AADE e-Advocacy Newsletter
November 2009
Invest in your Future – Keep the Momentum Moving

Exciting news, the Affordable Health Care for America Act (H.R. 3962) passed by the House of Representatives includes the CDE provision to improve access to diabetes self-management training (DSMT) by designating all certified diabetes educators as certified Medicare providers for purposes of outpatient diabetes self-management training.

Why do we say exciting? Because having CDE’s designated as a certified provider of DSMT is critical to raising the visibility and value of diabetes education and positioning its role in the changing landscape of health care.

The Minnesota Department of Health in collaboration with our local AADE chapter, Minneapolis/St. Paul Diabetes Educators, recently completed an independent survey to assess the scope of service reductions, if any, and to determine the potential impact on diabetes care. The findings confirm the changes we are seeing and the concern for ongoing care for people with diabetes: education programs are having to do more with less; many are seeing reductions in staff; longer wait periods for patients; decreased access to services; increased reliance by providers to assist in managing their patients and poor reimbursement which only fosters further program reductions. Reality and tough to read, yes! Yet, what appears to be the end may just be the beginning. How can we maximize the moment?

Right now, it is more important than ever to contact your Senator and ask that they support the CDE language in the Senate version of the Healthcare Reform Bill. Don’t count on someone else doing it for you. The future of your skills, as qualified diabetes educators, being utilized to meet patients’ needs is dependent on you taking action now! If you have done so already – thank you. Keep the momentum moving and engage others to offer continued support.

If you haven’t sent that email or made that phone call yet, spend five minutes reading and thinking about the information below. Then, determine your response.


Thoughts to Ponder

Actions to Consider

No Time. I have patients to see, charting to do, meetings to attend.

Diabetes educators have been on a treadmill for years, 10 hour days trying our best to meet multiple demands – has it paid off?

Stop! Take time to send an email. Tell your story and why increasing access is important.  Share outcomes and your value to patients. 
Use your skills, right now, to make a greater impact for patients in the future.

DSMT payment is inadequate – focusing there first versus getting CDE legislation passed.

You’re right but doing so is perceived as self-serving and it is not the next step. Can you imagine legislators responding to this request in this economy?

Improve access first to broaden our reach and further build the evidence to demonstrate the value of adequate reimbursement.

Why bother with having CDE’s as providers? We have payment already under our medical director. 

Think beyond your current scope.

Think new opportunities. Doors will open. You may wish to accept payment direct or you may be able to assign payment to other entities. 

The cost of co-pays and the fact a growing number of patients are without insurance is causing a decline in referrals. How will CDE as provider help?

Health care reform has renewed emphasis on quality.

CDE’s becoming providers enhances your visibility and strengthens your position as a key player.

Pay for performance is catching on even Medicare is beginning to pay for quality.  Organizations and small physician practice groups are beginning to position for success.

Pharmacy studies have shown great results with no co-pays or charge for educ. CDE’s could do the same. We need to replicate! 

Seek opportunities for pilot-projects to demonstrate the value of the CDE.

Think how the CDE role can support the medical home concept

NP’s and PA’s can provide education billing E & M codes as counseling and getting paid at much higher levels than the DSMT  G codes.

It’s true, payment is higher, and, there may be perceived value by the patients.

Yet, is this the best use of their time?

Will they still be expected to see all types of patients?

How will they maintain their expertise and stay updated on new approaches to management?

With the growing shortage of primary care providers, is this the best use of an NP or PA’s   skills?

Will this approach be the best ROI for their time?

Could the role be better filled by CDE’s or CDE’s being a liaison to medical home coordinators?

Why bother?
Diabetes educators may be taking a short-term view. 

Note, AADE has surveyed diabetes educators – our mean age is 54 years.  
Diabetes educators are known to be facilitators of change.  This is no time for apathy. 

CDE Provider Status:

Increases awareness of the value of CDE’s and DSME which, in turn will…

Attract new health professionals to the role of the CDE…

Fostering oversight and providers of quality diabetes education and care.

Take action by:

1. Going to the AADE Advocacy website 

2. Follow the simple steps to send an email to your Senators –it will send the email direct to your Senators with no need for you to look for their email address; there is a template there for you to use or you can tailor it to develop your message.

3. It takes no more than 5 minutes. Doing so may ensure your ability to continue to do what you love most – making a difference in the lives of people with diabetes.

