Statements on Introduced Bills and Joint Resolutions

Floor Speech

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Ms. COLLINS. Mr. President, I rise today to introduce legislation with my colleague from Ohio, Senator Sherrod Brown, that would remove an unnecessary, outdated barrier for Medicare beneficiaries managing diabetes. Our legislation would allow physician assistants (PAs) and nurse practitioners (NPs) to satisfy the Medicare documentation requirement certifying a patient's need for therapeutic, or diabetic, shoes, which will improve access to care, reduce barriers to proper diabetic management, and help to reduce the prevalence of costly complications that can arise if diabetic symptoms are not managed properly. This bipartisan bill, the Promoting Access to Diabetic Shoes Act, is a companion to H.R. 1617 from my fellow Diabetes Caucus Co- Chair, Representative Tom Reed of New York, which has growing support on both sides of the aisle in the House.

As the founder and co-chair of the Senate Diabetes Caucus, I have worked since the very beginning of my Senate service to increase awareness of the threats posed by diabetes, invest in research, and improve access to treatment options for the over 30 million Americans, including twelve million seniors, who suffer from diabetes. In addition to the human toll, diabetes is also the most expensive chronic illness in the country. A new American Diabetes Association report released in March titled, ``Economic Costs of Diabetes in the U.S. in 2017,'' found that the direct and indirect costs of diagnosed diabetes in the U.S. cost $327 billion in 2017, which is a 26 percent increase in just the last five years.

Preventable complications contribute enormously to the influx of dollars being spent on diabetic care and management. Today, more than one in five health care dollars and one in three Medicare dollars are spent on care for people with diabetes.

Under the current Medicare statute, physician assistants or nurse practitioners are required to refer their patients with diabetes to a physician in order to certify the patient's need for therapeutic shoes, which often results in delays in treatment and added costs. The Promoting Access to Diabetic Shoes Act would fix this problem by allowing nurse practitioners and physician assistants to certify a Medicare beneficiary's need for therapeutic shoes, which will improve timeliness and access to care while reducing costs.

Therapeutic shoes are a cost effective, preventive treatment option intended to avoid the costly complications that can arise if maintenance of diabetic care is delayed or unavailable. Types of complications that can result from unmanaged diabetic symptoms include poor circulation, infections, and foot ulcers that can require hospitalization, or even result in the amputation of toes, feet, or legs.

In addition to preventable complications and additional costs that can result from delays in treatment, the current documentation requirement under Medicare can also disrupt the trusted patient- provider relationship many patients have with an NP or PA. Current statute requires the certifying physician to be a patient's provider for diabetic care moving forward, which is often in conflict with a patient's preference. Moreover, in rural areas, including many parts of my home state of Maine, access to diabetic management though a PA or NP is not only necessary, but it is sometimes unavoidable due to the shortage of primary care providers in the area. Maine alone has 68 designated Health Professional Shortage Areas for primary care practitioners. These health care professionals are already providing accessible, high quality diabetic care across the country. In fact, a March 2018 article in the American Journal of Medicine concluded that PAs and NPs are able to perform as well as physicians in the management of diabetes at diagnosis through the first five years of follow-up care.

Stephanie Podolski, President of the Maine Association of Physician Assistants, which represents over 700 PAs in Maine, reiterated these points and the importance of the physician assistant profession in diabetes management in a letter of support for our bill saying, ``In a State like Maine, there are many rural communities that at times are served only by a PA as a primary care provider (PCP). The inability to order diabetic shoes is an outdated barrier to care that impacts both middle-aged and older Americans who frequently live in areas facing provider shortages.''

The Promoting Access to Diabetic Shoes Act is endorsed by the American Association of Nurse Practitioners, the American Academy of Physician Assistants, and the American Podiatric Medical Association. I am pleased to join Senator Brown in introducing the Promoting Access to Diabetic Shoes Act, which will improve access to diabetic care, and I encourage my colleagues to support its adoption.

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