Presented by Jacque Corey, RN, CNS, CDE Kirsten Gram, RD, LD, CDE Sue McGrath, RN, CDE

Transcription

1 Presented by Jacque Corey, RN, CNS, CDE Kirsten Gram, RD, LD, CDE Sue McGrath, RN, CDE

2 Lots of Diabetes, Shortage of Endocrinologists, Health Care Reform

3 We Can Help!

4 Diabetes by the Numbers 26 million Americans have diabetes 79 million Americans have pre-diabetes 7 th leading cause of death in the U.S.

5 The Need for Diabetes Education Diabetes Self-Management Training (DSMT) Healthy People 2020 priority

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7 Diabetes Education Patient Benefits Studies have shown people who receive diabetes education: Use primary care / prevention services Take medications as prescribed Control glucose, blood pressure, LDL cholesterol Have lower health costs

8 Diabetes Education Underutilized Few people with diabetes receive diabetes education

9 The research shows: People with Diabetes Don t follow through on referral Are emotional / shocked at diagnosis End up relying on family / friends Believe they know enough / can handle it on their own Providers Know importance of DE, but don t necessarily prescribe or don t prescribe definitively enough Sometimes forget to follow up with patients to encourage attendance

10 How Do Diabetes Educators Help? We help people with diabetes: Learn basic information Seven tenets of self-care behavior Incorporating diabetes management into life Understand how to use devices Blood glucose meters Insulin pens Insulin pumps Continuous glucose monitors Adopt healthy eating and physical activity habits Nutrition education Meal planning Weight loss strategies

11 Seven Tenets of Self-Care Behavior Healthy eating Being active Monitoring Taking medication Problemsolving Healthy coping Reducing risks

12 We help your patients: Develop self-management skills Achieve better metabolic control Improve lipid levels Reduce blood pressure

13 While you manage your patients care, we will Empower Teach Coach your patients to understand their diabetes in the context of their personal lives and work with them to set and meet behavior change goals to improve their health.

14 Traditional Diabetes Education Model Diabetes Education Center Cascade Health Solutions DEMS (Peace Health) Offering Individual appointments Group classes

15 Contemporary Trends in Diabetes Education Education in your office Expansion of an ADA Recognized program Can be done within an organization (Peace Health model) It is a satellite of their program Multi-Site of an ADA Recognized program An ADA Recognized program can rent space and provide the staff, materials, and collects the statistics. The Medical Clinic does the scheduling and billing.

16 Shared Medical Appointments How? Invite a group of patients with similar dx (10-15 usual) MD provides a short group visit where they manage and advise each patient in front of the others (10-15 minutes) Educator spends the remainder time with the group providing education Usually lasts 90 minutes Reimbursement varies in different regions Space can be a problem to host a group setting Other Codes maybe yes, maybe no, maybe not worth it need to check with payers

17 Requirements for Coverage American Diabetes Association (ADA) Recognized or American Association of Diabetes Educators (AADE) Recognized Peace Health and Cascade Health Solutions are both ADA Recognized

18 Requirements for ADA Recognition There is a sponsoring organization that supports the program Meet the National Standards for Diabetes Education (NSDSME) Advisory Group- consists of external stakeholders who provide quality input, at least annually Qualified personnel to deliver education RD, RD, CDE, Pharmacist Ongoing training in DSME topics 15 hours/year or maintaining CDE

19 ADA Recognition Requires Each participant receives an initial assessment & an educational plan is developed based on the assessed need(s) 2 program outcomes (at least) are tracked and measured Behavioral goal and another outcome Evaluate educational intervention, including follow up assessment of goal achievement

20 Medicare Coverage Initial Diabetes Education 1 hour individual assessment, 9 hours of group education Use it or Lose It (Must be used within 12 months) If group not appropriate, there are ways to arrange 1:1 education Medical Nutrition Therapy (MNT) for diabetes provided by registered dietitian 3 hours Must be used within calendar year Note: there are some exceptions with Medicare Replacement plans

21 Follow Up Diabetes Ed Coverage Follow Up Diabetes Education - 2 hours with nurse educator each calendar year MNT for diabetes 2 hours with registered dietitian each calendar year

22 TMC-Medicaid Diabetes coverage similar to Medicare Requires a prior authorization that we initiate with your notes, labs and referral Medical Nutrition Therapy covered if dx of obesity (BMI > 30) Requires a prior authorization that we initiate with your notes, including height, weight, labs and referral Generally covers 3 visits. Additional visits may be authorized with evidence of weight loss and behavior change

23 Private Insurance Varies greatly Some have: full coverage some with co-pay some a co-insurance and then those deductibles Not easy to know without calling the company or going online to check benefits for diabetes education Flex Spending Accounts can be used

24 Potential Cost Straight Medicare: covered at the 80% Those with Medicare + supplement: usually 100% Medicare Replacement: usually 100% TMC-Medicaid 100% with PA Private- VARIES!!

25 Where Frustration comes in. Medicare participants who start and stop education during initial benefit period (use it or lose it) Those with large deductibles that apply to diabetes education Limitation to billing- benefit exhaustion but still need help

26 How Do You Refer to PeaceHealth? PeaceHealth internal referrals are sent through EPIC Outside referring providers, please use the PeaceHealth Referral Form (a copy has been provided in your conference packet) Please note a new diabetes diagnosis will need the supporting labs

27 How Do You Refer to Cascade Health Solutions? Fax a referral please use the CHS Referral Form (a copy has been provided in your conference packet) or if using your EHR Include Diagnosis using ICD-9 code(s) Demographics Insurance Information Recent labs Recent chart notes Height and weight required for TMC-Medicaid

28 Tell us the service requested Diabetes Education (offered by RN and RD) Initial Education Follow Up Education Injectable administration (insulin, incretins) Note: Medical Nutrition Therapy (MNT) (offered by RD) Covered by Medicare for diabetes and CKD stage 3 & 4 TMC covers with a BMI > 30 Some private may, but if not, we will see them through DE If group setting not appropriate, indicate this and provide reason (i.e. hearing impaired, language, visual, phobia ) Diabetes Education can be requested by MD, NP, PA MNT can only be requested by MD

29 Pre-Diabetes Education Cascade Health Solutions PeaceHealth YMCA- Diabetes and Prevention Program

30 Partner With a Diabetes Educator We help you: Help patients improve outcomes Help delay onset of diabetes Track and monitor patients progress Increase efficiency Meet pay-for-performance and QI goals Make your job more manageable

31 Learn more American Association of Diabetes Educators American Diabetes Association Accurate Insulin Decisions YMCA Contact Information

32 There s No Place Like a Medical Home

33 Cascade Health Solutions- Diabetes and Nutrition Education Jacque Corey, RN, CNS, CDE Kirsten Gram, RD, CDE PeaceHealth- DEMS Marisue McGrath, RN, CDE

34 Questions?