The Payment Gap

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For years, many people with diabetes have lamented that their actual care falls short of the ideal of an attentive “health-care team” eager to address their needs. Many, in fact, feel rushed at the doctor’s office, and some find that while they may have received some diabetes education sessions shortly after diagnosis, ongoing discussion of issues related to diabetes management and lifestyle improvement is rare. Now, a study has highlighted the financial situation that may explain why so many people with diabetes have doctor’s appointments that feel less than thorough.

Released late last month, the study examined how payments from Medicare, private insurance plans, and Medicaid for diabetes-related visits corresponded to the costs of medical practices for these visits, and how doctors felt about financial and other barriers to delivering optimal diabetes care. It was sponsored by pharmaceutical companies but administered by unpaid members of professional and nonprofit diabetes groups (American Diabetes Association, American Association of Clinical Endocrinologists, American Association of Diabetes Educators, and others). According to an article on the study in Internal Medicine News, 1,056 diabetes care providers took the survey on barriers to ideal treatment and what kinds of patients they saw. The most frequently mentioned barrier was “patient compliance,” followed by “time with patients” and “compensation.” Next came “team coordination.”

Compensation for diabetes-related visits, however, could logically affect each of the other barriers mentioned in the survey. And as the survey made clear, that compensation appears to be inadequate. It estimates that the typical internal medicine practice for adults loses a yearly total of $754,623 on patients with diabetes. For pediatric patients with diabetes, the typical overall loss for a practice is $471,098. As the survey notes, practices tend to make up for these losses by seeing other, more profitable patients and by generally seeing as many patients as possible, limiting the time spent with each one. Furthermore, even when a doctor spends more time than usual with a patient, the practice is likely to submit an insurance claim for a shorter visit to avoid the scrutiny that a larger claim might encounter from the company or agency that reviews it.

The study authors recommend a variety of remedies for the ills they found in diabetes-related care, including increasing reimbursement to adequate levels and testing payment schemes that reward effective care rather than simply volume of patients or services provided. They also recommend greater inclusion of patients in medical decision-making, more coordination among health-care providers, and attracting more doctors to diabetes care through measures like student-loan forgiveness.

What do you think — do you feel rushed or otherwise undervalued at the doctor’s office? If medical costs must go up to accommodate more time with diabetes patients, how should that cost be covered: higher premiums or co-pays, just for people with diabetes or for everyone in the health-care system? Would you be willing to pay a bit more in exchange for more time and attention from your health-care team? Do you have any other ideas for how diabetes care might be improved? Leave a comment below!

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