Perspectives on Diabetes Care

We Need to Fix Diabetes Education and It Starts Today

Nov 1, 2020, 08:00 AM

by Leslie Kolb, MBA, BSN, RN, ADCES Chief of Science and Practice

Diabetes care and education specialists (DCES) know how valuable diabetes self-management education and support (DSMES) is for people with diabetes. The evidence is clear. However, outdated coverage requirements, cumbersome standards and payment challenges have turned a quality, evidenced-based service into an administrative nightmare.  

Health systems are finding it easier to close their programs than deal with the complexities of the reimbursement model. I hear all too often that the benefit is “too complicated” and there are just “too many boxes to check.” I have even heard that going to a DSMES service is boring. Why is this?  

• DCES, providers, administrators and billers do not effectively communicate with one another.  
• The DCES is frantically checking the boxes to meet the needs of administration.  
• Providers do not want to fill out the referral because it is so complex, or it is not easily accessible in their electronic medical record.
• Billing departments write off claims because they want to avoid the headache of dealing with payers on the small reimbursement amount compared to other services and tests.
• Administrators are closing programs without communicating with the people who run the service because their excel spreadsheet simply shows unfavorable numbers. Is DSMES really not worth it? What about the reduction in rehospitalizations for this same population or the increase in other services their education has encouraged the people with diabetes to seek out? Why do we never hear decision makers talk about those numbers? 

Some of these misconceptions could be perpetuated by the guidance accrediting organization develop to meet or exceed the quality standards developed by the Centers for Medicare & Medicaid Services (CMS). The National Standards for Diabetes Self-Management Education and Support (Standards) must meet or exceed the quality standards that were established under the Balanced Budget Act of 1997. This means the accrediting organizations for DSMES must develop guidance to meet these outdated requirements, yet the evidence to support DSMES has changed over the last 20 years. The diabetes self-management training (DSMT) benefit available for Medicare beneficiaries has had only minimal updates, despite changes in health systems, overt flaws in the system and underutilization.  

DCES feel pressure to make sure participants receive every component of the curriculum. Many times, the focus is on ensuring there is a stakeholder meeting or complex continuous quality improvement plans.  

DSMES should be person centered. Education should be provided based on the need of the individual through assessment and shared decision making. To be clear, no one should be receiving the entire curriculum unless they want to. Sharing data with stakeholders should not be so complicated. No one needs a black belt to ensure their service meets standard 10.  

Everyone has a responsibility in decreasing complexities and misconceptions. DCES need to pay attention and speak up! Providers need to refer or implement the service in their practice! Administrators need to take a deeper look at the data! ADCES, as an accrediting organization for DSMES, is already taking steps to work with CMS to reduce the burden and get out of the way of the service so many people need and deserve.   

Today, I encourage you to take the first step and stop focusing on just checking the box. This year during National Diabetes Education Week, a time meant to celebrate DCES and the service you offer, let’s take a step back and take a hard look at how we deliver DSMES. ADCES has a new podcast episode on how to navigate the Standards while offering person-centered care, as well as tips from other accredited programs. For more, visit DiabetesEducator.org/EngagingDSMES.

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