The Payment Gap

For years, many people with diabetes have lamented that their actual care falls short of the ideal of an attentive “health-care team” eager to address their needs. Many, in fact, feel rushed at the doctor’s office, and some find that while they may have received some diabetes education sessions shortly after diagnosis, ongoing discussion of issues related to diabetes management and lifestyle improvement is rare. Now, a study has highlighted the financial situation that may explain why so many people with diabetes have doctor’s appointments that feel less than thorough.


Released late last month, the study examined how payments from Medicare, private insurance plans, and Medicaid for diabetes-related visits corresponded to the costs of medical practices for these visits, and how doctors felt about financial and other barriers to delivering optimal diabetes care. It was sponsored by pharmaceutical companies but administered by unpaid members of professional and nonprofit diabetes groups (American Diabetes Association, American Association of Clinical Endocrinologists, American Association of Diabetes Educators, and others). According to an article on the study in Internal Medicine News, 1,056 diabetes care providers took the survey on barriers to ideal treatment and what kinds of patients they saw. The most frequently mentioned barrier was “patient compliance,” followed by “time with patients” and “compensation.” Next came “team coordination.”

Compensation for diabetes-related visits, however, could logically affect each of the other barriers mentioned in the survey. And as the survey made clear, that compensation appears to be inadequate. It estimates that the typical internal medicine practice for adults loses a yearly total of $754,623 on patients with diabetes. For pediatric patients with diabetes, the typical overall loss for a practice is $471,098. As the survey notes, practices tend to make up for these losses by seeing other, more profitable patients and by generally seeing as many patients as possible, limiting the time spent with each one. Furthermore, even when a doctor spends more time than usual with a patient, the practice is likely to submit an insurance claim for a shorter visit to avoid the scrutiny that a larger claim might encounter from the company or agency that reviews it.

The study authors recommend a variety of remedies for the ills they found in diabetes-related care, including increasing reimbursement to adequate levels and testing payment schemes that reward effective care rather than simply volume of patients or services provided. They also recommend greater inclusion of patients in medical decision-making, more coordination among health-care providers, and attracting more doctors to diabetes care through measures like student-loan forgiveness.

What do you think — do you feel rushed or otherwise undervalued at the doctor’s office? If medical costs must go up to accommodate more time with diabetes patients, how should that cost be covered: higher premiums or co-pays, just for people with diabetes or for everyone in the health-care system? Would you be willing to pay a bit more in exchange for more time and attention from your health-care team? Do you have any other ideas for how diabetes care might be improved? Leave a comment below!

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  • joan

    As a Type 1 diabetic for five decades plus, I can honestly say I have never been denied time with my doctors and their staff nor am I today. I listen, they listen and advise, and together we make a very good team!
    What I have learned over the years and suggest to others is if we are to remain a healthy person with diabetes or, in general for any health issues, then we had better pay attention, ask questions, listen, self educate, and do our best to follow the guide-lines given to us with the same type of care we expect our health team to provide for us!
    As to a higher cost? If this situation develops then it should include everyone who can afford to pay be across the board. Also it should include provisions to accept those who do not have sufficient funds. A healthy nation is a strong nation!
    For retired persons as well as the working folk there isn’t much room to pay a higher annual premium or co-pay presently! Not sure how the medical world can handle the on-going higher costs, either. However, from my experience, the really caring doctors and their staff and ER Centers, and Federal Qualified Care clinics will help those who need it, regardless!
    Medicare and Medicaid: some medical clinics and physicians will accept just so many using this type of coverage. For diabetics, this is a tough one to overcome. It is often the case that the person with diabetes or other chronic illnesses need to travel some distance for the care required or have far less than they need which is too often the case today. The cost for diabetics and other chronic illness I believe is higher than for the average person. So the more we self educate, pay attention, follow advice the less cost to everyone!
    At the same time, there are those who will not, do not take the care that is needed to help themselves and I believe there will always be a percentage of people who will fall into this category, unfortunately.
    It is my hope that the AFFORDABLE CARE ACT will remain in effect, be adjusted as needed over the years to help everyone at many levels of assistance financially to afford the care that they need. The insurance companies are another story and who knows what will occur for and with them to help their insured.
    My only suggestion to improve health care is for as many as possible to remember to self education, ask questions, seek advice from our medical team and follow it; take the time to learn about healthy food choices, and exercise 10 minutes or longer per day.
    Knowledge is Power!

  • Alfred D Balboni

    Diet and exercise are important,but a diabetic is often also a heart patient. Why cant we have someone write in detail a diet that benefits both the heart and diabetis.
    No one mentioned that both are cronic and cause a domino effect on such things as the teeth for which there is no insurance coverage or the eyes.
    Our blood test are redundent . I have too outstanding Dr’s but i dont have a team. Medicine is a complex issue for the Dr but more for the patient.

  • jim snell

    This excellent comment cleraly demonstrates some of the pifalls of all those peddling diets.

    At its core, it is excess glucose in the artery and veins that rots out the body and makes those items soft, flexible and cause hemrorages and other rot.

    Key to that is identifying the root issue.

    As the body relies on the ability to use insulin to cause storage of glucose in liver, fat cells , skeletal muscle cells and kidneys, it is mandatory to enure that energy balance of glucose production does not get out of whack with energy burn – utilization causing storage sells overloaded and backing up glucose in the blood system as it has no where else to go.

    Three major items namely medical conditions – leaky liver over releasing atored glucose in blood system inappropriatly, control of eaten carbs – energy generation and sufficient exercise to burn off energy keeping the storage sites getting filled to the brim (resulting Insulin resistance) are crucial.
    Carb control and exercise are mandatory to keep balance and stop rot. These are not “BUT” issues – optional and nice.

    Diets are a larger topic covering a raft of other issues needing addressing but the carbs control aspect is most crucial in these days of plenty preventing body rot.

    There are many excellent sites on diet namely Dr. Steve Harper’s Mediterranean diets and varieties and goals.