakeholders to outline possible solutions to assure patients’ access to high-quality glucose monitoring systems.
Participants on the General Sessions of the conference represented FDA (who did a great job in the face of the fair amount criticism they received in connection with post-market enforcement), patient advocacy groups, every medical, scientific, professional, and educational societies, industry representatives, and payers like Aetna, Humana, and UnitedHealthcare. Yet the Centers for Medicare and Medicaid Services (CMS) was not represented. We were told that “No one at CMS was available.”
You know me: I am always smiling, a very positive person. But I was very upset to not see Medicare at the General Sessions during the consensus conference. Because at the heart of a lot of problems currently faced by the 29 million people with diabetes in the US (almost 40% of whom are of Medicare age) are directly a consequence of Medicare actions or inactions.
Examples of inadequate coverage by Medicare include two items in the toolkits of people with diabetes:
- One is the lack of coverage for Continuous Glucose Monitoring (CGM) for people with type 1 diabetes who meet criteria. To address this shortsighted approach by Medicare, JDRF along with a coalition of partners is working very hard to get bills S. 2689 and H.R. 5644 passed.
- Another one is the effort to increase access to diabetes self-management education and support (DSMES) by having Medicare authorize credentialed diabetes educators (as defined in the legislation) to be directly reimbursed to provide DSMES within a Medicare accredited program (either by an ADA recognized program or AADE accredited program), AADE, other organizations and the diabetes community are working to increase this access by getting bills S. 945 and H.R. 1274 passed.
In both cases, valuable advocacy time and energy is being spent to have Congress turn into law benefits for people with diabetes that Medicare should be covering anyway.
Another example is the deeply flawed implementation of a Competitive Bidding process for Durable Medical Equipment (DME, which includes blood glucose monitoring devices) that was implemented largely as a black-box, as Kelly Close said.
The competitive bidding process lacked transparency and allowed things such as non-binding bids: some bidders artificially deflated the average bid and were able to walk away from the process. Medicare claims that the program has been a success, while observations made by groups such as AADE have found clear evidence that Medicare beneficiaries are consistently not receiving access to blood glucose monitoring systems in the way that Medicare claims they do.
On day two of the conference, the attendees split into pillars. I participated in the Patient/Lay Organizations Pillar on behalf of DHF, along with Cynthia Rice from JDRF; Kelly Close from Diatribe; Jeff Hitchcock from Children with Diabetes; Bennet Dunlap from StripSafely; Larry Smith and Larry Ellingson, from the National Diabetes Volunteer Leadership Council; and others.
In fairness, Medicare sent Dr. William Rogers, to participate in the Government, Regulatory, Payers, and Employers Pillar (a small sub-set of the attendees), but after the pillar small meetings were over, he was gone… Engaging with the larger group, including patients, being a TRUE part of the conversation with ALL stakeholders is badly needed from Medicare.
May today be the last time that CMS avoids facing all the other stakeholders: we need them at the table, we need everyone to stand up to their responsibility, and they have an important part to play to help us address this crisis.
In the meantime, I invite you to take action and act on the CGM and Diabetes Advocacy bills mentioned earlier, and also take action and contact your legislators about the bill sponsored by AACE that would result in the creation of a National Diabetes Care Commission, so that the left and the right hand in our government begin to coordinate policy for the greater benefit of people with diabetes, and we don’t see any more gaps like the ones we are trying to remedy today.