Learn how to handle common objections to community-based offerings of Diabetes Self-Management Training.
The Medicare Diabetes Self-Management Training (DSMT) benefit presents an opportunity for community-based organizations to partner with health care systems to offer evidence-based diabetes self-management education (DSME) for older adults and adults with disabilities. While there is a great need for DSME due to the high prevalence of diabetes, it is not uncommon for health care systems to object to having a community-based organization provide the DSMT benefit. Learn how to handle these objections to increase access to and use of this important benefit.
1. All of the physicians in my community already have a diabetes self-management education and support (DSMES) program as part of their practice.
Only accredited DSMES programs can be reimbursed under the DSMT Medicare benefit. There are two nationally recognized DSMES accreditation programs – American Diabetes Association (ADA) and Association of Diabetes Care & Education Specialists (ADCES). If you review the list of accredited programs, you will see very few private physician practices listed as having an accredited diabetes self-management education and support program.
2. Everyone in my community that has diabetes has probably already received the DSMT training benefit.
The ADCES conducted an analysis of Medicare claims data, going back ten (10) years. Over this period of time, they looked to see how many Medicare beneficiaries with a known diagnosis of diabetes also had claims history for receiving their ten (10) hour DSMT benefit. The analysis showed that of the entire population of beneficiaries with a known diagnosis of diabetes, only 1.5% had used their ten (10) hour DSMT benefit. This means that 98.5% had not received their ten (10) hour benefit.
3. Why should we work toward getting reimbursement for DSMT when we can have as many grant funded classes as we need? Let’s just continue referring to all of those as “free” classes, like before.
It is true that we have provided grant funded classes in the past. However, these classes were only free to the participants. There are defined costs for us to deliver the program, including personnel costs, organizational costs, and material expenses. These expenses were covered by a time-limited grant that our organization received. Unfortunately, grant funding is not guaranteed nor is it a permanent funding source. Therefore, we must seek alternative funding to continue providing the classes in our community. Without alternative funding, we will not be able to provide classes as we have in the past.
4. Since the community-based program uses lay leaders, it will not meet the accreditation requirements.
The current ten (10) National Standards for Diabetes Self-Management Education and Support formally recognize the contribution of lay leaders and community health workers in the delivery of DSMES. The contribution of lay leaders and community health workers has been noted as particularly valuable when addressing the needs of high-risk beneficiary groups, such as older adults and persons with disabilities.
5. With all of the new drugs and treatments for diabetes, DSMES is not as important as it once was in reducing complications related to diabetes.
Diabetes continues to be the number one cause of renal failure in adults, adult-onset blindness and non-traumatic lower limb amputation. Complications related to diabetes are actually increasing as the number of people with diabetes continues to rise, and self-management education is critical to reducing these complications and improving health outcomes.
6. The Self-Management Resource Center (SMRC) program model is not an acceptable program model to submit for accreditation.
The SMRC Diabetes Self-Management Program (DSMP) model is one that can meet the ten (10) National Standards for Diabetes Self-Management Education and Support, as long as some additional components are added in a manner that maintains fidelity of the SMRC model.
7. Reimbursement for DSMT is provided only for completers of the program.
DSMT is reimbursed under a fee-for-service model. As a fee-for-service program, a provider of DSMT is reimbursed for the services that are rendered. Therefore, if a person only comes to one class, the provider can bill and be reimbursed for providing services to the beneficiary during the one class that they attended. It is not a requirement that the consumer attends all six (6) sessions, or even a majority of sessions, for payment to be rendered.
8. A referral is required to attend a DSMT program. This referral can be provided by the beneficiary’s designated Medicare primary care provider.
Medicare beneficiaries are not restricted to receive services only from their primary care provider. They have the option of obtaining services from any eligible Medicare provider. As a result, any qualified Medicare provider can complete the referral for DSMT.
This project was supported, in part by grant number 90CR2001-01-00, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.