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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