UTTING DIABETES EDUCATION IN PRIMARY CARE将糖尿病教育的初级保健

WELCOMEtoPuttingDiabetesEducationinPrimaryCareLiveStreamBroadcastSept21stfrom12:00pm–1:00pmMDTReminder:TakethePre-Testathttps://www.surveymonkey.com/s/utahdiabetes_oct2011_pretestPUTTINGDIABETESEDUCATIONINPRIMARYCARECarolRasmussenMSNNP-CCDEhttps://www.surveymonkey.com/s/utahdiabetes_oct2011_pretesthttps://www.surveymonkey.com/s/utahdiabetes_oct2011_pretestOBJECTIVESLearnhowtomarketyourskillstoaPrimaryCarePracticeUnderstandhowprovidinganalternatefocusineducationwillbenefityou,theproviderandthepersonwithdiabetesUnderstandhowdifferentreimbursementoptionsworkBACKGROUNDCurrentlythereare24millionpeoplewithdiabetes.Another57millionhavepre-diabetesorhavenotbeendiagnosed.Diabetesasweknowrequireseducationforthepersonwithdiabetestoliveahealthylifeandreducecomplications.WHOVISITSADIABETESEDUCATORType2studybyAADE200659%haveseenaneducator78%ofthosewerereferredbytheirphysicianWhereisthedisconnect?IfaPCPisnotawareofeducationorisfrustratedbybeingabletogettheirpatientsintoaprogram,theywilltrytohandlethediabetesconcernsintheirpractice.Wheredidtheother40%getinformation?Family,friends,magazines,andtheinternet.AADESurvey,4/6-4/14,2006:HarrisInteractivePHYSICIAN/PATIENTPERCEPTIONS83%ofpatientsfeelthattheyareeatinghealthy29%oftheirphysiciansbelievethisnumber77%feelthattheyareexercisingappropriately18%oftheirphysiciansbelievethisnumber55%donotknowtheirA1clevel,havenothaditcheckedorareunsureiftheyhavehadittestedHOWMANYPROVIDERSENVISIONTHEWAYTHEIRPATIENTSSHOULDCAREFORTHEIRDIABETESPatientsProviderACCESSAccesstodiabeteseducationisnecessaryfor:PatientempowermentanddecisionmakingControlofdiabetesFamilyinvolvementProvidersatisfactionPatientsareeducatedtomakechoicesTheyhavetimetodealwithotherissuessinceDSMTisprovidedbyaneducatorESTIMATEDANNUALCOSTSAVINGSFORIMPROVEDA1CUtilizedAHRQtoolwww.ahrq.gov/populations/diabcostcalc680personswithdiabetesacross11centersAverageA1Cimprovedfrom8.1to6.8%Initialtotalcosts(medicalandlostproductivityatA1C=8.1%)=$4,510,300PostDSMEtotalcosts(atA1C=6.8%)=$3,331,000)Estimatedgrossannualsavings=$1,179,300($1,730perpersonwithdiabetes)UtahStateHealthDepartmentOTHEREVIDENCEOFCOSTSAVINGSNationalstudyof18,000low-incomepatientswithdiabetesComparedpatientswithandwithoutDSMEStudyspanned4.7yearsaftercompletionofDSMEThosewithDSMEhadaveragesavingsof$11,571inhospitalchargesoverstudyperiod($2,462peryear)DiabetesCare31(4),April2008KEYPOINTSOFDSMEEvidenceBasedCornerstoneofcareforthosewithdiabeteswhowanttoachievesuccessfulhealthoutcomesNationalStandardsReimbursableFocusesonlong-termmanagementandbehaviorchangestrategiesDATAFROMHEALTHDEPARTMENTUTAHANDNATIONALSUMMARYDiabetesSelf-ManagementEducationisproventoimprovehealthoutcomesandreducemedicalcostsUtahhasprogramsinplace,butthereisopportunityforexpansion,particularlyinruralareasofthestateNationallythesamedatahasbeenshownWhileDSMEisreimbursable,itisnotreadilyavailabletotheuninsuredDOYOURSALTERNATEEDUCATIONOPTIONSWiththeAADEAccreditationprogram,theavailabilitytoprovideeducationinanumberofalternatesites:CommunitycenterChurchHomeClinicALTERNATEEDUCATIONOPTIONSWithoutaccreditationitbecomesmorecreative.OptionsneedtobepresentedtotheclinicastowhyyouprovidingDSMTwillbevaluable.Needtobeawareofcosts,billingandfairreimbursementforyourskillsandtimePerceptionsPHYSICIANPERCEPTIONSEducationprogramsarenotspecificfortheirpopulationsorneeds.Wouldlikepersonalizedfortheirpopulation.Referralsarenoteasy,theremaybeawaitforclasses.