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Featured topic and speakers
What is MDPP coverage for Medicare? Why is it important to catch diabetes early? Does Medicare cover A1c for prediabetes? Does Medicare cover diabetes prevention program?
Our guests are Colleen Barbero, PhD, MPPA, model lead with the Centers for Medicare & Medicaid Services Innovation Center, and Kate Kirley, MD, MS, director of chronic disease prevention and programs at the American Medical Association. AMA Chief Experience Officer Todd Unger hosts.
- The AMA is your powerful ally in patient care. Join now.
- Learn more on how to prevent type 2 diabetes.
- Free diabetes resources for doctors via AMA STEPS Forward® Program (Team-Based Care of Type 2 Diabetes and Prediabetes).
- Medicare Diabetes Prevention Program (MDPP) Expanded Model.
- Learn more about Medicare Diabetes Prevention Program supplier and CMS MDPP program details (PDF)
- Googling "Medicare Diabetes Prevention Program near me"? Check Medicare Diabetes Prevention Program eligibility and more.
- Wondering about AMA legislative efforts and what is the medicare diabetes prevention program? Read more.
- Get your CMS final rule prior authorization questions answered, watch this episode.
- Stay up to date on all the latest advocacy news by subscribing to AMA Advocacy Update.
- See how the AMA fights for physicians.
Speakers
- Colleen Barbero, PhD, MPPA, model lead, Centers for Medicare & Medicaid Services Innovation Center
- Kate Kirley, MD, MS, director of chronic disease prevention and programs, AMA
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today, we're talking about changes in the CMS final rule that have big implications for diabetes screening and treatment. Our guests are going to help us break down these changes and what they mean to physicians.
Dr. Colleen Barbero is a model lead with the Centers for Medicare and Medicaid Services Innovation Center in Baltimore, Maryland. And Dr. Kate Kirley is the director of chronic disease prevention and programs at the AMA in Chicago. I'm Todd Unger, AMA's chief experience officer, also in Chicago. Dr. Barbero, Dr. Kirley, it's great to have you here today.
Dr. Barbero: Good to be here.
Dr. Kirley: Great to be with you.
Unger: Well, Dr. Barbero, why don't we start with you, and give us an overview of the final policies related to screening for diabetes and prediabetes in the 2024 Medicare physician fee schedule.
Dr. Barbero: Yes. So in 2024, CMS expanded Medicare coverage of diabetes screening from one test annually to up to two tests annually for all patients at risk for diabetes, for example, those who are 65 and older, those who are overweight or those who have been diagnosed with prediabetes.
In addition, Medicare added that hemoglobin A1C test is another test that could be used for diabetes screening without coinsurance. Also new in 2024 is that Medicare—that definition of diabetes can now be based on a doctor's diagnosis as opposed to more restrictive test, which was the case in earlier Medicare regulations.
And overall, we hope these policy updates will reduce barriers and increase Medicare beneficiaries' options for timely screening. This could enable earlier detection and lead to physician intervention to prevent diabetes and prevent or delay complications from diabetes.
Unger: And that's good news. I know the AMA has been advocating for these changes for many years and we're very happy to see them implemented. Dr. Kirley, I understand that the HBA1C test has some important advantages over other screening tests. What are some of the differences?
Dr. Kirley: Well, each of the screening tests that we can use to diagnose undiagnosed diabetes or prediabetes has their own benefits and drawbacks. But HBA1C really has a couple important benefits. First of all, for us clinicians, it gives us a picture of what a patient's glucose has been doing over a three-month period, which is really helpful.
But very importantly, an HBA1C test can be done when a patient is not fasting. So all of the other tests require fasting. And for many of our patients on Medicare, fasting can be a real barrier to getting screening.
So, for example, if a patient comes to see their doctor and they're not fasting on that day, they would have to come back on another day to have their hemoglobin A1—or to have their fasting glucose tested. But to have a hemoglobin A1C test, they can just get it done that day. So it really removes an important barrier.
Unger: Dr. Kirley, what impact do you expect that these changes are going to have on diabetes screening moving forward?
Dr. Kirley: We know that screening for undiagnosed diabetes and prediabetes is really important. If we can identify these conditions early, we can provide treatments for diabetes, or we can provide preventive interventions for prediabetes that really help reduce complications down the road and improve quality of life.
But we also know that screening for prediabetes and undiagnosed diabetes is a major care gap, which means many patients who need to be screened are not being screened currently. So we hope that with Medicare coverage of hemoglobin A1C, we'll start to see more patients being screened who need to be screened.
