Low reimbursement for diabetes care limits the ability of
endocrinologists and primary care physicians to deliver comprehensive diabetes
care, according to the results of a physician survey.
Researchers conducted a survey to evaluate physicians’ perceptions
on the adequacy of reimbursement and resources such as staff, facilities and
resources for the treatment of patients with diabetes. The web-based survey
questioned 200 primary care providers, 100 endocrinologists and an online
discussion group of 12 physicians. Questions focused on 10 services recommended
by the American Diabetes Association that may be prone to underreimbursement.
Most physicians said they are inadequately reimbursed for the 10
identified ADA services — 83% to 95% said Medicaid reimbursement was
inadequate, 75% to 89% said Medicare reimbursement was inadequate, and 67% to
86% said private insurance reimbursement was inadequate.
Inadequate reimbursement leads physicians to spend less time with each
patient — both major barriers to providing comprehensive diabetes care,
according to responses. Thirty-two percent of physicians said they could not
provide comprehensive diabetes care — most cited time or reimbursement as
the major barrier.
“Misalignment between payment systems and optimal quality of care
could cause some patients to go without necessary services, potentially leading
to poorer outcomes and quality of life,” the researchers wrote in
American Health & Drug Benefits. “The widespread view of
Medicaid reimbursement inadequacy has led some physicians to report that they
have rejected Medicaid patients, which is likely to make it difficult for
low-income patients with diabetes to find a provider.”
Survey responses also revealed differences between endocrinologists and
primary care physicians. Regarding care, 50% of endocrinology practices offered
medical nutrition therapy compared with 29% of primary care practices.
Responses indicated that significantly more endocrinologists provided
multidisciplinary care, self-monitoring of blood glucose instruction/evaluation
and intensive insulin therapy instruction compared with primary care
physicians. However, more primary care physicians provided psychosocial
screening and smoking cessation counseling.
Compensating for low reimbursement
Physicians said they compensate for low reimbursement levels in a
variety of ways, including spending less time with each patient, seeing more
patients each day, prioritizing the most important aspects of diabetes care on
a given visit and scheduling more follow-up appointments.
“These results suggest that given the complexity of diabetes,
better alignment, including a higher reimbursement level, is needed between the
payment systems and ADA guidelines. At current reimbursement levels, our
findings indicate that providers are unable to ‘do it all’ in the
limited amount of time they have with each patient; and, accordingly, patient
care suffers,” the researchers wrote.
The study had several physician recommendations, including:
- Expanding insurance coverage including for supportive diabetes
services not currently covered.
- Addressing insurers’ requirements for providers to become an
“approved entity”.
- Encouraging alternative approaches for physician visits such as
shared or group medical appointments to allow for more time per patient.
This survey was funded by the National Changing Diabetes Program, a
program of Novo Nordisk. To see the full report, visit the American Health
& Drug Benefits website.