The US Center for Medicare and Medicaid Services (CMS) mandates that beneficiaries who desire that Medicare cover their insulin pump supplies must comply with the agency’s quarterly visit requirement (QVR).
This requirement states that we must visit our doctor every 90 days. If we seek to purchase pump supplies on day 91, the supplier will likely refuse to ship this order.
I see this requirement as a nuisance that neither helps the beneficiaries nor the agency itself. Many people on Medicare report that they’ve adopted tactics to help them accumulate a buffer of supplies just to deal with the vagaries of this system.
They might, for example, push insulin infusion sites beyond the 2-3 day timeframe and possibly subject themselves to site irritation, inflammation, and erratic absorption. This Medicare policy is then doing the exact opposite of what it intends.
The Journal of Diabetes Science and Technology published a report on this issue in March 2019. Among other things, it found these results:
This study highlighted a few issues of the QVR [quaterly visit requirement] policy for Medicare patients to receive the supplies necessary for continued CSII [continuous subcutaneous insulin infusion or pump] therapy.
(1) This policy is not evidence-based. Data from the T1D Exchange Clinic Registry showed no correlation between visit frequency and A1c in patients over 65.12 Importantly, respondents in this study were consistently well managed for years before they went on Medicare, mandating a visit frequency violates the principle of individualization of diabetes care espoused by ADA18 and AACE.10
(2) The QVR policy adds an undue administrative and practical burden on patients, providers and suppliers. It also likely increases direct costs by requiring visits that may not be medically necessary because CSII therapy is a well-established evidence-based treatment that is often started prior to Medicare coverage.
(3) More importantly, our data showed that the QVR policy may lead to delays in receiving CSII supplies, which places individuals with type 1 diabetes at risk for harm. Finally, by mandating a face-to-face visit at a fixed frequency, the CMS [Center for Medicare and Medicaid Services] CSII policy indirectly prohibits developing new options for medical care including remote assessment, which might be the only feasible assessment available to patients in remote areas, or patients who might temporarily change their place of residence based on family or seasonal-weather considerations.
I am a well controlled T1D who feels no need to see my diabetes doctor every 90 days. I see this doctor visit frequency as wasting my, my doctor’s, my suppliers, and Medicare’s time and money. It is a nuisance policy originally intended to promote the health of beneficiaries. It has, unfortunately, morphed into a policy with unintended consequences.
If it were left up to me, I would only seek my doctor’s regular counsel about once per year or, if needed, sooner. Our health care system in the US is burdened with the huge weight of the growing diabetes crisis. Why should we waste precious resources without any benefit?
A tip of my hat goes to @Laddie for posting on this topic over at the Seniors with Sensors Facebook group and reminding me about this important topic.
Anyone else resent this seemingly arbitrary Medicare requirement?