(sometimesupto2months).Nofeedbackfromtheeducationprogram.Concernedthatregimensinmedicationwillbechangedwithouttheirinput.Concernedthattheirpatientswillbeencouragedtoseeaphysicianaffiliatedwiththeprogram(stealingtheirpatients).PHYSICIANPERCEPTIONSFeelthateducatorsdonotappreciatethefactthattheyhavetodealwithmultipleconcernsfromtheirpatientandthatdiabetesmaynotbeatthetopofthelist.Whenthediabetesis“undercontrol”theotherissuestakepriority.POSITIVESAppreciatediabeteseducationprogramsthatwerebasedinscientificallyreliablesources.Appreciatepracticalstrategiesthatofferhelpindealingwitheverydayissuesofdiabetescontrol.Doctorsvoiceconcernsaboutdiabeteseducation.(News)Publication:InternalMedicineNewsPublicationDate:15-OCT-06Author:Bates,BetsyEDUCATORPERCEPTIONSFeeleconomicpressuretojustifytheirjob.Feelthereisalackofreasonablereimbursement.Lackofawarenessforthebenefitstheycanprovidetopeoplewithdiabetes.LackofawarenessforthebenefitstheycanprovidetoPCP’s.Needforservicesismuchhigherthanactualdemand.PhysiciansdonotgivetheimpressionthatDSMTisnecessaryDoctorsvoiceconcernsaboutdiabeteseducation.(News)Publication:InternalMedicineNewsPublicationDate:15-OCT-06Author:Bates,Betsyisnecessary.EDUCATORCONCERNSClinicalrecommendationsonmedicationuseandtitrationisnotbeingfollowedbyphysicians.Theregimenisnotchangedwhenthediseasestartstoprogress.Notenoughattentionisgiventolifestyle,dietandexercise.Medicationsgivenmaybetooexpensiveforpatients.Fearofinsulin.TimeinaPCPvisit.Doctorsvoiceconcernsaboutdiabeteseducation.(News)Publication:InternalMedicineNewsPublicationDate:15-OCT-06Author:Bates,BetsyPrimarycarephysiciansoftenjugglethedemandsofseveralhealthconditionswhentreatingpatientswithdiabetes.Theytypicallyopttotreatthemostpressingproblemfirst,whichmaymeandelayinganeededadjustmentindiabetesmedicationsuntilasubsequentappointment.Researchershaveusedtheterm"clinicalinertia"todescribethesituationinwhichprimarycarephysiciansrecognizeaproblembutfailtoactuponit.Thecaseofelevatedglycosylatedhemoglobin,"byDr.Parchman,JacquelineA.Pugh,M.D.,RaquelL.Romero,M.D.,andKristaW.Bowers,M.D.,intheMay/June2007AnnalsofFamilyMedicine5(3),pp.196-201.CLINICMedicalHomeMostpeoplewouldprefertokeeptheircareinoneplace.Astheytrusttheirprovider,thisbecomesa“home”fortheirneedsandcare.IfDSMTisofferedinthisformattheresponseismuchgreaterthaniftheyhadtogoelsewhere.Inastudyonly40%ofpeoplereferredactuallymadeittoeducation.Aswelltheproviderisfullyawareoftheeducationformatandisabletoreinforceonfollow-upvisits.Theaveragevisittotheproviderisonly15minutesandneedstoaddressseveralconcerns.CLINICCONT.Theeducationinthissettingaswellasatraditionaldiabeteseducationsettingmaybedoneindividualorgroup.Theprovideralsohasinputintotheformatoftheeducation(alsoincreasingbuyin)Withthisconcepttheprovideralsohasbetteroutcomes,theseareimportantintodayofPayforPerformance.Theformatandgoalsneedtobedelineatedbytheeducatorworkingwiththeprovider.UtilizationofStandardsofcareisnecessary.AADESALARYSURVEYCompensationPercentilesBaseTotalPayCompensation10thpercentile(10%earnless)$23.92$49,92025thpercentile(25%earnless)$26.68$56,16050thpercentile(50%earnless)$31.20$65,52075thpercentile(75%earnless)$37.00$79,25090thpercentile(90%earnless)$44.85$94,890base:4,183reportingDEProfessionalsAADE2008SalarySurvey–ExecutiveSummaryMARKETINGYouneedtosellyourservicestotheprovider.TheknowledgethatDSMTisimportantmaybesomethingtheyacknowledgebutnotknowhowtoutilize.Youhaveaserviceandtheclinicandthecustomershaveaneed.Thegoalistobringthesetwotogether.MARKETINGIdentify:WhatisavailableinyourareaHowlongdoesittaketogetsomeoneintoDSMTclassesHowfaristhetraveltothenearestDSMTclassesHowmuchdoesitcostProviderswhohaveshownaninterestinhavingeducationavailablefortheirpatients.MARKETINGBuildaplan:WhatdoyoubringtothepracticeWhyshouldtheywanttohireyouinsteadofsendingtheirpatientstoanexistingprogram.WhatwouldbetheconcernsspecifictothispracticeHowwillyouidentifyqualityassuranceandtrackingHowwillyougetpaidSalary;theproviderisinvolvedandbillsforservices*Salary;andtheproviderisdealingwithcostAreyouAADEAccreditedandwillbeeitherbillingthepatientorwilltheclinicbillforyouSALARYISSUESSalary;theproviderisinvolvedandbillsforservicesMedicalGroupvisits.Typicallywhentheprovider,Physician,NursePractitionerorPhysicianAssistantisinvolvedintheclass.Aclinicvisitisbilled,chartsarereviewedforneededimmunizationsandlabs.Thepersonhasvitalsigns,weight,immunizationsandlabsdone.Theclassistaughtbyadesignatedinstructor,CDE,PCP,DieticianorPhysicalTherapist.DocumentationisintheclinicchartandbillingisdonebytheClinic.OPTIONSTOPRESENTTOTHECLINICHiringyouwouldallowtheirpatientstoaccessdiabeteseducationinatimelymannerTheywouldhaveinputintotheclasses,especiallysincetheyunderstandthecultureoftheirpractice.Theywouldnothavetospendtimeorignoreondiabeteseducation,allowingthemtoworkwithalloftheconcernsoftheirpatients.Theywouldknowwhatisbeingtaughtsoitcanbereinforcedorquestionshandledintheregularappointment.►TIPOnlyDSMTprogramsthathavesubmittedtheirCertificateofRecognitionfromtheAADE,ADAorIHSMaybillMedicareforDSMTservices.Otherpayersmightnotrequirethis,assuminganypracticethatbillsusingDSMTservicecodesG0108orG0109hasacertificate.WhileMedicarewillcoverMNTthatisprovidedbyaRDornutritionprofessionalwhomeetsspecificrequirements,otherpayer'scoveragemayextendtonutritionservicesprovidedbyadiabeteseducator.HCPCSLevelIIGCodesCodeSummaryTimeG0108Diabetesoutpatientself-managementtrainingservices,individualEach30minutesG0109Diabetesoutpatientself-managementtrainingservices,groupsession(twopersonsormore)Each30minutesG0270MNT,2ndreferral,sameyear,individual,face-to-facereassessmentandsubsequentintervention(s)Each15minutesG0271MNT,2ndreferral,sameyear,group;reassessmentandsubsequentintervention(s)Each30minutesTheMedicarePhysicianFeeSchedule(PFS)liststhefeesthatMedicarewillpayforservicesbasedonlocalitiesandprocedurecodes.Allprovidershaveaccesstotheirlocalcarrier'sorFI'swebsitesandcanlookupthisinformationunderProviderPricing.ThePFSisupdatedannuallybyCMSandtellsproviderswhatMedicareallowsinpaymentforservicestobothparticipatingandnon-participatingproviders.AnexampleofthisisoneMedicarePartBCarrier's2007PFSforDSMTservicesperunitof30minutesoftime:80%oftheAllowedAmountMedicareactuallypays80%oftheallowedfeeandtheremaining20%isthenbilledtothepatientortheircoinsurance(minustheunmetdeductible).Forparticipatingproviders,anychargebeyondwhatMedicareallowsmustbewrittenoffasapayercontractadjustment.ProcedureCodeParAmountNon-ParAmountLimitedChargeG0108$31.77$30.18$34.71G0109$18.44$17.52$20.16StrategiesandMethodologiesinPricingFees(whatcontractedcommercialpayerswillpayyou)areoftendeterminedbytheprocedure'sRVUnumbermultipliedbyaconversionfactor.Theconversionfactoristherateoranumberthattakesintoaccountsuchthingsas:theregionorlocationofyourfacility;thehealthcaremarket;previouscontractpricingwithpayers;andthequalityofcarethatpayersreportyourfacilityprovidestotheirinsured.AnexampleofsettingpricingforDSMTserviceswiththismethodologyis:Code:CMS'sRVUConversionFactorPrice/ChargeG0108.84(perunitoftime)x70=$59G0109.49x70=$34CPT®CodesthatMayBeAcceptedbyPrivateInsurersCPT®CodeSummaryTimeDiabetesSelf-ManagementEducation/Training98960*Educationandtrainingforpatientself-managementbyaqualified,non-physicianhealthcareprofessionalusingastandardizedcurriculum,face-to-facewiththeindividualpatient(couldincludecaregiver/family)Each30minutes98961*Educationandtrainingforpatientself-managementfor2–4Patients30minutes98962*Educationandtrainingforpatientself-managementfor5–8Patients30minutes97802**97802Medicalnutritiontherapy;initialassessmentandintervention,individual,face-to-facewiththepatient,Each15minutes.Thiscodeistobeusedonlyonceayear,forinitialassessmentofanewpatient.Allsubsequentindividualvisits(includingreassessmentsandinterventions)aretobecodedas97803.AllsubsequentGroupVisitsaretobebilledas97804.97803**97803Re-assessmentandintervention,individual,face-to-facewiththepatient,Each15minutes.Thiscodeistobebilledforallindividualreassessmentsandallinterventionsaftertheinitialvisit(see97802).Thiscodeshouldalsobeusedwhenthereisachangeinthepatient’smedicalconditionthataffectsthenutritionalstatusofthepatient.97804**97804Group(2ormoreindividual(s)),Each30minutes.Thiscodeistobebilledforallgroupvisits,initialandsubsequent.Thiscodecanalsobeusedwhenthereisachangeinapatient’sconditionthataffectsthenutritionalstatusofthepatientandthepatientisattendinginagroup.BillingforEvaluationandManagementIfaphysicianprovidesservicestopatientswithdiabetes,his/herpracticecanprovidediabeteseducation/training,someofwhichmayrelatetoevaluationandmanagement(E&M).TherangeofHCPCScodesforE&Mservices,99211–99215(establishedpatient)and99201–99205(newpatient),describeaphysician-patientencounterfortheevaluationandmanagementofapatient’scondition(s).Patienteducationandcounselingarecomponentsoftheservicesdescribedbythesecodes.TheE&Mcodesarefurtherdefinedbylevelsthatclearlyarticulatetheintensityofservicesprovided.