Unger: That's good news. Very important. And these changes aren't the only way that CMS is working to improve diabetes prevention. Dr. Barbero, can you tell us about your Medicare Diabetes Prevention Program and how that works?
Dr. Barbero: Yes, CMS MDPP is an evidence-based behavioral intervention to prevent or delay the onset of type 2 diabetes for Medicare beneficiaries diagnosed with prediabetes. MDPP uses a CDC National Diabetes Prevention Program curriculum. The program addresses diet, physical activity and weight loss with the long-term goal of improved health.
In MDPP, Medicare pays organizations, called MDPP suppliers, to provide up to one year of sessions facilitated by coaches. And MDPP suppliers can be hospitals, community-based organizations, physician practices, federally-qualified health centers, diabetes self-management training providers, YMCAs, churches and other similar types of organizations that meet eligibility requirements.
Beneficiaries can attend up to 22 sessions during the year-long program. MDPP does not require a physician referral. And suppliers can receive up to $768 per MDPP beneficiary. And there's no out-of-pocket cost for MDPP for beneficiaries enrolled in Part B Medicare.
So beneficiaries must have results in the prediabetes range from a blood test conducted within a year of their first session to be eligible for MDPP. And one of the acceptable blood tests to determine MDPP eligibility is the hemoglobin A1C test.
Unger: Dr. Kirley, can you explain what impact these changes to screening requirements are going to have on that program?
Dr. Kirley: Well, as we just heard, an HBA1C test is one of the potential screening tests that can be used to determine eligibility for Medicare DPP. Additionally, an HBA1C test is recommended by the United States Preventive Services Task Force as a screening test for undiagnosed diabetes and for prediabetes.
So what we see with Medicare now covering the screening HBA1C test is that that is really aligning prevention, both with screening as well as the preventive intervention that Medicare covers the Medicare Diabetes Prevention Program. We really hope that this alignment will ultimately result in increased utilization and patient enrollment in this important preventive intervention, the Medicare DPP.
Unger: Excellent. Dr. Barbero, one of the administration's strategic pillars is to advance health equity by addressing the disparities in our health system. How do the changes that we're talking about to diabetes and prediabetes screening help to advance those goals?
Dr. Barbero: That's a great question. People in rural areas and from racial and ethnic minority communities often have higher rates of diabetes and face a higher rate of complications. So an exciting enhancement in 2024 is that MDPP suppliers can furnish MDPP services in person, virtually through distance learning, or through a combination of both. In an MDPP distance learning session, coaches provide synchronous delivery of MDPP sessions in one location and the participants call in or videoconference from another location.
Additionally, MDPP now includes fee-for-service payments for session attendants. So, currently, CMS is providing support to MDPP suppliers in implementing these changes and is working on a strategy to expand MDPP in the areas that have the highest need for the program. It's our goal, over the next several years, to increase MDPP sustainability, as well as to help reach underserved areas and improve health equity.
Unger: Dr. Kirley, anything to add?
Dr. Kirley: Well, I will say that the AMA has advocated for these changes for a long time. We have heard from physicians for a while that really would love to be able to screen their patients with Medicare with an HBA1C test. They really have advocated for different ways for their patients to be able to participate in the Medicare DPP. So we're thrilled to see these changes. We completely agree. We think this is going to increase access to preventive services and also really be important changes that could improve health equity.
Unger: Dr. Barbero, before we wrap up, is there anything else you'd like to share with physicians about these changes?
Dr. Barbero: They may be interested to know that there are currently physician practices that have become MDPP suppliers. And we're also encouraging physicians taking advantage of the new diabetes screening benefit to follow up on a patient screening indicating prediabetes by referring them to an MDPP supplier.
There's lots of information about MDPP on the CMS website if you'd like to learn more about this program. There are materials that you can share with patients, as well as resources for organizations that are interested in enrolling as MDPP suppliers. And this includes the new MDPP business case resource. There's also a map of all current MDPP suppliers and their contact information if you would like to refer patients to a program in your area. And you can visit the MDPP web page and join our listserv to stay up-to-date on everything about MDPP.
Unger: Excellent. Dr. Barbero, Dr. Kirley, thank you so much for joining us today. We're going to add links to those materials and more resources from the AMA in the description of this episode. To support the work of the AMA, including our public health advocacy efforts and more, we encourage you to become an AMA member at ama-assn.org/join.
That wraps up today's episode. We'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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