Oregon's Diabetes Death Squad: HERC

773209_26624240Your health care professional walks into the room, plunks a file on the table, and grimaces at you.

“Your A1C is 7.5. Your fasting blood glucose level is 143.

You have Type 2 diabetes.

Here’s a prescription for a blood glucose meter and test strips. You don’t need insulin or medications right now. Let’s see how that goes. Check your blood glucose level with the meter and I’ll see you for a follow-up. 

Oh, wait. You have Oregon Health Plan. Hmm… Yeah, go ahead and use the meter and the 50 strips that you are permitted to have, but after you’ve used up those 50 strips, you’re on your own. You want to continue to check your blood glucose level? Buy your own strips.” 

This is not fiction. This is what Oregon thinks is completely appropriate for those who must use the state health care plan, which is funded by Medicaid. The rationale behind the Oregon’s Health Evidence Review Commission (HERC) recommendation, handed down yesterday in a public meeting:

  • People with T2 diabetes who aren’t on insulin or oral meds don’t need to check
  • It’ll save a bunch of money because these people don’t test anyway
  • Randomized clinical trials prove that daily blood glucose testing doesn’t make a difference in A1C levels
  • Hey, Kaiser Permanente is doing it and no one has died. 

The Facts About This Recommendation

Here’s the report from the Bend Bulletin. Please raise your tray table and extinguish all smoking materials before you read it.

If you’re curious as to what the public had to say (and what HERC pretty much ignored and said wasn’t important), you can sift through pages and pages here.  (p. 46 – 75). The responses from HERC would be comical, if they weren’t real.

The response to a Registered Nurse and Diabetes Educator from Eugene, OR who shared her thoughts about the impact that self blood glucose monitoring has on her patients:

Thank you for your comment. HTAS appreciates the perspective you bring to diabetes education, but finds the lack of effect of SBMG on patient outcomes more compelling. 

Their responses to the American Diabetes Association, Endocrinologists, Nurse Practitioners, and patients were all dismissive and condescending. The HERC relied on very little data from randomized clinical trials that did not take into account the educational component needed to incorporate SBMG (self blood glucose monitoring) into a T2’s daily life. (Want to know which trials? Delve deep into the link above (before p. 46’s public comments) and ta-da.)

Meet Oregon’s Diabetes Death Squad

 This group of people is the Oregon Diabetes Death Squad, who made a recommendation that people with Type 2 diabetes on Oregon’s Health Plan (OHP) don’t need to know what their blood sugars are on a daily basis. Because, you know, their own doctors can’t be trusted to know better.

Would you like to know what qualifications HERC has to make this important, life-changing decision (and in my mind, one that will cost them significantly more in the long run in emergency room and complication treatments)? They must all work with people with diabetes on a daily basis, right?

Wrong.

Here’s the bios from the Health Evidence Review Commission Members page:

  • Gerald Ahmann, MD, –  recently retired hematologist/oncologist.
  • Wiley Chan, MD, – internal medicine physician and Director of Guidelines and Evidence-based Medicine for Kaiser Permanente Northwest.
  • Alissa Craft, DO, MBA, – pediatrician specializing in neonatal and perinatal medicine and Medical Director for Samaritan Health Plans.
  • Irene Croswell, RPh, – retail pharmacist.
  • Lisa Dodson, MD, – family physician.
  • Leda Garside, RN, BSN, MBA, – Clinical Nurse Manager.
  • Mark Gibson – Former fire fighter and current Director of the OHSU Center for Evidence-based Policy.
  • Vern Saboe, DC, – chiropractic physician.
  • Som Saha, MD, MPH, – general internist at the Portland VA Medical Center.
  • James Tyack, DMD, MAGD, – dentist.
  • Beth Kaplan Westbrook, PsyD, – clinical psychologist.
  • Susan Williams, MD, – orthopedic surgeon.

For those of you keeping score, we have a psychologist, a former firefighter, a dentist, two chiropractors, and a pharmacist on HERC. How likely are those individuals to deal with people with diabetes on a daily basis? Unless they have a personal connection, they do not treat Type 2s as a member of a health care team.

Of the remaining members of the HERC, I wouldn’t bet the farm on extensive daily interaction with people with diabetes unless there is a personal connection. (Please note: I don’t have a farm, but if I did, I would raise naughas. For their hide, of course.)

 Stopping The Future Carnage

I truly hope that this recommendation is not implemented. Is there anything we, as a community – or as humans – can do?

Yes.

Why is this important? Why should you care?

Because…

Your state might be next.

Your insurance company might be next.

Your Type 1 diabetes might be next.

Your health might be next, even if you don’t have diabetes.

We are all on the firing line.