1982-P: Delivery of Evaluation and Management Services Are Key to the Financial Success of a Primary Care Virtual CGM Initiation Service

Introduction and Objective: The ADA recommends CGM for people with diabetes on any diabetes treatment where CGM helps in management. Most people with diabetes receive their care in primary care settings, and though primary care CGM prescribing lags that of endocrinologists, primary care is responsible for most of the growth in new prescriptions to people with type 2 diabetes in recent years. Primary care practices need practical financial evidence to select an appropriate CGM implementation strategy. This cost and revenue analysis examines the effect of delivering and billing Evaluation & Management (E&M) services in a virtual CGM initiation service (virCIS) to generate evidence to guide CGM implementation in primary care. Methods: We built on our time-driven activity-based costing framework by analyzing costs and revenue of developing and operating a virCIS model that included delivery of and billing for E&M services to assess the model’s break even and internal rate of return (IRR) in evaluating its implementation internally within primary care. Calculations used net cash flow including amortized startup costs, operational and service delivery costs, and revenue over 60 months. Results: Incorporating delivery and billing of E&M services improved the financial sustainability of virCIS beyond the model accounting for CGM-related services alone. Modeling conservatively for average flow of 10 new patients/month with low-complexity visits (20-to-29 minutes, CPT code 99213), a small virCIS would break even after 5 months of operations with a 60-month IRR of 26%. Delivering a still-conservative combination of half low- and half moderate-complexity visits (30-to-39 minutes, CPT code 99214), virCIS would break even in 4 months with a 60-month IRR of 32%. By comparison, without E&M services, break even was 21 months with IRR of 5%. Conclusion: Primary care practices can consider a virtual CGM initiation service as a rapidly sustainable model for increasing access to effective diabetes technology. Disclosure S. Oser: Research Support; Current; Dexcom, Inc., Sequel MedTech, Insulet Corporation. T. Oser: Consultant; Ended; Dexcom, Inc. Research Support; Current; Dexcom, Inc. Advisory Panel; Current; Abbott Diabetes. Consultant; Ended; Medscape. Research Support; Current; Abbott Diabetes. Research Support; Ended; Insulet Corporation. T.L. Hall: None. C. Sobczak: None. K.T. Wiggins: None. W.P. Dickinson: None. R.M. Gritz: None. J. Cronin: None. Funding This study was supported by a research grant from the Leona M. and Harry B. Helmsley Charitable Trust.