Cost and Reimbursement as Determinants of the Quality of Diabetes Care: 3. Reimbursement Determinants

Earlier articles in this series havenoted that diabetes care in theUnited States involves the evolu-tion of more and more complex tasks for less and less reimbursement per task. At the same time, there has been an appro-priate movement to demand increased provider adherence to standards or guidelines to improve the quality of care delivery. These guidelines have further increased the complexity of care deliv-ery. When these trends are analyzed from a business perspective, one must ask whether these increasing demands for service for decreasing reimbursement are undermining their own success. This consideration of the delivery of diabetes care strictly from a business perspective suggests that the current system actually rewards less-excellent providers and penalizes more-excellent ones. This arti-cle will consider whether that business situation actually exists and, if so, what remedies may be implemented to alter the situation