Diabetes is relatively EASY to prevent.
a whole lot harder to deal with AFTER the fact…
Comment by Averal on NPR Post, “What Diabetes Cost You”
November 20, 2014
When it comes to type II diabetes and gestational diabetes, prevention is much easier that treatment. But the current U.S. health care system spends much more time and energy treating diabetes than preventing diabetes, to the tune of 344 million dollars a year. That works out to about $1000 per capita for every man, woman and child (counting all of us–not just those diagnosed with the disease) Costs continue to rise for everyone diagnosed with diabetes, as well. A recent NPR report charts the growing problem and tallies the dollar costs per person.
HOW DO WE SPEND TREATMENT DOLLARS?
The American Diabetes Association website goes on to break down how treatment dollars are spent. The largest components of medical expenditures are:
- hospital inpatient care (43% of the total medical cost),
- prescription medications to treat complications of diabetes (18%),
- anti-diabetic agents and diabetes supplies (12%),
- physician office visits (9%), and
- nursing/residential facility stays (8%)
The dollar costs are staggering, and it is clear where there is money to be made. It’s not in providing support for patients trying to figure out what to eat; I couldn’t find any mention of the cost of Medical NutritionTherapy (MNT) in any of the documents I reviewed, nor the cost of Diabetes Self Management Training (DSMT). Are these dollars so insignificant that they aren’t even tallied?
WHO MAKES MONEY CATERING TO DIABETICS?
I recently scanned through Los Angeles Time’s advertising supplement during National Diabetes Month in November. The publication perfectly illustrated the distortion of care. Out of 26 advertisements, I noted only one whole food item. Peanuts. A simple tally of advertisers yielded the following results:
On the pseudo-food front:
- Two artificial sweeteners (Splenda and Stevia)
- One condiment (bouillion) and one food supplement, Boost (a highly refined concoction despite it’s “glucose controlled” label)
The bulk of the advertisements featured items where more significant profit margins exist:
- Three medications
- Five appliances like glucose meters and insulin pumps
- Six products specifically formulated and manufactured for diabetics
- Four medical procedures
To be fair, the publication promoted three opportunities for diabetes education and feature articles discussed food choices. But there was no mention of the disconnect between the foundation of a healthful diet and what was actually advertised in the publication.
THE ROLE OF MEDICAL NUTRITION THERAPY AND DIABETES SELF MANAGEMENT TRAINING
Ideally effective nutrition and lifestyle counseling could stem the tide of insulin resistance and poor metabolic health. But that doesn’t happen. A recent CDC report tells us that during 2011-2012 only 6.8 of all newly diagnosed persons received diabetes self management training, the kind of support that provides patients with education and coaching regarding diet, exercise, and other means of decreasing risk. Another document prepared from a webinar sponsored by the National Council of Aging in 2013 stated that DSMT is one of the most underutilized Medicare benefits, with only 1.5% of eligible Medicare beneficiaries known to have used their benefit. With benefits available, what keeps patients from accessing care?
BARRIERS AND OPPORTUNITIES
Scan the National Council of Aging report more carefully and you will find an answer. Months of process and mounds of paperwork for providers.
Just this past year I endeavored to become a medicare provider so I can provide Medical Nutrition Therapy (MNT) for diabetic patients, a parallel benefit. I started the process in April. Nine months later with over 50 hours of my time in the process, and I am now certified but still waiting on one more step that the representative said should take just two weeks. Well, at least that is what I was told three weeks ago.
Despite mostly good information and helpful support, I have been misinformed, delayed, and dropped through the process more times that I can remember. More than once I considered abandoning ship. Even now, I wonder what I am getting myself into as I have yet to tackle actually billing for a single session. A 2010 Step by Step Guide for Medicare Medical Nutrition Therapy (MNT) Reimbursement counts 81 pages long. If I am ever inclined to apply for the right to bill for reimbursement by private insurers, I have two stacks of legalese to navigate. One is 67 pages, the second is 18.
EXISTING PROBLEMS, SOME POSSIBLE SOLUTIONS
The opportunities to offer and receive MNT and DSMT may be wide open for both the patient and the practitioner, but at least for private practitioners the process of qualifying to be a provider remains a significant barrier. The application materials need some significant attention. I called for help countless times, and talked to kind and willing representatives that readily admitted someone needed to interpret many of my questions. Even after one supervisor walked me through the paperwork and deemed it complete , there were mistakes and omissions that needed attention over the following 8 months. The application is fraught with vague and confusing directions, especially since not all parts of the form apply to every practitioner.
Artificially low reimbursement rates, especially by private insurers, is another issue. If I agree to their terms, I’ll have to accept less than 50% of my customary and usual fee. I am not allowed to ask patients for a co-pay to make up the difference or request that they make some viable investment in their own care. I already know what happens when patients have no skin in the game.
For now, I can’t quite get my head around the misguided use of our health care dollars. None of this makes sense except in a system that values profits over prevention. Without meaningful change, I can imagine patients will continue to struggle to find enough registered dietitians and others certified to offer DSMT who are willing to jump through all the hoops for the privilege of providing care at a discount. I’d like to find out how this is working out for anyone else. Let me know.