[Congressional Record (Bound Edition), Volume 145 (1999), Part 5]
[Extensions of Remarks]
[Pages 7333-7334]
[From the U.S. Government Publishing Office, www.gpo.gov]




              MEDICARE COVERAGE OF DIABETIC RETINAL EXAMS

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Thursday, April 22, 1999

  Mr. STARK. Mr. Speaker, on Monday, April 19, the Washington Post ran 
a story about the failure of Medicare beneficiaries to get adequate 
preventive care. The article was based on a recent study by Dr. John 
Wennberg of the Dartmouth Medical School. Dr. Wennberg found that the 
level of retinal eye exams for Medicare beneficiaries with diabetes--so 
very important for helping prevent blindness in diabetics--was 
abysmally low. Only 43-45 percent of Medicare beneficiaries with 
diabetes received this critical service.
  One reason this important test is not provided more frequently is 
that, unfortunately, Medicare does not cover this service or pay 
doctors to do it.
  We should.
  Today, I am introducing legislation to rectify this omission and add 
this service to the list of preventive care benefits covered by 
Medicare--the ``Medicare Diabetic Eye Exam Act of 1999.''
  Diabetes affects over 16 million Americans, and over 150,000 die from 
diabetes and its complications each year. Individuals of African, 
Asian, and American Indian descent are particularly vulnerable to this 
disease. Most of the morbidity and mortality of diabetes is due to the 
complications associated with the disease, including blindness, kidney 
failure, nerve damage, and cardiovascular disease.
  Diabetic retinopathy is the leading cause of blindness in the United 
States. Studies show that many of the complications of diabetes can be 
slowed or even prevented by better management of the disease, including 
regular eye examinations. Studies show that a periodic dilated eye exam 
is cost-effective in reducing the burden of diabetic retinopathy and 
blindness.
  The Diabetes Quality Improvement Project (DQIP) is an effort to 
recommend a set of diabetes-specific performance and outcome measures 
that health plans and providers can use in treating patients with 
diabetes. DQIP began under the sponsorship of the American Diabetes 
Association, Foundation for Accountability, Health Care Financing 
Administration, National Committee for Quality Assurance, and joined by 
the American Academy of Family Physicians, American College of 
Physicians, and Veterans Administration. HCFA is asking Medicare+Choice 
plans to use the DQIP measures this year in improving their care of 
diabetic Medicare beneficiaries enrolled in the plans.
  One of the measures contained in DQIP is retinal eye exams. DQIP 
recognizes that the dilated eye exam may not be necessary for everyone 
every year, and has developed a risk stratification scheme to guide 
plans and providers in determining frequency of providing the test.
  It is inexcusable that Medicare does not provide coverage and payment 
for this test that is so critical in preventing blindness. If we expect 
Medicare+Choice plans to provide this test,

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we should also provide payment for it. And we should provide payment 
for it in traditional fee-for-service Medicare, as well.
  Following is a copy of my bill. I urge that we add this provision to 
whatever Medicare bill is enacted by this Congress.

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