Medicare's quarterly visit requirement, a help or a nuisance?

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?

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Sounds like another Medicare policy that needs to be rewritten and updated for modern times.

I am on Medicare MDI so only need to go every 180 days, however, this is one of the major reasons I stay on MDI rather than switch to a pump. My endo is about 90 miles from my home and between my travel schedule and her schedule even making the 180 days is such a challenge that it has to be closer to 150 days to meet everyone’s schedule. Historically, until I went on Medicare, I went to endo nominally once a year but due to schedules that often slipped to 14-16 months between visits.

Going more than once a year is a total waste of time and other resources for both my endo and for me. I would even be happy to upload my Clarity reports periodically to Medicare to demonstrate that an endo visit is not needed at a certain specified time and that insisting on these visits for doctor notes is just totally wasteful in time and money.

Additionally, with a booming growing number of diabetics annually, it would make far more sense for a diabetic in far greater need of a visit to take my slot.

This is one fight I am willing to participate in, so if anything is being formally put together to change this absurdity, I will be happy to participate.

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I’m not on Medicare, but either my insurance or both groups want you seen every 4 months. My old endo and NP were both type 1’s and I would alternate the visits. I didn’t mind as they would always talk about the latest tech available etc. But really they would glance at the readings and usually say you are doing great ask if I needed anything, look at the bloodwork and that was that.

So far my new endo just looks at everything and says you’re doing fine do you need any prescriptions and that is that.

So really it is a waste all around. However I have to wonder if one of the objects of this is to prevent issues? You might not be avid to make an appointment say for the small foot sore, but if you are already seeing the doctor you will tell them if you are there? Someone loses a bunch of weight but they won’t make an appointment but if they are there??? etc

So I would be curious as it seems pretty useless, but how much/often side issues get picked up and treated because of the routine visits? When some people get older they tend to want to ignore issues sometimes and at what age does that start at with each person? I don’t know if you can easily pick an arbitrary age?

It would be nice if an endo could decide, but we all know what a shortage there is so for the brief minutes they spend with you to be able to judge that would be hard. On the other hand if it was switched to a longer length of time if you are well controlled it would certainly free up time for the ones that need it more.

Looks like I am not alone in my antipathy toward this Medicare policy.

I see your point but I’d prefer if the system let me make this judgement. Now I know that some patients, often men, will minimize health issues. I just don’t like any system that seeks to protect me from myself.

I’ve taken the aggressive lead seeking medical professional help regarding heart, thyroid, and foot care in the last few years. I’ve had to abandon traditional medical care as I seek out practitioners of alternative functional medicine.

I know my habits do not represent my cohort well but I would appreciate a medical care system that responds to me when I need it and doesn’t nag me when I don’t.


This is one of my comments on the Facebook post sharing my story of the absurdity of the every 3-month requirement.

“Related to this article: I saw my endo on Monday and have ordered pump supplies and will order insulin in about 10 days. I made my appointment for November (91 days out) and will order pump supplies and insulin in November. Then I made an appointment for December–5 weeks after the November visit. You might ask why! I go to Arizona on Jan.1 and I have the December visit so that I can order pump supplies and insulin in February. I don’t get lab work in December because that wouldn’t be covered by Medicare. But the visit is and will be a couple of hundred dollars. A waste of Medicare money. A waste of my time. A waste of my endo’s time. Fortunately my endo likes me and we’ll have a quick visit and talk about her kids and my grandchildren.”



My wife has been on Medicare for 5 years - gets bloodwork and sees him every 90 days - no big deal - never a problem

If only to force one to get the bloodwork it is worth it

quit fussing :grinning:

My wife gets even more aggravated with the time-wasting 90-day requirements for our endo visits than I do, which of course means a visit to a lab as well. Who wants to sit in a waiting room full of potentially sick patients? However, we now have a new endo who is light-years better than our previous one, so she is already reaping the benefits of better health management for both her bg control and some other issues. I guess our previous doc’s retirement wasn’t such a bad thing for us as we expected, except for the countless hours I spent researching endos in our area. there are a number of them that I already know about and have seen ages ago that I wouldn’t go back to unless they were the only endos for 300 miles.

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