Medicare underpayment for Diabetes Prevention Program: implications for DPP suppliers

Amanda S. Parsons, Varna Raman, Bronwyn Starr, Mark Zezza, Colin D. Rehm

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

OBJECTIVES: To examine if Medicare reimbursements for the Diabetes Prevention Program (DPP) cover program costs.

STUDY DESIGN: A retrospective modeling study.

METHODS: A microcosting approach was used to calculate the costs of delivering DPP in 2016 to more than 300 patients from Montefiore Health System (MHS), a large healthcare system headquartered in Bronx, New York. Attendance and weight loss outcomes were used to estimate Medicare reimbursement. We also modeled revenue assuming that our program outcomes had been similar to those observed in national data.

RESULTS: The 1-year cost of delivering DPP to 322 participants in 2016 was $177,976, or $553 per participant. The costliest components of delivery were direct instruction (28% of total cost) and patient outreach, enrollment, and eligibility confirmation (24%). Based on our program outcomes (14.3% lost ≥5% of their initial weight and 50% attended ≥4 sessions), MHS would be reimbursed $34,625 ($108/patient). If outcomes were in line with national CDC reports (eg, better attendance and weight loss outcomes), MHS would have been reimbursed $61,270 ($190/patient).

CONCLUSIONS: In a large urban health system serving a diverse population, the costs of delivering DPP far outweighed Medicare reimbursement amounts. Analyzing and documenting the costs associated with delivering the evidence-based DPP may inform prospective suppliers and payers and aid in advocacy for adequate reimbursement.

Original languageEnglish (US)
Pages (from-to)475-478
Number of pages4
JournalThe American journal of managed care
Volume24
Issue number10
StatePublished - Oct 1 2018

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Medicare
Costs and Cost Analysis
Weight Loss
Health
Urban Health
Centers for Disease Control and Prevention (U.S.)
Retrospective Studies
Delivery of Health Care
Weights and Measures
Population

ASJC Scopus subject areas

  • Health Policy

Cite this

Medicare underpayment for Diabetes Prevention Program : implications for DPP suppliers. / Parsons, Amanda S.; Raman, Varna; Starr, Bronwyn; Zezza, Mark; Rehm, Colin D.

In: The American journal of managed care, Vol. 24, No. 10, 01.10.2018, p. 475-478.

Research output: Contribution to journalArticle

Parsons, Amanda S. ; Raman, Varna ; Starr, Bronwyn ; Zezza, Mark ; Rehm, Colin D. / Medicare underpayment for Diabetes Prevention Program : implications for DPP suppliers. In: The American journal of managed care. 2018 ; Vol. 24, No. 10. pp. 475-478.
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