Jan Pearson, BAN, RN, CDE
Incoming AADE Board Member
Member, 2009 AADE Advocacy Committee
Sr. Consultant
International Diabetes Center
Comments: janice.pearson@parknicollet.com


CDE Legislation Updates and Alerts

The CDE provision, which was included in the Senate Finance Committee (SFC) version of health care reform, has been omitted from the final 'merged' bill between SFC and the HELP Committee. We are told this is not due to any policy concerns or opposition to this provision by any Senator.

Instead, it has been erroneously assumed by some that the provision may not be essential to the provision of DSMT care.

It is extremely urgent that you contact your Senators now and express your serious concern, and to request that the CDE provision be inserted into the Senate bill. In addition to sending an email, we encourage you to call Senate offices.

Silence on the part of AADE members indicates that we agree with the assumption that the CDE provision is not a vital part of health care reform. With the Senate poised to take up the health care bill, time is of the essence to weigh in.

AADE will continue to monitor the progress of this legislation as it moves through Congress and communicate that to membership as needed and available. Our efforts are not done yet so what we need from AADE members and supporters is to continue to take action by sending letters to your Senators and ask that they support the CDE language in the Senate version of the Healthcare Reform Bill.

Let your Senator know the importance of including the CDE provision in the final Senate healthcare package.

You can do so by clicking here.

The U.S. House of Representatives, recently, passed the Affordable Health Care for America Act (H.R. 3962) that includes the CDE provision to improve access to diabetes self-management training (DSMT) by designating all certified diabetes educators as certified Medicare providers for purposes of outpatient diabetes self-management training services.

Below is an updated listing of all co-sponsors for AADEs legislation H.R. 2425: Medicare Diabetes Self-Management Training Act of 2009

Rep DeGette, Diana [CO-1] Introduced 5/14/2009
Rep Castle, Michael N. [DE] - 5/14/2009
Rep Kirk, Mark Steven [IL-10] - 5/14/2009
Rep Becerra, Xavier [CA-31] - 5/14/2009
Rep Space, Zachary T. [OH-18] - 5/14/2009
Rep Young, Don [AK] - 6/17/2009
Rep Terry, Lee [NE-2] - 6/17/2009
Rep Moore, Dennis [KS-3] - 6/17/2009
Rep LoBiondo, Frank A. [NJ-2] - 6/24/2009
Rep Sestak, Joe [PA-7] - 6/24/2009
Rep Paulsen, Erik [MN-3] - 6/24/2009
Rep Boucher, Rick [VA-9] - 6/26/2009
Rep DeFazio, Peter A. [OR-4] - 6/26/2009
Rep Latham, Tom [IA-4] - 7/8/2009
Rep Sarbanes, John P. [MD-3] - 7/9/2009
Rep Welch, Peter [VT] - 7/9/2009
Rep Farr, Sam [CA-17] - 7/15/2009
Rep Wolf, Frank R. [VA-10] - 7/15/2009
Rep Connolly, Gerald E. "Gerry" [VA-11] - 7/22/2009
Rep McMorris Rodgers, Cathy [WA-5] - 7/30/2009
Rep Paul, Ron [TX-14] - 9/9/2009
Rep Wu, David [OR-1] - 9/9/2009
Rep Murphy, Patrick J. [PA-8] - 9/14/2009
Rep Lofgren, Zoe [CA-16] - 9/14/2009
Rep Scott, David [GA-13] - 9/25/2009
Rep Speier, Jackie [CA-12] - 10/6/2009
Rep Lowey, Nita M. [NY-18] - 10/6/2009
Rep Green, Gene [TX-29] - 10/6/2009
Rep Lance, Leonard [NJ-7] - 10/22/2009
Rep Chandler, Ben [KY-6] - 10/22/2009
Rep Delahunt, Bill [MA-10] - 10/22/2009
Rep Grijalva, Raul M. [AZ-7] - 10/29/2009
Rep Lewis, John [GA-5] - 11/18/2009
Rep Edwards, Donna F. [MD-4] - 11/19/2009


Chapter Legislative Coordinator Spotlight

This month AADE Advocacy is spotlighting Jenifer Janetski, RD CDE, the Chapter Legislative Coordinator from the Montana Chapter of Diabetes Educators (MAADE). Jennifer and her fellow constituents and peers were instrumental in obtaining Senator Baucus' support of the CDE legislation language to be included in the Senate Healthcare Reform Bill.

Jennifer, how did you get interested in becoming a CLC?

