Home Glucose Monitoring - Patient Testing, Testing Our Patience

July 8, 2014
Melissa Young, MD

Home glucose monitoring benefits patient and physician alike, but getting test strips is harder than ordering a PET scan. Why?

Home glucose monitoring is, of course, an essential part of diabetes management. The information it provides can prompt you to increase or decrease medication dosages, or to change drugs or add new ones to the patient’s regimen. Knowing what time of day the blood sugars tend to be high or low helps determine the appropriate changes to make.

It also is a teaching tool for patients. They discover what happens when they eat certain foods (“My reading sky-rockets when I eat Chinese food!”) or do certain things (“My blood sugars are definitely better when I exercise.”).  It is the only way to know if their symptoms are because of their blood glucose. “Feeling funny” can be because of hypoglycemia, hyperglycemia or something completely unrelated. How is a patient to know if they can’t check?

And yet, especially for those with Medicare, getting test strips is harder than ordering a PET scan. First of all, the diagnosis code needs to be written on the prescription. Why? Do you need a diagnosis code to prescribe insulin? Prednisone? Percocet?

Then there is the form that inevitably arrives asking for the Hba1c, whether or not they are taking insulin and justification for frequent testing. And now, they are asking for visit note, glucose logs and labs, too.

Then there are the diabetes testing supply companies that tell patients that the strips their physicians prescribed aren’t covered by Medicare. Patients don’t know this is untrue. Medicare doesn’t care which strips you use, but they will pay suppliers the same amount regardless of which brand it is, so the suppliers want to ship the least expensive ones to patients because that is how the company makes money. I tell patients to look for a different supplier or go to their local pharmacy.

And just to make life more interesting (and frustrating), there are the companies that fax us order forms. Companies that the patient is not using. One day I received three faxes from three different companies for the same patient. I had my staff call the patient to find out which one she was really using. Guess what. None of them. She goes to her local pharmacy. I decided from then on that I will not fill out these forms without the patient’s OK. I will bet that most offices won’t bother. They’ll fill out the forms, the patient gets shipped new junky meters, and Medicare foots the bill.

I don’t understand why we can’t just prescribe testing supplies the same way we prescribe anything else.