Problem Solvers

Finding a Home in HME

As Continuous Glucose Monitors gain wider use, are they right for your diabetes business?

• By Joseph Duffy
• Mar 08, 2012

Glucose monitoring, which is the recording of blood sugar levels, helps diabetics manage their disease and avoid the many associated problems that can occur when their disease is not managed properly. For example, a person can use glucose monitoring results to make decisions about eating, exercising,and medications.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, which is part of the National Institutes of Health, continuous glucose monitoring (CGM) systems use a tiny sensor inserted under the skin to check glucose levels in tissue fluid. The sensor stays in place for several days to a week and then must be replaced. A transmitter sends information about glucose levels via radio waves from the sensor to a pager-like wireless monitor.

CGM systems are more expensive than conventional glucose monitoring, but they may enable better glucose control. CGM devices produced by Abbott, DexCom, and Medtronic have been approved by the U.S. Food and Drug Administration (FDA) and are available by prescription. These devices provide real-time measurements of glucose levels, with glucose levels displayed at five-minute or one-minute intervals. Users can set alarms to alert them when glucose levels are too low or too high. Special software is available to download data from the devices to a computer for tracking and analysis of patterns and trends, and the systems can display trend graphs on the monitor screen.

To learn how CGMs might fit into an HME providers’ business model, HME Business magazine spoke to Adam Clark, director of U.S. Managed Markets for Medtronic Diabetes, which manufactures and sells CGMs.

HME Business: Should HME providers make CGMs part of their mainstream business?

Adam Clark: Yes, for two reasons: First, the future of diabetes management is related to continuous glucose monitoring in one form or another. Information is power for a self-managed disease like diabetes and our sensors today continue to become more accurate and comfortable to wear. The current continuous sensor we sell at Medtronic give 288 readings per day (one every five minutes) and comes with access to download comprehensive reports onto a computer, aiding in the ability to understand patterns and trends of blood sugar.

The second reason why HME providers should consider offering CGM products is because of the increased pressure around competitive bidding for test strips and testing supplies. Unfortunately test strips in the U.S. are starting to be classified as commodity-type products, where payors and the government are not differentiating the value of brand ‘A’ vs. brand ‘B.’ That’s a challenge for HME/DME providers because testing supplies are a major portion of their revenues if they serve the diabetes population. CGM products are a more sophisticated technology that provides enhanced value for clinicians and patients, and payors recognize that value.

What are the opportunities for providers to offer the devices?

Medtronic Diabetes has direct contracts with numerous large DME providers and offers CGM products via our wholesaler network for smaller companies and HME providers.

What kind of expertise is needed on staff?

CGM is different than basic testing supplies in that the patient requires some training on insertion of the sensor and how to interpret the results with the healthcare providers. However, Medtronic provides education and training for HME/DME re-sellers of our products in order to ensure successful outcomes for the patients. In addition, we offer online training and support for both patients and healthcare providers so people can learn at their own pace.

What are the reimbursement opportunities?

Personal CGM devices are billable to insurance companies on behalf of patients and have become one of the fastest-growing product lines for many large DME providers that Medtronic partners with in the space. They bill under standard HCPCS codes, A9276, A9277, and A9278. The rates are either set via allowables from the government or health plans or negotiated separately with HME/DME providers.

The second kind of reimbursement opportunity is for professional CGM. This is our diagnostic version of CGM, which acts much like a blood sugar recorder. The device is used by thousands of physicians and diabetes educators today and has established reimbursement for the practice under two CPT codes: 95250 and 95251. The reimbursement rates vary depending on the geography but are published by Medicare so your readers can look them up for their service areas.

Will the expansion of Round Two of competitive bidding affect CGMs?

We don’t believe so. CGM devices are class III devices and by the competitive bidding laws on the books today, class III devices were exempt from the competitive bidding process. However, in reality, it’s too early to tell what will happen. For now, they are not on the list.

Overall, are CGMs leading edge or are they considered mainstream?

The CGM market has increased from nearly nothing five years ago to more than $200,000,000 today across the industry. We project this market will accelerate in growth as the sensor technology becomes more user friendly, accurate, and comfortable for consumers.

What are the best practices for HME providers to leverage CGMs?

HME providers, like many businesses in healthcare, may find themselves trying to differentiate their product offerings to attract referrals from healthcare providers and doctors. The rapid adoption of CGM usage in the market will help it move toward a standard of care in Type 1 diabetes and accelerate in the Type 2 space as well. HME providers serving diabetes populations may find themselves competitively disadvantaged if they do not have a comprehensive service offering with cutting-edge technology.

This article originally appeared in the March 2012 issue of HME Business.