Veterans with diabetes who are covered by both the Department of Veterans Affairs (VA) and Medicare tend to use more glucose test strips and are also more likely to overuse strips, according to data published in JAMA Internal Medicine.
“The costs of [self-monitoring of blood glucose] in the United States are substantial. Medicare contractors paid more than $1.2 billion for test strips and/or lancets in 2007, and the VA, where use and cost are lower, approximately $50 million per year is spent on test strips alone,” the researchers wrote.
Both Medicare and the VA, however, place restrictions on the number of test strips used per a prespecified time period based on the patient’s diagnosis and treatment regimen. Even so, veterans who use the VA with concomitant Medicare coverage have access to strips through both benefit plans, “which may reduce the effectiveness of each system’s attempts to discourage overuse,” they wrote.
To learn more, the researchers conducted a cross-sectional, retrospective cohort study using national VA administrative data linked to Medicare Parts A, B and D claims for fiscal years 2008 and 2009. Data from 363,996 veterans aged at least 65 years with diabetes who used the VA health care system who received strips in 2009 were included.
Overuse of test strips was defined as more than one strip per day, or more than 365 strips per year, for those taking no diabetes medications, oral diabetes medications only or long-acting insulin without short-acting insulin. For those taking short-acting insulin, overuse was defined as more than four strips per day, or more than 1,460 strips per year.
A total of 260,688 veterans (71.6%) with diabetes received strips from the VA only, 82,826 (22.8% from Medicare only and 20,482 (5.6%) from both the VA and Medicare, according to the data.
The researchers found that those receiving strips from the VA and Medicare received more strips (median, 600), as compared with Medicare only (median, 400) and VA only (median, 200; P<.001).
Odds for overuse also appeared to be considerably greater for those receiving coverage from both the VA and Medicare vs. the VA only. Adjusted ORs were 16.3 (95% CI, 14.6-18.1) for those not taking medications, 19.8 (95% CI, 18.9-20.8) for those taking oral medications; 3.69 (95% CI, 3.30-4.14) for those using long-acting insulin; and 3.24 (95% CI, 3.05-3.45) for those taking short-acting insulin.
Patterns remained similar, the researchers noted, even when more conservative thresholds of overuse were employed.
“These findings illustrate the profound importance of understanding dual health system care and are emblematic of waste and inefficiency that must be addressed,” the researchers concluded.