Diabetes test strips likely overused among dual VA, Medicare patients

(Reuters Health) – - Millions of blood sugar testing strips may be unneeded by the U.S. veterans who receive the strips through two government insurance programs each year, suggests a new study.

There was potential waste in the two insurance programs, researchers found, but the most waste occurred among veterans who received strips through both programs.

“There’s nothing illegal going on,” said Dr. Walid Gellad, the study’s lead author from the Pittsburgh VA Medical Center. “These individuals have benefits from both, but when you look at overall health spending it’s a matter of what’s efficient.”

He and his colleagues, who published their results online November 10 in JAMA Internal Medicine, looked at the receipt of blood sugar testing strips among U.S. veterans who received benefits from the Veterans Health Administration (VA), Medicare, or both.

They had data linked from the VA and Medicare on 363,996 veterans 65 years old and older with type II diabetes who used the VA healthcare system and received test strips during fiscal year 2009.

They found that about 72% received test strips through the VA, about 23% received test strips through Medicare, the government-run healthcare program for the elderly and disabled, and about 6% received strips through both.

On average, people received about 200 strips per year through the VA and about 400 through Medicare. People who received strips through both programs received about 600 per year.

Based on the number of medications the people were taking to manage their diabetes, the researchers estimated how likely the strips – if used – were not needed.

They estimate that about 15% of people receiving strips through the VA, about 46% of those getting strips from Medicare and about 54% of those getting strips from both programs received extras.

Overall, about a fifth of the 157 million strips dispensed to all the veterans were possibly unnecessary, the researchers write.

Gellad, who is also affiliated with the University of Pittsburgh, cautioned that there is debate over how often people should test their blood sugar. “There’s no consensus about how often someone should be testing their sugar if they’re not on insulin,” he said.

Gellad said they can’t say how many of the test strips were actually used and whether the people were told to test.

“In general there is overuse of these test strips by many people based on the data, whether in VA or Medicare,” said Gellad. “It’s not just a cost issue. It’s an issue of quality. Pricking your finger is burdensome and painful.”

Dr. Sethu Reddy, chief of the Adult Diabetes Section at Joslin Diabetes Center in Boston, said the study’s results are interesting.

“The predominant conclusion is whenever you have two government agencies providing a related benefit, it would really help to have communication between the two agencies to reduce duplication,” said Reddy, who was not involved with the new study.

He also cautioned that the study can’t say for certain how often patients should be testing. For example, people may need to test more when they’re newly diagnosed and after surgeries.

Additionally, receiving more strips does not mean the patients are testing too often. Instead the strips may go unused.

“It’s like me going out on Halloween twice,” he said. “It doesn’t mean I’m going to eat twice as many candies.”

For policymakers, the researchers write that the findings should reinforce that waste and inefficiency must be addressed.

For doctors, Gellad said it’s important to know where their patients are getting their medications, testing strips and other therapies and whether it is necessary.

“Whether you’re talking about medications or test strips or surgery, it’s important to ask if what you’re doing is necessary," he said.

SOURCE: bit.ly/1qAWlE1

JAMA Intern Med 2014.