A Closer Look at the Diabetes Educator Jan Pearson, BAN, RN, CDE Sr. Consultant International Diabetes Center A Closer Look at the Diabetes Educator Presentation Overview 1. Meeting the Demand 2. The Role of the Diabetes Educator 3. Resources/Tools for Career Growth 4. Looking to the Future Hass et al. The Diabetes Educator.. 2012 8 (619). Hass et al. Diabetes Care. 2013 (36).1:S100.
Epidemiology of Diabetes 29.1 million people in U.S. have diabetes. 9.3% of U.S. population 1.7 million new cases diagnosed in 2012 1 in 3 children will develop diabetes 7 th leading cause of death Estimated by 2025 14.9% of population will have diabetes (~53 million) Type 1: ~1.3 million GDM: ~250,000 Type 2: ~19.5 million Undiagnosed ~8.1 million CDC National Diabetes Statistic Report 2014 www.cdc.gov/diabetes; Rowley and Bezold. Population Health Management 2012; volume 15. Estimated Economic Cost of Diabetes in the United States for 2012 Total cost of diagnosed diabetes is $245 billion; includes $176 billion direct medical costs and $69 billion in reduced productivity 13% of all U.S. healthcare dollars attributed to diabetes Distribution of Direct Medical Costs Nursing Home, Home Health and Hospice ($19.2 billion) 2% 11.5% 11.0% Medications for Complications ($31.7 billion) 18.1% 15.5% 43.1% 50% Inpatient ($76.0 billion) Outpatient: Office Visits, ER, Podiatry ($27.3 billion) 12.3% Diabetes Medications and Supplies ($21.6 billion)) American Diabetes Association. Diab Care 2013; 36:1033-1046.
DSME Bends the Cost Curve Commercial Claims Data: Costs PMPM (Adjusted) Lower costs with increased use of DSME Why? Change in use of services primary and preventive acute, inpatient hospital More likely to follow best practice treatment recommendations e.g. HEDIS measures medication adherence Duncan I et al. The Diabetes Educator 2011;37:638-657 External Forces Driving Need for Support Top 10 Health Conditions Targeted to Reduce Readmissions Diabetes is #6 AHIP Smart Brief 3/20/2014 Patient Engagement - Leadership Survey revealed that 49% of the 330 organizations surveyed currently have a telehealth or mhealth strategy in place mhealthintelligencetelehealth April 14, 2015 Medicare - Physician Compare search which physicians, other health professionals, medical groups take part in Medicare s Quality Program www.medicare.gov/physiciancompare
Evolution of Diabetes Education Early Diabetes Education Sharing of Knowledge (expert health professional to patient recipient) DSME (DSMT) DSME and DSMS = DSMES Moved to techniques that promote effective self management and selfmanagement support keys to success! AADE Work Force Survey Number of Diabetes Educators Needed 2011 2025 30,000 Educators 43,000 educators are needed to meet the current demands of the diabetes population 54,000 Educators By 2025, with the inclusion of pre-diabetes education, the demand will grow to 100.000 educators Dobson DaVanzo & Associates, AADE Workforce Analysis Report, 2011
Powers et al. The Diabetes Educator, June 2015 Diabetes Educator Practice Levels Purpose is to increase access to DSME and achieve better patient care: Delineating the roles and responsibilities of the multiple levels of diabetes educators and associate diabetes educators Suggest a career path for all diabetes educators Clarify the contribution that can be made by individuals who have the knowledge, capability, diversity and language skills to address DSME/S in a variety of settings
Excerpt from Diabetes Educator Practice Levels, AADE 2014 see www.diabeteseducator.org Excerpt from Diabetes Educator Practice Levels, AADE 2014 see www.diabeteseducator.org
Other Factors Driving Demand for Diabetes Educators Expansion of FQHC s and other Community Health Care Centers (CHC s) Need to provide uninsured and underinsured individuals with much-needed access to DSME and DSMS Anticipated increase in level 1 & 2 Associate Diabetes Educators (DEs) Higher level educators needed to Train and supervise level 1 and 2 Associate DE s in core diabetes skills and competencies Meet the demand for complex management Martin A. Lipman n R. Diabetes Educ.39(4):July 2013. Diabetes Education: The Challenge Before Us Develop professional expertise Demonstrate value and positive outcomes Improve access and increase referrals Maximize scheduling and staffing Understand reimbursement regulations Follow national standards Mean HbA1c 10 9 8 7 6 9 8.2 $$ 6.5 6.5 6.5 6.5 5 Baseline 3 Month 6 Month Hass et al. The Diabetes Educator. 2012 38(5):619-629. Hass et al. Diabetes Care. 2013. 36(1):S100-108
Key Resources/Tools for Career Growth 1. Professional Organizations American Association of Diabetes Educators (AADE) American Diabetes Association (ADA) 2. National Accreditation of DSME/S Programs AADE ADA 3. Educator Certification NCBDE CDE AADE BC-ADM 4. International Diabetes Center Professional Organizations: American Association of Diabetes Educators See www.diabeteseducator.org AADE Fact Sheet About Diabetes Education Professional Resources DEAP Accreditation Practice Documents Policy and Advocacy AADE Foundation Member Center My AADE NETWORK
