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Higher levels of insulin often needed for glucose control

Quality Improvement Monitor, September 26, 2008

Hospitals that want to keep their diabetics’ glucose levels under control need to test their patients’ blood sugar as many as eight times per day—for those who are severely ill—and ensure that staff members know that those coming in with infections or other comorbidities might need significantly higher units of insulin.

Beginning October 1, CMS will stop paying for certain manifestations of poor blood sugar control in patients who developed that condition while in the hospital. Hospitals whose patients already had out-of-control glucose levels when they were admitted will receive their full Medicare reimbursement if they document it as present on admission. Manifestations of poor blood sugar control include diabetic ketoacidosis, nonketotic hyperosmolar coma, and hypoglycemic coma.

Some endocrinologists say CMS’ no-pay policy will improve quality of care. “I do think it will help diabetic patients,” says Jack Wahlen, MD, an endocrinologist at Intermountain Healthcare in Salt Lake City. The rule is not unreasonable, Wahlen adds.

Others take a different view, saying the no-pay policy will unfairly punish patients and hospitals, especially those who treat a poorer population.

“Blood sugar control in hospitalized patients is extremely difficult,” says Joel Zonszein, MD, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City.

Access the full story in the October issue of Quality Improvement Report; access is free for subscribers, nonsubscribers can purchase a copy of the story for $10.

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