Forms, Forms, and More Forms

With all the challenges of modern health care practices, the proliferation of certification for medical necessity (CMN) forms and other documentation requirements has become an increasing distraction from conversing with, examining, and critically thinking about patients. In particular, CMNs for self-monitoring of blood glucose (SMBG) have become a major impediment.

In 2011, diabetes care providers were notified by the Center for Medicare and Medicaid Services (CMS) about new regulations to obtain coverage for blood glucose monitoring strips for individuals with diabetes. Those using only oral agents are allowed 100 strips for 90 days; those using insulin are allowed up to 100 strips per month.

This will suffice for many Medicare-covered patients. However, those of us who scrupulously review glucose diaries and meter downloads and use this information to adjust intensive regimens or to help complicated patients achieve their glucose goals know there are many patients for whom these restrictions will not work. Many seniors or disabled individuals are prone to hypoglycemia because of extreme insulin deficiency or erratic dietary intake. Many require multiple injections of adjustable-dose insulin or use insulin pumps. Performing SMBG three times per day will not suffice …