CDC, CMS Introduce Diabetes Prevention Program
by Valerie A. Rinkle, MPA
On July 7, CMS posted a fact sheet regarding a newly proposed Diabetes Prevention Program (DPP). This new benefit was proposed in the calendar year (CY) 2017 Medicare Physician Fee Schedule proposed rule.
The DPP is a specific curriculum and delivery program developed by the CDC. The CDC reports that more than one-third of adults in America have prediabetes. Prediabetes means that an individual’s blood glucose level is elevated, but not yet quite as high as a diabetic. It also increases an individual’s risk of heart disease and stroke, in addition to the likeliness that the individual will develop diabetes if the matter is not addressed appropriately. Weight loss and exercise can reduce this likelihood by as much as 50%. Additionally, the vast majority of people who have prediabetes are unaware that they are at risk. Therefore, they do not work towards improving their condition. The CDC has developed this program and has documented its effectiveness to help pre-diabetic patients.
According to the CMS fact sheet regarding the DPP, it is a “structured lifestyle intervention” that is delivered via 16 “core” sessions and includes dietary coaching, lifestyle intervention, and moderate physical activity. The program is targeted for beneficiaries that are considered pre-diabetic, and is specifically designed to prevent the onset of full-fledged diabetes.
The curriculum includes group-based, classroom-style instruction centered around behavioral interventions intended to lead to lifelong dietary change, a greater amount of exercise, and any other alterations in activities or behaviors that would lead to long-term weight loss and control. After the 16 core sessions, less intensive monthly follow-up meetings are designed to help ensure that the participants maintain healthy behaviors and weights.
The secretary of HHS announced in March 2016, that CMS’s Office of the Actuary (OACT) certified the pilot DPP model as a program that reduced net Medicare spending. Furthermore, CMS confirmed that the model program improves the quality of patient care without limiting other Medicare coverage or benefits. The DPP will be the first ever preventive service model certified for expansion by the CMS Innovation Center.
CMS does not address how these benefits will be incorporated into Medicare Part C or their other innovation programs. Will those programs also be required to cover and ensure provision of DPP services? Will these services count towards the targets and benchmarks?
Imagine, for example, an orthopedic patient who needs a total joint procedure, but who would increase the likelihood of improved outcomes with weight loss and other benefits of DPP. Does the hospital provider in the mandated CJR program defer surgery until the patient completes the 16 sessions? Does this cost get included in the CJR benchmarks and targets? Providers need to comment and ask CMS these questions.
CMS will accept comments on the proposed rule until September 6, 2016, and will respond to comments in a final rule to be published around the first of November 2016.
To read the complete, detailed artcile that appeared on Medicare Compliance Watch, click here.