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Oregon Health Plan to Cut Diabetes Testing by 95%

The authors contend that policy will harm patients and increase costs
July 10, 2013

OPINION – July 10, 2013 – Ask anyone with diabetes. Testing blood sugar levels is a pain. It takes time, fingers become sore and the levels change during the day based on diet, exercise and other factors.

They tolerate that because it is important. Managing blood sugar levels is critical to managing diabetes. Patients who test regularly can take steps to ensure their illness does not get worse, leading to serious problems like blindness and even amputation.

Now, the state of Oregon is considering dramatically changing the standard of care for thousands of people with diabetes. The state’s Health Evidence Review Commission is considering cutting the assistance that patients receive that helps them afford test strips. This would gravely impact the number of times patients test from three times a day to once a week. You read that right. It would be a 95% cut in coverage for this critical element of managing diabetes.

There are many problems with this policy.

Despite claiming it focuses on “health evidence,” this policy is not based on science.

For testing to be relevant, patients need to understand how their blood sugar levels vary based on diet, exercise, sleep, and numerous other factors. Since levels can vary during the day, testing once a week provides almost no useful information. Is the glucose level normal or is it an unusual spike? It would be impossible to know.

This is like driving a car with no gas gauge and no speedometer – there is no relevant information to control the car or to get you to your destination.

This is why the American Diabetes Association and physicians who treat patients with diabetes recommend testing daily.

What evidence did the state commission use to make this decision? None. One member of the state panel making the decision simply guessed, saying that diabetes patients test just for the sake of testing. He said, “I’ve had patients that just go crazy testing themselves… They just want to know, want to know.  And it, it really makes no difference in their care as far as I can see.” Actual science, however, contradicts that.

What’s more, the panel’s own decision indicates they know it isn’t correct. Included in the policy are nine exemptions for a range of groups. Again, these groups were not chosen based on evidence but on guesses.

The policy is being justified on the grounds that it will cut costs. Failure to manage diabetes, however, can – and will – lead to much more expensive outcomes.

Patients who do not monitor can quickly become hypoglycemic, requiring a visit to the doctor, which takes time and money. Worse, because testing only once a week can give misleading results, patients can be encouraged to overuse health care, falsely thinking their blood sugar is too high.

Worse yet, many will believe they are doing well because infrequent testing gives them a false sense of security. These patients risk expensive visits to the emergency room. It does not take very many such visits before any savings from cutting coverage is eaten up.

At a time when our health care policy is looking to expand access, it makes little sense to tell those who now have coverage that critical health care, like diabetes management, is not part of that coverage.

During the next year, Oregon will be making many decisions about how to implement the Affordable Care Act. Deviating so dramatically from the standard of care for diabetes would be a bad precedent to set as the state looks for ways to provide quality health care. Rejecting these cuts in care would send a clear message that Oregon will not put the health of its residents at odds with health care policy.

Image for this story by bodytel (CC BY-ND 2.0) via Flickr.

Judy Fry RN, is a certified diabetes educator and Denise Cedar is a registered dietitian and a certified diabetes educator.