Have you ever experienced being short-sheeted in a group environment? Some may consider such an action to be funny. When it is you, it can be a personal embarrassment. The diabetic community needs to watch very carefully to avoid the Medicare population from being ripped off by a poorly written policy by the Centers for Medicaid and Medicare Services (CMS).
CMS has begun to draft a policy regarding personal continuous glucose monitoring units (pCGM). The diaTribe website has published an article dated January 13, 2017, concerning the announcement by CMS on the Critical First Step Toward Medicare Coverage of CGM. The diabetic community needs to stay on guard so that the development of the new policy does not rip us off.
It is interesting to note that Medicare has a habit of changing the warranty period as defined in the FDA rulings and within the same CMS-1682-R ruling! Page 6, of this CMS ruling states: “Once the coating wears off in 6 or 7 days, the sensor must be replaced for safety reasons”. Later, on page 13, of this CMS ruling states: “The monthly fee schedule amount is established using invoice prices for four sensors”. It is interesting to note the difference of referring to monthly purchases verses a 28 day cycle purchase for four, seven day sensors based upon the safety factor. Stay consistent and uniform with definitions. Ordering should be by the count of the number of days and not on a per month basis. Four sensors per month would be equal to 48 sensors per year. A year has twelve months. A non-leap year has 365 days per year and a leap year has 366. What would be the value when 365 days is divided by a 7 day sensor period? The answer is 52.14. We cannot purchase a pro-rata portion of a sensor. We need to round up to a whole number. Result for a 365 day year would be equal to 53 sensors per year! The difference between 53 sensors and 48 sensors is a total of five sensors. They are not equal to each other. How do you feel about being five sensors short per year? Could this be called a rip-off?
I am thankful for the article which the team from the diaTribe website for their dedication on this very important and necessary need for the diabetic community. We need to stay on guard. The detail is critical. For CMS, write a common sense and easily readable policy from the start. Take the time to study the facts and stay consistent with the warranty periods and the language. For my non-Medicare diabetic friends, this is important to you. The finalization of a sloppy policy can result in serious, dangerous, and dilatory consequence for all physicians, medical personal and diabetic patients. Being ripped off of the number of sensors needed per year could place the life of seniors at risk