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Statement From Internists on Advancing Efforts to Expand Medicare Coverage to Help Prevent Type 2 Diabetes

Attributable to:
Wayne J. Riley, MD, MPH, MBA, MACP
President, American College of Physicians
(ACP)

March 25, 2016

The American College of Physicians (ACP) is strongly supportive of promoting effective prevention and treatment of type 2 diabetes, a disease that is growing in prevalence, is hugely expensive to treat, and can result in numerous debilitating complications. Therefore, we applaud CMS for authorizing coverage of lifestyle change programs to prevent the onset of type 2 diabetes based on the demonstrated success of the Innovation Center Diabetes Prevention Program--and, in fact, specifically called on CMS to provide this coverage in our comment letter on the 2016 physician fee schedule.

Along these lines, ACP has been advocating for CMS to cover the Chronic Care Management (CCM) code without cost sharing by the beneficiary as it provides significant preventive benefits to the patient and to authorize a higher level CCM code for patients with more complex chronic conditions. The College also has been seeking the development of a code bundle for Diabetic Care Management (DCM) to emphasize better care coordination, communication, and integration of the care team aimed at a better overall outcome and cost of care for the Medicare beneficiary. Additional ACP recommendations to improve the prevention and management of chronic disease are included in our recent letter to the Senate Finance Committee's Chronic Care Working Group Policy Options document.

In addition to these options for payment, physician practices could also consider adopting the patient-centered medical home (PCMH) model of care, which includes key approaches such as team-based care, greater patient engagement, and population management, that will be helpful to ensuring patients are able to access these lifestyle change programs. The PCMH model is being incentivized across the country by a number of payers, both public and private, and is a key component of the new MACRA law via payment incentives in both the MIPS and alternative payment model (APM) pathways. Some case study examples of how practices have been able to better prevent and manage diabetes within their patient populations are outlined in a report by the Patient-Centered Primary Care Collaborative (PCPCC).

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The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 143,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.

Contact:
David Kinsman, (202) 261-4554
dkinsman@acponline.org