Building Connections Local Networking Groups State Coordinating Body National Access to members across the U.S. Communities of Interest - 17 Allows members with common interests, practices to share knowledge and learning www.diabeteseducator.org Professional Organizations: American Diabetes Association See www.diabetes.org see For Professionals Standards of Medical Care in Diabetes Meetings Slide library Diabetes Insight Audio CME Program Diabetes Rx Patient Resources Professional Section Interest Groups Books for Professionals/Consumers Scientific Session Webcasts
Key Resources/Tools for Career Growth 1. Professional Organizations American Association of Diabetes Educators (AADE) American Diabetes Association (ADA) 2. National Accreditation of DSME/S Programs AADE ADA 3. Educator Certification NCBDE CDE AADE BC-ADM 4. International Diabetes Center National Accreditation Organizations (NCO s) for DSME Currently, only two organizations are accredited by CMS (Medicare) for accrediting entities to furnish Diabetes Self- Management Training (Education) Accrediting Entity AADE ADA Name of Program Diabetes Education Accreditation Education Recognition Program Abbreviation DEAP ERP Website www.aadenet.org www.diabetes.org Evidence of Accreditation/Recognition is required to receive reimbursement by CMS Mensing C. Diab Spectrum 23(1), p65, 2010
Ten National Standards for DSME 1. Internal Structure 2. External Input 3. Access 4. Program coordination 5. Instructional staff 6. Curriculum 7. Individualization 8. Ongoing support 9. Patient progress 10.Quality improvement Hass et al. The Diabetes Educator. 2012 ; 38 (619). Hass et al. Diabetes Care 36(1):S100. Misunderstandings of National Standards for DSME A CDE is needed for a program (NO) A medical director is needed for a program (NO) Data needs to be analyzed for all patients seen (NO: subsets of patients are fine) An education program needs to be 10 hrs. (NO: CMS (Medicare) pays for up to 10 hours of education for newly diagnosed or patients who have never received education but education can be any number based on assessed needs of the patient) Group size for classes must be 8 or more (NO: CMS defines the group as 2 or more)
Misunderstandings of National Standards for DSME (cont) Advisory Group must have meetings (No: they can provide input for the program through other means review and approve program tools like curriculum, education methods, etc.) Curriculum = PowerPoint slides or patient education materials (NO: curriculum must include outline learning objectives, methods of delivery and learning evaluation) CMS (Medicare) only pays for DSMT, not DSME (No: they are the same but when submitting billing, DSMT terminology is used) Conditions for CMS (Medicare) Coverage CMS (Center for Medicare Services) DSMT must be: Ordered by the primary care provider Needed to ensure compliance or to provide necessary skills/knowledge Delivered in a group setting (unless barriers) Provided by an accredited(deap) and or recognized (ERP) education program
CMS (Medicare) FFS Payment Billing Codes for DSME/T DSME Programs must be Nationally Accredited or Recognized to Bill CMS G0108 ($53.38 per 30 minutes - national) Diabetes outpatient self-management training services (DSMT) billing code for: individual session, face-to-face with the pt, each 30 minutes of training G0109 ($14.69 per 30 minutes national) Diabetes outpatient self-management training services (DSMT) billing code; group session (2 or more), face-to-face with the pt, each 30 minutes of training www.cms.gov/apps/physician-fee-schedule CMS Expansion of Telehealth Services - 2011 Individual and group DSMT Involves several requirements see AADE s Ask the Reimbursement Specialist (Q & A section) for more specifics
Payment Model Evolution - Experimentation Opportunities for Diabetes Educators Facilitate health outcomes Enhance patient satisfaction Fee for Services Bundled pricing Pay for Performance Shared Risk Global Payments Establishing the identity of the Qualified Health Care Professional may be key Key Resources/Tools for Career Growth 1. Professional Organizations American Association of Diabetes Educators (AADE) American Diabetes Association (ADA) 2. National Accreditation of DSME/S Programs AADE ADA 3. Educator Certification NCBDE CDE AADE BC-ADM 4. International Diabetes Center
