Karen - Thanks for the links. I will follow. I'm new to Medicare in 2014 and if I don't have to go more than once per year, that would be better for everybody. Now I hope I am mistaken!
Shadow - I hadn't read the chapter and verse before but this squares with my original understanding.
Zoe - I think you've made this point before and I've read other references to it but did not hunt down the actual language.
I agree, Deb. I'd like a doctor to review my regular lab-work. I don't need a face-to-face for that unless there are issues.
Great you have a team you like and trust!
Well...a cure might be a bit better!
I'd be happy doing most of my doctor communication electronically. Doctors have to see too many patients, you'd think the system would reward people who want less service?!!
Also from ShadowDragon's Medicare link:
The pump must be ordered by and follow-up care of the patient must be managed by a physician who manages multiple patients with CSII and who works closely with a team including nurses, diabetes educators, and dietitians who are knowledgeable in the use of CSII.”
I hope I don't have to see a dietitian. I don't think we'd see eye to eye on my LCHF way of eating.
terry, i go to the endo twice a year, am actually going today! its the same for me. she has me there for about 30-40 minutes, asks me the same routine questions, talks to her computer screen. she cant get me a pump with the economic crisis here in spain, she doesnt know much about nutrition. i feel like its time wasted as well, but i go because its ust twice a year. she sends me to the eye doc and also to the diabetes clinic at the hospital if i need it, thats the only thing she does, shes the gatekeeper to other specialists.
if i could i would just have my bloods drawn and have the results sent to my house.
So, I guess you wouldn't go if you could access the eye doc, hospital, and other specialists.
I guess it's a mixed bag, some like their doc visits, some don't.
I have a different relationship with my endo. I can just call or send an email and she will renew my prescriptions without requiring a visit. She is very prompt and efficient. That being said I visit her every 3 months for two primary reasons. First, we continue to fine tune my control and second I have more health issues than just diabetes.
I have discussed going to a longer period between appointments with her but actually if every appointment is full with a valued health consultation I see no need to press the issue.
ps. And my endo calls herself the "Low Carb Queen" and actually follows a low carb diet.
well, im just back from the endo, a 20 minute cycle over there, 20 minute wait because im always early. i go in and the lab hadnt dont the a1c. so i have to go and get bloods drawn again and then phone her in a couple of weeks for th eresults. my month of doc appts-endo, gyn, blood draws, appts for results-has extended itself another 2 weeks.
So after going over this link, my impression is that even if I am already diagnosed as a T1D and successfully using a pump, I will have to "re-qualify" when I move to Medicare??
Do you all know of another CMS document that speaks to just being able to continue your current, pre-Medicare treatment protocol?
I agree - most appointments are a waste of time. I have had much better luck with nurse practitioners. They not only are CDEs, but they can write the prescriptions too. All of them have been great listeners. My NP in Massachusetts was the bet diabetes expert I have ever been to.
I mostly tell the endo what I need and they send an escript. My endo never asks to see any logs. She think 7.3% is an ok A1C. I do not think this is good. I am now at 6.2% by making my own adjustments....
Just got a Dexcom and just had the doctor sign the faxed order from the diabetes care supplier. So...I could do mostly without an endo. My Endo only wants to see me once a year now....
Here's the CMS that talks about the criteria.
You must meet A or B. Criterion B is:
Criterion B: The patient with diabetes has been on a pump prior to enrollment in Medicare and has documented frequency of glucose self-testing an average of at least 4 times per day during the month prior to Medicare enrollment.
This is also in the memo at the other link.
The link above also confirms that a doctor visit every three months is required to maintain coverage.
One more EDIT to add that I think it means you have to “re-qualify,” but it should just be jumping through the hoop of proving you were on the pump prior to enrollment and that you test at least 4 times a day.
It's nice to see a report about a truly enlightened physician. It continues to mystify me about the ongoing resistance among medicos about the value of a low carb way of eating to diabetics. Things are changing and the day will come when a low carb high fat way of eating will seem sensible to doctors and patients.
My doctor admires the blood glucose results of my way of eating but is quiet when the subject of low carb arises. Maybe this is the sensible middle-ground before the big change.
Thank you Shadow!What about this part, though:
In addition to meeting Criterion A or B above, the following general requirements must be met:
The patient with diabetes must be insulinopenic per the updated fasting C-peptide testing requirement, or, as an alternative, must be beta cell autoantibody positive.
Sounds like a T1D (or insulin dependent diabetic of any stripe) will have to have additional testing done to document the condition for Medicare.
While I am deeply concerned about what will happen when I am Medicare eligible in approx. 5 years, and hopeful for changes by that time, I am also concerned for all those going through bureaucratic hassles and denials today.
Actually, "deeply concerned" doesn't cut it ... boiling mad might be better!
Great that you've connected with nurse practitioners and CDE's. Even better is your self-directed path from 7.3% to 6.2% A1c. What's your secret?
The Dexcom CGM can be a real game changer. Good luck with getting started. Most CGM users don't take advantage of regularly uploading their data to analyze their recent trends. It really helps me this way.
You're very welcome! It's an insanely tangled web for people to try and figure out. Between the statutes, regulations, decision memos, random rules, etc., the only thing we can be certain of is somewhere there is always a catch that will let them deny things. :-(
Hell no. I've said it many times, and I will say it again.
Sentiment duly noted.
I found a good, young endo who is on top of her stuff and she only requires me to come in once a year(which she said is strictly for insurance purposes). I started out once every 4 months after dx, but once I nailed down my bgs close to normal, she had nothing left to tell me and we end up talking about our families, etc most of the time. So I slowly went from every 4 months to year. and I would probably go less than that if I could get away with it, unless my numbers start changing drastically.
It makes sense to limit doctor visits if you’re in good BG control and don’t have any other health issues. These visits are not cheap and there’s no lack of demand for the doctor’s time.