Reimbursement for the Medicare Diabetes Prevention Program Should be Increased

Based on positive results from the Diabetes Prevention Program (DPP) study carried out between 1996 and 2002, Medicare started offering a version of the Diabetes Prevention Program to Medicare beneficiaries in April 2018. The program is called the Medicare Diabetes Prevention Program (MDPP). However, there are currently very few MDPP providers in the U.S. That means that many Medicare beneficiaries don’t have access to an MDPP. One reason for the limited number of MDPP providers is the cost of delivering the program. The cost is often more than the Medicare reimbursement. MDPP reimbursement should be increased to entice more providers to offer the MDPP.

The DPP study showed that the intensive lifestyle intervention (ILI) employed in the study could lower the risk of type 2 diabetes by 58% for people with prediabetes. But more importantly, the study showed that for persons over 60, the risk reduction was 71%. Because of the DPP study results, CMS carried out its own test.

The CMS investigators concluded that by using the DPP methodology, Medicare could save $278 per participant per quarter of each year. Because of the savings, Medicare started offering the MDPP in April of 2018. However, a study published on June 12, 2020, indicates that MDPP providers are in short supply. For example, In July 2019, it [was] estimated that there was one MDPP “site per 100,000 Medicare beneficiaries nationwide.”

One of the reasons for the lack of MDPP providers is the cost of delivering the program compared to the Medicare reimbursement. For example, in 2019 the maximum reimbursement was $470 per participant for the first MDPP year, while the cost of delivering the program was typically in excess of $500 per participant per year.

So adjustments should be made in the MDPP reimbursement to attract more MDPP suppliers. If adjustments are made in the reimbursement that improve return-on-investment (ROI), providers will see that they can improve the health of their patients while realizing a net income.

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