Wednesday, October 23, 2019

It's Official: Launch of CMMI Diabetes Prevention Program Was A Hot Mess

With much fanfare, CMS announced an Innovation Center program for diabetes several years ago.  The program underwent review by CMMI, and literally two annual cycles of rulemaking (hundreds of pages of rulemaking) before it was launched.

I wrote an analysis of potential flaws in the program and data in 2016, here.

The program started in CY2018, and by late spring, only 3 providers had been able to enroll (Kaiser Health News, April 2018, here.)   In providing a link to the KHN article, I noted that the Diabetes Prevention Program was just one of several CMS efforts that got bogged down in dizzying complexity (here.)    About the same time, Spring 2018, GAO decried the low productivity of the Center for Innovation (here).

New News: Bad News

This week, Politico (open access) runs an article by Darius Tahir, "Languishing Medicare Diabetes Program Frustrates Provider."  (With a picture that makes the Humphrey Building, the DC home of HHS, look like a prison designed to keep diabetes providers from getting in.)

Here's the key passage:
A flagship Medicare program that HHS expected to engage up to 110,000 people annually each year in measures to help them avert Type 2 diabetes only managed to enroll about 200 people last year, according to an analysis of CMS data.
He continues, "People familiar with the program said a heavy regulatory burden had kept many providers from offering the diabetes prevention service. CMS’s rollout of the program, these sources said, could presage difficulties for any future programs..." with similar goals.

Do The Math

HHS under Obama announced the program with great fanfare in 2016 (see original press release here, fact sheet here, NPR article here.)  They estimated the program would save $2600 in the first year for every enrollee.  (I decimated this phony math in my 2016 blog, above).  With 200 enrollees, let's hope the program saved the $600B Medicare program $520,000.   At that rate, it would take 23 years until 2040 just to pay off the $11.8M pilot study that kick-started the protocol.*

Providers complained that the proposed reimbursements were intolerably low (here).  Some providers told Politico they still haven't been paid for 2018 claims.


Politico notes that about 400 patients were enrolled by 1Q2019.


Track Darius Tahir at Twitter, here.   He recently retweeted (rt'd, in the lingo) a 2019 article in Politico about Seema Verma's alleged high costs for media consultants (here).


For a 2016 article on overuse of the concept "pre-diabetes," here.