This will not go away

While we’re not quite sure if its required by law it seems as though every insulin pump wannabe must not just say how way cool whiz bang their toy is but also how they will do what has never been done before and get insulin using Type 2 patients on a pump. Now keep in mind only 35% of Type 1 patients, patients who must be on insulin, use an insulin pump. Nor does it matter that this number has not changed substantially over the past 10 or so years. Nope if you are an insulin pump wannabe the road to riches is get insulin using Type 2’s onto a pump.

Why is insulin pump usage a minuscule number when it comes to insulin using Type 2’s? Well there are lots of reasons but one that all the insulin pump wannabes overlook is 80% of patients with diabetes are treated by a primary care physician (PCP) and these physicians are not against pump therapy. No they are against the hassle of insulin pump patients and all the work they create which they are not paid for. As great as insulin pump therapy can be the honest truth is insulin pump patients can be a big pain in the rear.

So naturally all the insulin pump wannabes want to help PCP’s manage their insulin using Type 2 patients when they get on a pump. They want to provide them with all this way cool whiz bang software which monitors the patient, provides lots of pretty charts and of course recommendations for how to work with the patient the next time they come in for a visit.

Software which is nice but with sensor augmented insulin dosing algorithm driven pumps this software isn’t needed. See in the not so distant future insulin pump therapy will be pretty simple. Things like carb counting, time to action, duration of action, insulin to carb ratios, correction factors, etc. will be a thing of the past. Training a patient on a pump will also be a snap largely focused on the mundane mechanics of pumping- how to insert an infusion set, fill the reservoir (maybe by then we’ll have cartridges instead of reservoirs that must be filled by the patient) sensor insertion, priming (for wired pumps), etc.

The system will do all the heavy lifting for the patient and will make pump therapy easy peasy. This assumes of course the CGM works and delivers accurate readings. Something any Dexcom system will do, Libre too but Medtronic well maybe. But lets not go there today. The fact is in five years maybe sooner thanks to accurate CGM’s like Dexcom and Libre and great insulin dosing algorithms insulin therapy will be easier than ever.

What won’t go away however is all the damn paperwork that payors require so the pump is reimbursed. Getting an insulin pump covered is one of the most time consuming processes faced by the physician and a HUGE reason why PCP’s don’t prescribe more pumps. Remember physicians like everyone else in this wacky world want to make money. The last thing they need is to have their staff filling out reams of paperwork, writing letters of medical necessity, filling out form after form so the pump is reimbursed and the patient is happy. A happy patient keeps coming back and the money comes with them.

So why then has no one and we do mean no one automated this process? Why have they not helped the physician where they need and want help? Remember time unlike money is not a renewable resource and filling out and tracking all these damn forms takes lots of time which costs the physician money. One would think that perhaps an insulin pump wannabe would understand this and instead of focusing on building a better mouse trap instead focus on getting this mousetrap into the hands of as many patients as possible and what better way then helping PCPs save or make money.

Listen we know that thinking outside the box is a foreign concept to all the toy makers. Yes and we also understand that most of them haven’t a clue about running a commercially viable insulin pump company or franchise. Yep even very large and well known companies, who truth be told should be nowhere near the pump market, haven’t a clue about the actually business of SELLING and then SUPPORTING insulin pumps. Heaven forbid the team that is designing and building the toy work with the team that is supposed to sell the toy or support the toy, this just makes sense and we can’t have any of that can we.

Hey guess what happens if they automated the paperwork process, if they helped physicians save time and make money. Not only would they sell some toys that 35% penetration for Type 1’s might go up too. To illustrate exactly what we are talking about take a look at this from an article posted on HITConsultant,net;

“According to one study, clinicians spend 35% of their time on documentation and only 19% spent on patient care,”[1] said Rick Valencia, President, Qualcomm Life, Inc. “Not being able to spend enough time with patients is a huge dissatisfier for both parties. Manual data entry and documentation are administrative burdens that can impact HCAHP scores resulting in lost revenue.”

While Mr. Valencia was talking about hospitals it’s no different in a PCP’s office. Paperwork is a major time and financial burden. Therefore it makes perfect sense that a problem that is facing almost every PCP is not being addressed. Let’s build a better mouse trap, let’s spend millions on development and not spend anything on making getting the pump into the hands of patients any easier. Yep makes perfect sense.

Is it any wonder that Medtronic has never really been seriously challenged. The competition is not just outgunned they are shooting at the wrong targets. The reality here is automating this process will also help in another way, unlike what Medtronic is doing and placing employees in the physicians office there is no danger of software doing things its not designed to do. Unlike the Medtronic employees who are doing things they really shouldn’t be doing but are doing which the physician lets them do even though this is technically illegal because it saves the physician money. This practice is now the subject of a whistleblower lawsuit and is just one more ethical lapse by the evil empire.

Sorry we didn’t mean to dump on the empire today but seriously the empire is facing so many ethical, legal and regulatory issues these days its hard not to mention them.

So let’s get back to all the insulin pump wannabes and heck Tandem and Insulet too. Automating all this damn paperwork is the shortest distance between two points. Yes we know that each insurance company has it’s own unique set of requirements, heaven forbid these requirements were standard throughout the industry, that too would only make sense and save money too. Yes we know that 100% of this process cannot be automated but my goodness 85% isn’t a bad goal.

Folks we know this is hard to understand but they call it the BUSINESS of healthcare for a reason. As we say all the time this is all about money, who makes it, who saves it and who spends it. So why not think out of the box a little. Take a walk on the wild side. It’s not like you’d be running around in public stark naked, or dancing the hippie hippie in your underwear.

This is about transforming that way cool whiz bang toy into … wait for it …. Money.