Medicare

At least 10 percent of Medicare beneficiaries are diagnosed with diabetes. Although experts agree that close medical and patient monitoring is important to slow or prevent complications of the disease, Medicare beneficiaries are not receiving recommended levels of physicals, eye exams, blood tests, and other screening services. Several factors may contribute to low use of monitoring services, including doctors' lack of awareness of the latest recommendations and patients' lack of motivation to maintain adequate self-management care. Efforts by Medicare health maintenance organizations (HMO) to improve diabetes care have been varied but generally limited. The Health Care Financing Administration (HCFA) also has begun to test preventive care initiatives for diabetes and has targeted this area for special emphasis. But like the efforts of Medicare HMOs, HCFA's initiatives are quite recent, and the agency does not yet have results that would allow it to evaluate their effectiveness. GAO summarized this report in testimony before Congress; see: Medicare: Provision of Key Preventive Diabetes Services Falls Short of Recommended Levels, by Bernice Steinhardt, Director of Health Services Quality and Public Health Issues, before the Subcommittee on Health and Environment, House Committee on Commerce (GAO/T-HEHS-97-113, Apr. 11).

GAO noted that: (1) although experts agree that regular use of preventive and monitoring services can help minimize the complications of diabetes, most Medicare beneficiaries with diabetes do not receive these services at recommended intervals; (2) more than 90 percent of fee-for-service Medicare beneficiaries with diabetes visited their physicians at least twice in 1994; (3) however, only about 40 percent received an annual eye exam, and only about 20 percent received the recommended two specialized blood tests per year to monitor diabetes control; (4) on the whole, these fee-for-service utilization rates did not vary substantially by patient age, sex, or race; (5) the provision of preventive and monitoring services under managed care is also below recommended levels, although data for this service delivery approach are limited; (6) for example, among people with diabetes aged 18 to 64 who were enrolled in private HMO plans, less than half received an eye exam in 1995; (7) according to diabetes experts, several factors may contribute to low use of monitoring services, including physicians' lack of awareness of the latest recommendations and patients' lack of motivation to maintain adequate self-management care; (8) Medicare HMO efforts to improve diabetes care have been varied, but generally limited; (9) most plans report that they have focused on educating their enrollees with diabetes about self-management and their physicians about the need for preventive and monitoring services; (10) some HMOs have begun to take additional steps, such as tracking the degree to which physicians provide preventive care, and a few plans have developed comprehensive diabetes management programs; (11) because virtually all of these efforts have begun within the past 3 years, little is known about their effectiveness; (12) HCFA also has begun to test preventive care initiatives for diabetes and has targeted this area for special emphasis; (13) its efforts include helping to plan a nationwide diabetes education program, encouraging local experiments to increase use of monitoring services and improve quality of care for people with diabetes, and developing performance measures for providers of diabetes care; (14) but like the efforts of Medicare HMOs, HCFA's initiatives are quite recent, and the agency does not yet have results that would allow it to evaluate effectiveness; and (15) to the extent that these initiatives prove cost-effective, they may help promote better management of diabetes care.