Cost and Reimbursement as Determinants of the Quality of Diabetes Care: 3. Reimbursement Determinants

Abstract

Earlier articles in this series have noted that diabetes care in the United States involves the evolution of more and more complex tasks for less and less reimbursement per task. At the same time, there has been an appropriate movement to demand increased provider adherence to standards or guidelines to improve the quality of care delivery. These guidelines have further increased the complexity of care delivery. When these trends are analyzed from a business perspective, one must ask whether these increasing demands for service for decreasing reimbursement are undermining their own success. This consideration of the delivery of diabetes care strictly from a business perspective suggests that the current system actually rewards less-excellent providers and penalizes more-excellent ones. This article will consider whether that business situation actually exists and, if so, what remedies may be implemented to alter the situation. The present climate represents a difficult economic environment for the clinical practice of diabetes. As shown in Table 1, the profit margin for rendering quality diabetes care on an ongoing basis is very narrow. These costs can increase with a variety of factors, many listed in the two earlier articles of this series.1,2 Common cost increments include missed appointments; costs of handling forms and documentation, such as forms from mail-order providers of diabetes supplies; and excessive patient utilization of services. Costs also increase …