Guest Post – Hope Warshaw Diabetes Education and Educators

Diabetes Education and Educators: Who, What, Where and How?

Brief intro: Hope Warshaw, MMSc, RD, CDE, has been a dietitian and diabetes educator for more than 30 years. She’s the author of several books about diabetes care and healthy eating published by American Diabetes Association. She’s currently on the national board of directors for the American Association of Diabetes Educators. She’s a member of Diabetes Advocates (www.diabetesadvocates.org) and is passionate about building bridges between diabetes educators and the diabetes online community (DOC). Check out her interview with DOC leaders filmed at AADE 2011 (http://presentdiabetes.com/etalk/Joy-Pape-Hope-Warshaw-Interview-t4441.html#-1). Connect with Hope at www.hopewarshaw.com.

 

Stats show only 30 to 40% of people with diabetes in the U.S. ever meet (that’s even once) with a diabetes educator or attend a diabetes education program. What’s up with this? Oh let me count the reasons!

Even though Medicare and many large or small employer-based and individual health plans cover the services of diabetes educators (at least a few hours a year), far too few primary care providers (the people caring for the vast majority of people with diabetes, especially type 2s) make this important referral. Plus too few people with diabetes know about diabetes educators/education. It’s likely you do, so we’re hoping YOU will help spread this important message.

It’s my goal here to make sure you know who diabetes educators are, where they typically practice, how to access us and how YOU can take action to increase PWDs access to diabetes educators throughout the U.S.

Who are diabetes educators?
Diabetes educators are credentialed health care professionals who are most often nurses (including nurse practitioners, clinical specialists), dietitians, or pharmacists. A scattering of diabetes educators are social workers, psychologists, exercise physiologists, physical therapists or physicians.

Many diabetes educators make the choice to obtain the additional credential as a Certified Diabetes Educator (CDE). Another credential is BC-ADM, Board Certified in Advanced Diabetes Management.

Unfortunately there are far too few U.S.-based diabetes educators (<30,000) for the growing population of people with diabetes (excess of 18 million diagnosed, 80 million with prediabetes).  AADE is the multidisciplinary professional organization of diabetes educators (http://www.diabeteseducator.org). Learn more about AADE and about the field of diabetes education. As you’d suspect, a goodly number of diabetes educators are PWDs.

How diabetes educators can offer an assist?
You know this first hand…taking care of diabetes is a relentless 24/7/365 job which requires you to be in the driver’s seat making hundreds of decisions about your care each day. Study after study shows that people with diabetes can stay healthier with frequent and continual education and SUPPORT.

Working with diabetes educators has the potential to:
– help you learn more about diabetes in general and your diabetes specifically
– assist you to analyze your BG/CGM records and think through options to improve control
– be a shoulder to cry on when you are burnt or bummed out
– serve as your advocate with other HCPs
– be one of your cheerleaders or coaches.
Plus, they can help keep you up to date on the latest research, medications, devices, technology and more.  (I’ll admit it, I’m a bit biased!)

Where are diabetes educators?
Diabetes educators most often work in diabetes education programs most typically found within the campus of a hospital/medical center out-patient clinic. You’ll often find a few diabetes educators working together in a program – most commonly a nurse and dietitian. These programs are often referred to as diabetes self-management education (or training) programs, abbreviated DSMT or DSME.

Due to the current evolution of how and where healthcare is/will be delivered, where diabetes educators practice is changing. More educators and programs are and will continue to be found in large primary care provider offices (duh? That’s where all the people with type 2 diabetes are), in pharmacies, supermarkets, and other convenient locales.

Eventually I believe there will be more online and telephonic education and support offered by educators. Mobile health (mhealth) will offer even more opportunities. AADE has just embarked on an exciting mhealth program with AT&T to deliver DSMT via AT&T mobile devices (http://www.diabeteseducator.org/About/Media/09.12.11_Release_-_mHealth_project).

Is diabetes education a covered/reimbursed Medicare or health plan benefit?
Medicare and many other health plans require a DSME programs to be “recognized” by a Medicare accredited organization to cover/reimburse the service. To date there are two major accrediting organizations for DSME, American Diabetes Association and American Association of Diabetes Educators.

Medicare and many other health plans cover/reimburse a limited amount of diabetes education. Medicare covers up to 10 hours of DSME within the first year of your diagnosis of diabetes and then an additional two hours in consecutive years (link to Medicare.gov).

You may be eligible for coverage of another service called medical nutrition therapy (aka nutrition counseling). Medicare beneficiaries who have diabetes are eligible and many health plans also cover this benefit.

Laws passed in most states across the country require private health plans mandated by state law to cover some diabetes education (http://www.diabetes.org/living-with-diabetes/treatment-and-care/health-insurance-options/health-insurance-in-your-state).

If you believe you should have access to diabetes educators/education and it is being denied, talk to your health plan or your worksite health benefits plan administrator. Today, most people with a health plan can have access to some diabetes education.

How to find diabetes educators/programs?
To find a “recognized” DSME program approved by American Diabetes Association in your area go to: http://professional.diabetes.org/erp_zip_search.aspx?utm_source=WWW&utm_medium=GSA&utm_content=keymatch-Diabetes-Education&utm_campaign=DP). You’ll come to a screen to search for programs in your area.

To find a “recognized” AADE program in your area, go to http://www.diabeteseducator.org/ProfessionalResources/accred/Programs.html. From here go to your state.

Want to Help More PWD Access Diabetes Educators Across the U.S.?
Here’s the current problem: Medicare regulations only allow reimbursement for diabetes education to Medicare beneficiaries within a DSMT in-person program and not directly to individual credentialed diabetes educators (those with the CDEs and BC-ADM). This restricts where and how diabetes educators can practice and restricts access for PWDs.

To fix this AADE is forging ahead to change the Medicare regulations (Title XVIII of the Social Security Act or Medicare). The goal is to authorize direct reimbursement to credentialed diabetes educators for DSMT provided in-person and via telehealth (a growing method of delivering healthcare to people in small and rural communities) under Medicare out-patient services (Part B). 

The legislation is the Medicare Diabetes Self-Management Training Act of 2011, (House Resolution 2787, Senate Bill 1468). I ask that you support AADE’s effort to widen PWDs access to diabetes education/educators. Learn more about HR 2787 and SB 1468 and contact your Representative in the House and your two Senators to request their support of this legislation via AADE: http://www.diabeteseducator.org/PolicyAdvocacy/Federal_x_State_Legislation.html. Take one more action (30 seconds) to show your support for this important legislation. Sign on to the petition: http://www.thepetitionsite.com/1/support-access-to-diabetes-self-management-training/

In conclusion, if you’re reading this blog you likely value the support you get from the diabetes online community (DOC). Perhaps you follow the diabetes news and connect with PWDs on twitter, Facebook and other social networking venues. Social networking has created an exciting and dynamic venue for PWDs to give and get support. In addition, consider connecting with a diabetes educator on an ongoing basis as another vehicle for supporting your efforts to take the best possible care of your diabetes and you through the years.