Educator Certification: CDE NCBDE : Certified Diabetes Educators (CDE) National Certification Board for Diabetes Educators Eligibility Requirements for CDE* Discipline Eligible health care professional e.g. registered nurse, dietitian, pharmacist, clinical psychologist, physical therapist, physician, podiatrist, etc. or, Health care professional with a master s degree or higher in social work or, If you do not meet any of the two above, see NCBDE s Unique Qualifications Pathway *See www.ncbde.org 2015 Certification Examination for Diabetes Educators Handbook Certified Diabetes Educators Initial Certification Requirements (cont) Professional Practice* Minimum of 2 yrs professional practice experience Example 2 yrs RN or RD Minimum of 1000 hours of DSME experience with: 400 hours* in the most recent year Hours must be compensated as DE educator or in a Diabetes Educator Mentorship Program Minimum of 15 hours clock hours CE in past 2 yrs. Application and Exam refer to the NCBDE website *See www.ncbde.org for specifics
Diabetes Education Mentorship Launched by NCBDE, AADE and ADA January 2011 Goal: to assist professionals with meeting the current hours of experience practice requirement for CDE certification Up to 400 of the 1000 hours required for DSME experience See www.ncbde.org for mentor/mentee eligibility criteria Certified Diabetes Educator Continuing Education Renewal 2014* Professional license same as for initial certification Minimum of 1000 hours of professional practice experience during 5 year cycle Renewal Options By CE 75 clock hrs. in content areas applicable to diabetes in the certification cycle (5 yrs) By exam if unable to meet the practice experience (75 clock hours of CE is still required) * See 2013 Certification Examination for Diabetes Educators Handbook at www.ncbde.org
Board Certified-Advanced Diabetes Management Certification (BD-ADM)* Certification Managed by AADE Eligibility Criteria: RN, RD, R. Ph, PA, Physician with current active license/registration Advanced Degree: Master s or higher degree in a relevant clinical, educational, management area Experience - 500 clinical practice hours within 48 months prior to taking certification examination. Clinical hours must be after relevant licensure and advanced degree has been obtained *See www.diabeteseducator.org for more details Resources/Tools to Address the Levels of Diabetes Educator Level s IDC External Sources Assoc. Db. Educ. Level 1 Assoc. Db. Educ. Level 2 Db. Educ. Level 1 Diab. Educ. Level 2 Diab. Educ. Level 3 Community Programs/Caring for Patients Caring for Patients/Lunch and Learn, Foundations Program Diabetes Care in a Back Pack Health Professional Curricula and patient education materials SDM Quick Guide to Medications Advanced Strategies Programs for DE. Clinical Diabetes Management in Primary Care SDM Training Annual Symposium for Advanced Diabetes Educator AADE: Fundamentals of DE AADE: ABC s of DE Core Concepts Program and webinars. Annual Meeting DSME Desk Reference and Enduring Materials Quick Guide to Medications Reimbursement, CQI, Curriculum Webinars Capstone Courses, GDM, Inpatient, CGM Annual Meeting
Advocacy State Level State Licensure of Diabetes Educators Ensures patient protection, increases recognition of the specialty and enforces high standards of care How do you determine qualification State Scope of Practice Those who have the license have the qualification A license defines the profession and their abilities to deliver care Why is Licensure Growing in Importance? Licensed /Registered Health Care Professional Credentialed as CDE or BC- ADM Legal Scope of Practice for each Discipline Voluntary credentials. No legal scope of practice Status of State Licensure in its Infancy Kentucky - Passed Indiana Passed States interested in Pursuing Florida Pending 2015 Introduction Pennsylvania Pending 2015 Introduction Mississippi North Dakota Washington
Advocacy Federal Level Your Support is Needed Access to Quality Diabetes Education Act HR. 1726 and S.1325 Amends current DSMT legislation to By authorizing state licensed or certified diabetes educators to provide DSMT Study the barriers to access to DSMT for Medicare beneficiaries Develop a series of recommendations on outreach methods to educate physicians and others about the benefits of DSMT to promote health outcomes See www.diabeteseducator.org 37
Broadened Scope of Employment Settings Accountable Care Organizations (ACOs) Patient Centered Medical Homes (PCMHs) Industry Retail-Based Clinics Community-Based Settings Workplace Wellness Program Renal Disease Home Health Care and Long-Term Care Facilities Research Cultivating the Future Landscape of Diabetes Education What Can You Do? Utilize Tips for Reach Prescribers Build your contacts Create Key messages Develop a one page document that highlights the services you provide Create a referral order and acknowledge referrals! Think creatively Communicate, Communicate, Communicate Promotion of the role of the diabetes educator Support advocacy www.diabeteseducator.org/professionalresourceslibrary