By John Gever, Senior Editor, MedPage Today
Almost one-third of doctors in an industry-sponsored survey said they didn't spend enough time with their diabetic patients and blamed low reimbursement rates for diabetes care, researchers said.
In a survey of 200 primary care physicians and 100 endocrinologists, 32% reported an inability to provide comprehensive diabetes care, Alyssa Pozniak, PhD, of Abt Associates in Cambridge, Mass., and colleagues reported online in American Health & Drug Benefits.
Only half of the physicians in both specialties said they were able to teach patients how to monitor their own blood glucose, and nearly two-thirds said they couldn't provide medical nutrition therapy.
Most cited a lack of time and/or low reimbursement rates for these and other services as reasons for the incomplete care, Pozniak and colleagues said.
"Physicians compensate for low reimbursement levels in a variety of ways, including spending less time with each patient, seeing more patients each day, prioritizing the most important aspects of diabetes care on a given visit, and scheduling more follow-up appointments," the researchers wrote.
For every one of 10 categories of diabetes care, more than two-thirds of respondents said reimbursements were inadequate from the three major types of payers: Medicare, Medicaid, and private insurance.
Medicaid had the worst reputation among the doctors surveyed, with at least 92% saying reimbursements were too low in nine of the 10 categories.
The survey found few major differences between the primary care physicians and endocrinologists. Two exceptions were the proportions reporting they provided diabetes self-management education (70% of primary care doctors versus 48% of endocrinologists) and medical nutrition therapy (41% of primary care physicians versus 16% of endocrinologists).
Physicians in the Novo Nordisk-funded survey were a convenience sample, recruited by the online medical information company Epocrates to respond to periodic surveys.
Twelve other physicians participated in an online focus group to detail their attitudes about barriers to providing comprehensive diabetes care.
Pozniak and colleagues said focus-group participants suggested that higher reimbursements could actually cut overall costs while boosting care quality.
Better pay would allow physicians to spend more time with patients per visit, thereby lessening the need for repeat visits or referrals to other providers, panelists said.
Under the current system, they said, treatment guidelines developed by the American Diabetes Association were impractical.
Pozniak and colleagues quoted one physician as saying, "Guidelines without adequate reimbursements and services to patients are meaningless."
The researchers suggested several potential fixes:
- Expanding insurance coverage to include supportive services not currently reimbursed and therefore not often provided
- Addressing Medicare's and other insurers' requirements for providers to become an "approved entity" and the allowable frequency of education and training visits
- Encouraging alternative approaches for physician visit such as group appointments to provide more time per patient.
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