Proposed Fee Schedule Details Diabetes Prevention Program Payments

Proposed fee schedule details Diabetes Prevention Program payments

The 2018 Medicare Physician Fee Schedule proposed rule recently issued by the Centers for Medicare and Medicaid Services (CMS) includes proposals to boost coverage of diabetes prevention and telehealth services.
The CMS proposal includes “a number of positive changes that could improve patient care and save taxpayer dollars,” according to the AMA. Chief among these are a plan for expanding the Medicare Diabetes Prevention Program (MDPP), and new possibilities for telehealth services.
“The annual physician fee schedule update is a chance for CMS to modify Medicare policy to ensure the best possible treatment options for patients,” said AMA President David O. Barbe, MD (@DBarbe_MD). “The AMA is encouraged by many of the proposed changes and applauds the administration for working with the AMA to address physician concerns.”
Sept. 11 is the deadline to submit comments on the document’s proposed Medicare payment rules and policies—which includes an overall positive payment-rate update of 0.31 percent.
Diabetes Prevention Program setup
Included in the proposed rule are steps that would further implement a Medicare DPP, which the CMS describes as a structured intervention aimed at preventing a progression from prediabetes to type 2 diabetes in at-risk individuals. Previous research has shown that evidence-based lifestyle changes resulting in modest weight loss can sharply cut the rate at which people with prediabetes go on to develop type 2 diabetes.
In a news release, the AMA said it “commends” CMS for going forward to expand coverage of the DPP model the Ass Continue reading

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Workplace bullying associated with a higher risk of diabetes, says study

Being the victim of bullying or violence in the workplace could mean your risk of developing type 2 diabetes is up to 46 per cent higher, a study has said.
Around nine per cent of participants reported they had been bullied in the past year, and this group was more likely to develop diabetes later in life.
New research says bullying is a “severe social stressor”, and this has an impact on metabolism, appetite and weight in various ways that make diabetes more likely.
Understanding the wider health impacts of workplace stress is particularly important as a report earlier this year showed a third of UK workers are experiencing anxiety, depression or stress.
The study was led by researchers at the University of Copenhagen in Denmark and followed the health of 46,000 people aged 45 to 60 who were not initially diabetic.
Nine per cent reported bullying in the past year around 12 per cent said they experienced violence or threats, typically from people outside their organisation like customers or patients.
Bullying included a range of “unkind or negative behaviour from colleagues”, unfair criticism, humiliating work tasks and also feelings of isolation.
In follow-ups with these participants 1,223 went on to develop type 2 diabetes – this was a 46 per cent higher likelihood than the general population.
The study controlled for other factors that could impact diabetes risk, but statisticians said this “can never be perfect” so it was important to note this was one association in a complex field.
The study, published in the journal Diabetologia, pulled data from severa Continue reading

Diabetes Insipidus

Recently, @EMHighAK (Alex Koyfman) asked about any “teaching points” with respect to Pediatric DKA and Cerebral Edema. In addition to referencing an oldie, but a goodie morsel on Cerebral Edema, I also mentioned that we should all be careful not to attribute all ketonuria in vomiting kids to “starvation ketosis.” That got me to thinking about other potential diabetes related urine pitfalls. What about the child with polyuria but no glucosuria? Is that reassuring and do I quickly assume that the child is just super-hydrated? Let us take a minute to recall that there is another diabetes to consider: Diabetes Insipidus.
“Diabetes,” etymologically, has origins in words that mean “to pass through” and was used to describe excessive passage of urine (polyuria).
“Mellitus” has origins from words that mean honey and/or sweetness.
“Insipidus” stems from words that meant lacking flavor or taste.
So to differentiate between the two, all we have to do is taste the urine. Simple.
This was how physicians of antiquity would evaluate the urine. (Delicious!)
Ok… I don’t advise this… and I’m pretty sure there are some hospital regulations that make that practice a reason to terminate your employment.
I am glad we have replaced human tongues with urine dipsticks for this!
Diabetes Insipidus = the inability to concentrate urine
Can be due to:
Central CNS process – vasopressin deficiency
Any process that impairs production and release of vasopressin can lead to diabetes insipidus. [Dabrowski, 2016]
Central Diabetes Insipidus (DI) is more common than Nephrogenic Continue reading

Stress of divorce can 'triple risk' of children getting diabetes

Stressful life events in childhood such as death or illness in the family, divorce or separation can triple the risk of developing type 1 diabetes, research has suggested.
A study carried out in Sweden analysed more than 10,000 families with children aged between two and 14 who did not already have the condition and also looked at factors including whether there was any family conflict, change of family structure, interventions from social services or unemployment.
Parents were given questionnaires asking them to assess such serious life events, parental stress, worries and the parent's social support and 58 children were subsequently diagnosed with type 1 diabetes.
Diabetes: the facts and figures
Cure for Type 1 diabetes imminent after stem-cell breakthrough
Researchers said that, as it is unlikely such stressful events can be avoided, families need support to cope if such problems occur.
The study said that while the causes of type 1 diabetes are unknown, it is usually preceded by the body's own immune system attacking and killing beta cells in the pancreas, which produce insulin.
Environmental factors such as viral infection, dietary habits, birth weight and early weight gain, as well as chronic stress, have all been proposed as risk factors, and the new research aimed to examine whether psychological stress during a child's first 14 years of life might increase the risk.
They said that since rates among young children are increasing in most countries, environmental factors are being examined even more seriously.
You need to have the Adobe Flash Player to view this conte Continue reading

The anti-diabetes diet: a 2,000 calorie-a-day food planner

Have we forgotten what a healthy amount of food looks like? GP Ann Robinson thinks so. Writing in the Guardian, she responded to the warning by the charity Diabetes UK, that the rise in cases of the disease is threatening to bankrupt the NHS.
Robinson pointed out that because the rise in cases seems to be due to the increase in the number of people living with Type 2 diabetes – which can be linked to obesity – tackling it will require a “massive change in the way we lead our lives”. With the UK becoming a “nation of grazers”, it was time schools taught pupils what 2,000 calories a day “looks and feels like”, said Robinson.
So we asked Kelly McCabe of the British Dietetic Association to produce a working week’s approximate 2k-a-day plan. We hope you like lentils:
Monday
Breakfast: Yoghurt with berries, nuts and seeds (100g Total 0% yoghurt, handful mixed berries, 1 tbsp mixed seeds, 2 sliced brazil nuts).
Lunch: Smoked salmon, low-fat cream cheese and spinach sandwich on soya and linseed bread, with a handful of cherry tomatoes.
Dinner: Sweet potato, spinach and lentil dhal (made with 100g red lentils, and a large sweet potato: makes enough for lunch tomorrow).
Tuesday
Breakfast: Banana porridge (3 tbsp whole rolled porridge oats, semiskimmed milk, ½ sliced banana, 2 sliced brazil nuts).
Lunch: Sweet potato, spinach and lentil dhal (leftovers).
Dinner: Parma-ham-wrapped salmon (one small fillet, 2 slices ham) with asparagus and 4 tbsp pesto sauce, 80ml creme fraiche, handful new potatoes.
Wednesday
Breakfast: Scrambled eggs with smoked salmon and avocado o Continue reading