Medicare offers new ways for your practice to potentially benefit financially from the work you do to help at-risk patients prevent the onset of type 2 diabetes.

Two AMA-suggested population-health Improvement Activities (IAs)—glycemic screening services and glycemic referring services—have been added to available options for physicians participating in the Medicare Quality Payment Program’s Merit-based Incentive Payment System (MIPS).

Physicians will not get direct Medicare payment for the screening and referring services, but they will count as IAs, which will count toward their final MIPS score and will Medicare reimbursement rates in 2020. Physicians can choose to participate in one or both of these IAs.

To get IA credit, physicians will need to attest they have implemented systematic screening of at-risk Medicare beneficiaries for abnormal blood glucose levels for 60 percent of the patients in their electronic health records for at least 90 consecutive days within the 2018 reporting period.

For patients found to have prediabetes, physicians have to attest that they referred 60 percent of their patients to a diabetes prevention program recognized by the Centers for Disease Control and Prevention (CDC) operating under the framework of the National Diabetes Prevention Program for at least 90 consecutive days within the 2018 reporting period. The 60 percent threshold for both of these IAs will rise to 75 percent in 2019.

Related Coverage

For this clinic, diabetes prevention program is in the house

Prevent Diabetes STAT, hosts a wealth of diabetes-prevention tools and resources—including a toolkit that details how to engage patients, incorporate screening, testing and referral into practice, and connect your patients with a CDC-recognized lifestyle change program.

The AMA offers a wide array of resources to help you understand and succeed if you choose to pursue the MIPS track of the Quality Payment Program, including the “2018 MIPS Strategic Scoring Guide.”

Medicare DPP

Also, as of April 1, the Centers for Medicare & Medicaid Services (CMS)-approved organizations can start billing services provided under another new AMA-supported initiative, the Medicare Diabetes Prevention Program (MDPP) expanded model.

To be eligible to enroll in a MDPP, patients must:

  • Be a Medicare Part B beneficiary.
  • Have a body mass index of at least 25 or 23 if self-identified as Asian.
  • Have no previous diagnosis of type 1 or type 2 diabetes (other than gestational diabetes).
  • Not have end-stage renal disease.
  • Have either a hemoglobin A1c test with a value between 5.7 percent and 6.4 percent, a fasting plasma glucose between 110–125 mg/dL, or a two-hour plasma glucose between 140–199 mg/dL.

It is estimated that the MDPP will save Medicare $182 million over a 10-year period. In 2016 alone, CMS estimated, Medicare spent $42 billion more on patients with diabetes than it would have spent if those beneficiaries did not have diabetes.

Online or virtual sessions are allowed to make up for attendance absences in an MDPP, but a full virtual program is not yet eligible to participate. The AMA has strongly urged CMS to include full online programs in the MDPP and CMS has indicated that a pilot of a virtual program is planned.

“There is a tremendous population-health need to expeditiously increase access to diabetes prevention programs,” AMA Executive Vice President and CEO James L. Madara, MD, wrote in the AMA’s fee schedule-comment letter to CMS Administrator Seema Verma. “The AMA is concerned because the current access and availability of the in-person program is limited and nonexistent in certain markets.”

Type 2 diabetes is an extremely difficult disease for patients to manage. Endocrinologists have noted that, while they may see their patients with type 2 diabetes three or four times a year, patients must live with the impact of their diabetes every day. Eligible Medicare patients should try to access these important preventive services.

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