HHS: Prevention Saves Money

March 29, 2016

A Message from Academy President Dr. Evelyn F. Crayton, RDN, LDN, FAND

HHS: Prevention Saves Money

The Secretary of Health and Human Services (HHS), Sylvia Burwell, announced March 23 something that Academy members have known for a long time: Prevention saves money.

The Secretary announced that "the independent Office of the Actuary in the Centers for Medicare & Medicaid Services (CMS) certified that expansion of the Diabetes Prevention Program, a model funded by the Affordable Care Act, would reduce net Medicare spending. The expansion was also determined to improve the quality of patient care without limiting coverage or benefits. This is the first time that a preventive service model from the CMS Innovation Center has become eligible for expansion into the Medicare program."

CMS will be looking at "the best strategies for incorporating the Diabetes Prevention Program into Medicare," and the Academy is prepared to offer some best practices for RDN-led nutrition interventions.

As Academy members know, about 30 million Americans have type 2 diabetes, resulting in two deaths every five minutes in this country. Additionally, one in every three adults has prediabetes – putting them at increased risk for developing type 2 diabetes, heart disease and stroke. Many people with prediabetes develop type 2 diabetes within ten years.

This new development builds on the Academy's efforts that will increase opportunities for persons with prediabetes to see an RDN. Last fall, the United States Preventive Services Task Force issued its final recommendation statement (with an impressive Grade B recommendation) for diabetes screening and treatment that aligns with the Academy's guidelines to expand screening and referral to intensive behavioral counseling interventions to asymptomatic patients at risk for diabetes. The Academy continues to work with HHS and CMS to ensure that implementation of these new diabetes screening guidelines include opportunities for our members to help treat and manage diabetes and prediabetes.

Results of a demonstration project through CMS's Innovation Center showed that the Diabetes Prevention Program (DPP) reduces health care costs and helps prevent diabetes. The DPP is a lifestyle intervention program that includes changing participants' nutrition and physical activity behaviors. Many of these DPPs are delivered in the same locations as Diabetes Self-Management Education (DSME) programs, making prevention and treatment of diabetes available to patients. The Academy continues to advocate for RDNs' delivery of the most effective services for preventing diabetes.

As coverage is expanded, the Centers for Disease Control and Prevention (CDC) will ensure the fidelity and rigor of the DPP through the accreditation process of the established CDC Diabetes Prevention Recognition Program (DPRP). This accreditation helps ensure that decisions about individual participation, patient referral and health insurance benefits are based on accurate, reliable and trustworthy information. Many of the programs with DRPR accreditation rely upon RDNs to lead programs in their communities. In addition, expanded coverage will offer new opportunities for our valued nutrition and dietetic technicians, registered (NDTRs).

Details of the proposed new coverage are not known at this time, but the Academy will be integral in formulating the regulatory language CMS will include in its CY 2017 Medicare Physician Fee Schedule proposed rule to be released in the summer. Because RDNs and NDTRs are very much involved in, and are being recognized for, our efforts with the Diabetes Prevention Program – whether leading these programs or implementing them in our communities—we will work with CMS to include strong language recognizing the value RDNs and NDTRs bring to such programs. We will continue to engage our diabetes experts to provide input and guidance into the Academy's formal comments to ensure that final details of coverage are favorable to Academy members and the Medicare beneficiaries we serve.

Please continue to share your outcomes and impactful stories with Academy staff and research networks, as this is what is needed to be successful in driving better policy. And it remains critically important to promote our value to physicians and other providers about the cost- and clinical-effectiveness of MNT and the need for improved Medicare coverage. Your efforts will help increase referrals and provide the solution for physicians searching where to send patients with prediabetes and diabetes for the best treatment.

Meetings are already scheduled with key Congressional leaders on the passage of the Preventing Diabetes in Medicare Act (H.R. 1686), which would expand the Medicare Part B MNT benefit to include coverage for patients at risk of prediabetes. Your robust legislative advocacy and concomitant Academy initiatives with CMS on the proposed rules will enable persons with prediabetes to have access to quality RDN- and NDTR-provided nutrition services.

Members' response to Action Alerts are crucial to help pass legislation. We will continue to keep members informed of activities and actions on both the regulatory and legislative fronts.