►TIPDiabeteseducationprovided‘incident-to’aphysiciansplanofcarebyancillarystaffinaclinicsettingthatisnotadepartmentofahospitalmayqualifyforreimbursementusingCPTcode99211.DeterminingDSMTFeesFormostDSMTprograms,thefacility'scontracting/payerrelationsdepartmentnegotiatesallfeeswithcommercialpayers,includingDSMTfees.Thefacility(hospital,clinic,ordoctor'soffice)annuallydeterminespricingfortheirservicesorproceduresbysettingpricesjusthigherthanwhattheirbestcommercialpayerpaidthepreviousyear.Prenatal,Obesity,orDiabeticInstruction99078*Physicianeducationalservicesrenderedtopatientsingroupsetting(prenatal,obesity,ordiabeticinstruction)CheckwiththeinsurerToolsforDiabetesEducation/TrainingTheAADEDiabetesServicesOrderFormisdesignedtobeaneasyandconvenientwayforaphysicianoraqualifiednon-physicianpractitionertorefertheirMedicarepatientswithdiabetestoadiabeteseducatorforDSMTandtoaRDforMNT.ThereferralformmaybeusedbyanyfacilityorhealthcareprofessionalandincludesthekeyreferralinformationrequiredtomeetMedicareregulatoryrequirementforMNTandDSMTreferrals.Theformisavailabletothepublicatthefollowingwebpage:http://www.diabeteseducator.org/ProfessionalResources/Library/ServicesForm.htmlAnon-demandwebcastonreimbursementandthisdocumentareavailablefreeat:https://www.diabeteseducator.org/ProfessionalResources/products/view.html/target=40&sub1=ONLRESOURC&sub2=Online.Morein-depthinformationonreimbursementisavailableinAADE’sOnlineReimbursementGuideforDiabetesEducators,availableatthefollowingwebpage:http://www.diabeteseducator.org/ProfessionalResources/products/SelectOnlineResources.NAVIGATINGTHEMAZEPhysician-BasedProgramsAADE’sReimbursementResourcesNavigatingtheMazeisaseriesofbooklets•HospitalOutpatientPrograms•Physician-BasedPrograms•Independentor/FreestandingPrograms•Pharmacy-BasedProgramsReimbursementTipsforPrimaryCarePracticeThisBookletcovers•GettingStarted•Referrals•Documentation•Billing&DistributionofFunds•OpportunitiesandChallengesDiabetesEducationServices:AMA’sCPTbookprovidesfurtherdetailsaboutCPTcoding.ToolsforPhysiciansIfyouwouldliketofindadiabeteseducatorinyourcommunity,useourFindanEducatortool,whichisavailableat:http://www.diabeteseducator.org/DiabetesEducation/Find.htmlhttp://www.diabeteseducator.org/Public/Join_Information.htmlAdditionaltoolsforphysicianswhoareinterestedinlearningbestpracticescanbefoundatthefollowingwebsites:·InstituteforHealthcareImprovement(IHI):http://www.ihi.org/ihi·TheCentersforDiseaseControlandPrevention(CDC):http://www.betterdiabetescare.nih.gov/·MedicareLearningNetwork(MLN)http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM3185.pdfDiabetesEducationServicesReimbursementTipsforPrimaryCarePracticeRevisedMay2009WHATCANYOUDOTOSTART??????BuildanetworkofeducatorswillingtoworkinPCPclinic’s.(DatingserviceforDSMT)Promoteyourservicestothemedicalcommunity.Presenttheideainworkshops,letters,andtoPCP’sthatyouknow.Theideamayneverhaveoccurredtothiscommunity.Knowwhatthebillingisinyourarea,CPTcodesandallowablefees.GetyourselfAADEAccredited!!!!PersevereSUMMARYPuttingDSMTintoaformatthatisaccessibletoyou,thepersonwithdiabetesandthePCPisachallenge.YourjobistomeetthischallengeandprovideoptionsforallTheideaofalternativesforDSMTisandideathatislongoverdueThankyouforparticipatingPuttingDiabetesEducationinPrimaryCareReminder:TakethePost-Testathttps://www.surveymonkey.com/s/utahdiabetes_oct2011_posttest