2004S-0170 - Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Section 1013: Suggest Priority Topics for Research
FDA Comment Number : EC42
Submitter : Ms. Marianne Smith Edge Date & Time: 06/07/2004 07:06:38
Organization : The American Dietetic Association
Health Care Association
Category :
Issue Areas/Comments
The American Dietetic Association (ADA) welcomes this opportunity to offer comments and suggestions for research priorities to improve the quality, effectiveness, and efficiency of the Medicare, Medicaid, and SCHIP Programs. With nearly 70,000 members in a multitude of disciplines ranging from research to community health, and from clinical to the foodservice industry, the ADA is the nation's largest organization of food and nutrition professionals. ADA members are the most experienced healthcare professionals in the food and nutrition field providing nutrition care and services that improve and save lives every day. Members of the ADA who serve Medicare, Medicaid, and SCHIP beneficiaries agree that the exploding epidemic of diabetes fits well with the intent of Section 1013. And equally important and intimately linked to diabetes, is obesity, a major risk factor for diabetes. How can we better deliver healthcare to prevent and treat these two diseases efficiently, effectively, and earlier? Evidence shows medical nutrition therapy (MNT) for diabetes and other conditions to be cost-effective. Yet, it is an underutilized service. This may be because physicians are not generally well trained in nutrition and are unfamiliar with the benefit or they are unaware it is covered by Medicare. To improve medical outcomes for diabetes care and treatment of Medicare, Medicaid, and SCHIP beneficiaries, the ADA proposes these research questions. Most can be addressed through evidence-based analysis: 1. To what extent do primary providers refer a child who is above the 95-97 percentile on the growth chart to a registered dietitian (RD) for obesity intervention (SCHIP or EPSDT)? For example, in the state of Ohio, there are data that the growth charts are being used, but no data about what is done with the information. Obesity is closely tied to diabetes in children. Early intervention may save a lifetime of costs. 2. What is the effectiveness of the chronic care model in treating and managing obesity in the Medicare, Medicaid, and SCHIP populations? 3. What will be the costs and savings associated with MNT for pre-diabetes resulting in preventing or delaying the development of full-blown diabetes? 41 million Americans are estimated to have prediabetes. MNT that includes physical activity as an intervention component is indicated as a first-line treatment in pre-diabetes. 4. With the advent of disease management of chronic diseases, what is the minimal effective 'dose' of MNT for diabetes for children, adults, and the Medicare elderly population? What is the most effective mode of delivery over time: in-person, group, telephonic, or electronic? 5. What percent of the Medicare, Medicaid, and SCHIP beneficiaries has diabetes education? What percent has received MNT by an RD? 6. To what extent are adults and children diagnosed with diabetes referred to a RD for MNT? Which triggers are most effective in alerting the primary provider to make a referral? 7. Is non-pharmacological (lifestyle) therapy more, less, or equally effective than drug therapy for controlling plasma glucose in the elderly? 8. What types of nutrition and/or physical activity interventions are most effective in the elderly, including population segmentation to examine the effects of other chronic diseases, risk factors, and living circumstances (i.e. institutional, homebound, active)? 9. What is the average reduction in cost of diabetes medications for individuals with type 2 diabetes who receive MNT provided by a RD? What is the average reduction in cost of reducing the amount of medication that is needed by individuals with selected cardiovascular and renal diseases that receive MNT provided by an RD? The ADA is concerned that all US citizens have access to quality healthcare and nutrition therapy to improve the health and productivity of our country and to harness the escalating costs of diabetes and obesity, especially for our children. See attached letter.