The impact of a Medicare Public Health Emergency policy change for continuous glucose monitors on utilization and total cost of care for diabetes

Home glucose monitoring was revolutionized in 1999 when the U.S. Food and Drug Administration (FDA) approved the first professional continuous glucose monitor (CGM). With the advancements in technology, newer CGMs are available for personal use and have greatly impacted the way diabetes is managed. Although there are data regarding the benefits of CGMs in lowering hemoglobin A1c, data is currently lacking regarding whether the use of CGM affects the number of hospitalization/emergency department visits as well as the effect on cost of care. In addition, while CGMs have been traditionally used in patients with type 1 diabetes due to their insulin necessity, they have also shown benefit in patients with type 2 diabetes on basal-bolus insulin therapy. According to Ruedy et al, “Continuous Glucose Monitoring in Older Adults with Type 1 and Type 2 Diabetes using Multiple Daily Injections of Insulin”, use of CGMs was associated with improvements in hemoglobin A1c as well as reduction in glycemic variability. Criteria for coverage of CGMs for Medicare beneficiaries is outlined in the Local Coverage Determination (LCD) L33822 “Glucose Monitors;” use is restricted to patients with diabetes using multiple daily insulin injections that had been testing blood sugar at least four times per day with traditional finger stick tests. On March 30th, 2020, the Centers for Medicare and Medicaid Services (CMS), in response to the COVID-19 Public Health Emergency (PHE), issued a memo allowing Medicare plans to relax requirements on coverage of CGMs to provide better access. At this time, PHA lifted the prior authorization requirement on the preferred therapeutic CGM (Dexcom®) for Medicare beneficiaries. The purpose of this study is to explore the effects of the PHE removal of PA on utilization of CGMs, impact on management of diabetes, and total cost of care related to diabetes. This is a single institution, retrospective data and chart review of PHA Medicare members with a diagnosis of diabetes utilizing a CGM and continuous enrollment from April 2019 through March 2021. Patients were identified using eligibility information, primary ICD-10 codes for diabetes (type 1 diabetes, type 2 diabetes, or other diabetes), and if members had a claim for a CGM from April 2020 through March 2021. The primary outcome is the utilization of CGM and total cost of care related to diabetes to the health plan and members pre and post removal of PA. The secondary outcomes include member’s hemoglobin A1c and number of hospitalization/ED visits related to diabetes pre and post removal of PA. The outcomes will be compared against two different reporting periods: the baseline reporting period from April 2019 through March 2020 and the comparator reporting period from April 2020 through March 2021. Data regarding utilization, cost, hospitalization/ED visits, and adherence will be pulled from claims data. Chart review will be conducted for Medicare members with access to electronic medical records (EMR) to analyze hemoglobin A1c. Results and conclusions will be shared when the project is completed. (IRB Approved)https://digitalcommons.psjhealth.org/oaa_ppmcstvin_22/1016/thumbnail.jp

Encouraging Feedback In The Large College Class: The Use Of A Question/Comment Box

This article examines the use of a question/comment box in a large course, as a communication strategy to enhance student participation and involvement in the said courses. Specifically, the categories into which questions and comments were coded are reported, and examples of actual messages received are included. In addition, the results of a questionnaire that assessed student perceptions of involvement, instructor quality, course quality, and learning as a result of the question/comment box are reported for male and female lower-division and upper-division students

Healthcare prioritisation at the local level: a socio-technical approach

Cost effectiveness analysis is a systematic tool to inform resource allocation decision in healthcare. There is extensive evidence, however, that the tool is difficult to apply in practice, particularly at the level of local health planners, because it is not accessible to those involved in the prioritisation process and not embeds assumptions which are felt to be unacceptable for ethical or other reasons. Pragmatic tools such as Program Budgeting and Marginal Analysis appear to be more suitable for supporting local decisions by engaging stakeholders in a deliberative process. Unlike cost-effectiveness analysis, however, these tools are hard to relate to widely accepted health economic principles. This paper presents a socio-technical approach which draws explicitly on health economic theory and in a practical and reproduceable way through an action research case study with a local healthcare planner of the English National Health Service. Through close and iterative work with those responsible for allocating resources we present a formal model to capture the objectives of the health planners, a communicative procedure and interactive elicitation methods to help key stakeholders to articulate their knowledge and values. The approach proved accessible and acceptable and has been used in making spending decisions

Caulerpa chemnitzia in Darwin threatening Galapagos coral reefs

Coral reefs are rare in the Galapagos and there is concern that, like in many areas around the world, they may be degrading due to increasing anthropogenic pressure, which can cause changes and reorganizations of structure and function with associated phase shifts. Algae of the genus Caulerpa J.V. Lamouroux, 1809 are known as widespread and persistent marine invaders. They grow rapidly, particularly in disturbed areas where they can opportunistically monopolize substratum and compete with native species, thus reducing biodiversity. Caulerpa chemnitzia increased in abundance and overgrew corals on the reef since 2012, ultimately raising fears that a phase-shift from coral to algae might be imminent. However, from 2019 onwards algae populations strongly contracted and while not having returned to baseline level, there is currently low risk of corals being displaced. Visual censuses were conducted on a yearly basis since 2004 using sample quadrats (0.5 x 0.5m) every 5 m along a 50-m-long transects at a depth of 6–15 m at 5 permanent subtidal ecological monitoring sites around Darwin. In addition, 10 m photo-transects were taken using a graduated meter-long measuring stick in the centre of the frame in 2012, 2014, 2016, 2017, 2018 and 2021 at a depth of 15m at Wellington reef. The authors hypothesize that this species could have expanded its distribution over Wellington Reef because of its known morphological plasticity due to a response to change in the environment, in this case high temperature and low nutrients. As ENSO events are predicted to increase in intensity and frequency due to the impact of climate change it is important to develop and implement a functional alert system. Early Detection Rapid Response (EDRR) protocols are recommended to avoid climate driven Non-Indigenous Species (NIS) entering the GMR or for native species becoming invasive due to warming-related phase shifts