I have been the CLC for the past 2 years, I never had done anything like this before, but I was asked by the prior legislative chair and she was encouraging and would not take no for an answer.

How did you manage to convince Senate Baucus of the importance of this legislation?

My father and Senator Baucus had worked together on issues with the timber industry in Montana. This was a good way for me to get my foot in the door. It is important to use any connection you may have in order to get your legislator’s attention.

What strategies did you use?

I met with the past legislative aide of Senator Baucus, Rebecca Manna, who is now working as the government affairs person for Kalispell Regional Medical Center. She was very helpful in offering some helpful tips.

  • Inform the legislator’s office that you have been appointed to the position of Chapter Legislative Coordinator for the American Association of Diabetes Educators – this gives you credibility and you are now the expert he/she will call on
  • If you have personal connections to the legislator use that as a way to contact the Senator or Congressman directly
  • Acquire your state statistics on diabetes – gather diabetes facts, statistics these may be found at the CDC state diabetes control program
  • When having your conversation with the legislator it is important to provide both the up and the down side to the bill
  • Get your chapter members engaged in the process and encourage them to think about a way to personalize their communications by telling a story or providing an example of how they made a difference.
  • Be sure to thank your members for their support

Had you ever had experience with advocacy prior to you taking the CLC position for your chapter?

No, this was the first time I had ever done anything like this. I had to learn a lot. There is good information on the AADE Advocacy website and I spent time on the phone with James Specker from AADE and Debra Outlaw who works with Martha Rinker, our Advocacy officer. They were very helpful in providing information on how the legislative process works and how to advocate for our cause.

They also provided contact information for the health legislative aide, it is important that you are in contact with the correct person in the office. I also learned a lot attending the AADE Public Policy Forum in June 2009.

How did you get your chapter involved in this effort?

It is important to do your homework. I established a committee to help and tried to have someone from each part of the state involved. Montana has only one chapter and we only meet once a year so I created an email list and a phone tree so I would be able to contact everyone quickly if we needed to respond to an issue or a request. I also made contact with key people in the state; we have a CDE involved with the Diabetes Project so she was instrumental in providing detailed statistics on how diabetes affected residents of Montana.

At our yearly meeting we had 80 members attend and I was on the agenda to explain about the legislation and why it is so important to us. I really tried to stress to members that no one else was going to fight for this legislation but us and we needed to brag about our efforts as we do make a difference. I was able to get members to sign a note to Senator Baucus encouraging him to keep the HR 2425 language in the Health Care Reform bill at the meeting and sent the print version to James to have included.

I also send out emails informing our members of what is happening and what we need. I encouraged feed back on my emails as to who contacted their senator and will plan to have a read receipt on the next set of emails I send, since this will help our members further understand the importance of responding to legislative issues.

I provided a template of a sample letter or email and the contact information of all the legislators. I also provided some talking points and encouraged them to take what had been provided and make it their own personal message. I also asked members to consider other organizations that may support our cause. I think it has been the support shown by our Montana members that ensured Senator’s Baucus’s support. Our members were very responsive in communicating with his office.

Jennifer, do you have any other words of wisdom to share with other CLC’s?

It is important to realize you can make a difference. When I took this position, I spent time thinking about what I saw as important for the residents of Montana regarding diabetes education. Also there is good information available that will help you be a better CLC – sign up for advocacy alerts from ADA and other healthcare organizations in order to stay informed, the New York Times, Healthcare section is worthwhile reading online. Thomas.gov website is a way to track progress of which legislators are co-sponsors and list all legislation submitted. Go to the CEO of your organization and ask them to write a letter of support, you are an asset to your organization, it is important that they support your efforts. Be consistent, it is the squeaky wheel that gets the attention, be the squeaky wheel.

I would like to thank my committee for all the help they have offered - Lisa Ranes, RD CDE, Karrie Fairbrother, RN CDE and Susan Garnic, RD CDE. Two other people are Marci Butcher, RD CDE who is with the Montana Diabetes Project and Helen Amundson, RN CDE who is a past president of MAADE and always is making contact with our congressmen. She works at a community Health Center in the State capitol.

Interviewed by Kathy Gold, RN MSN CDE, Chair, 2009 AADE Advocacy Committee


Mississippi "Health First" Collaborative Project

In 2009, Mississippi was ranked number one in obesity in the U.S. for the fifth straight year by the Robert Wood Johnson Foundation and the Trust for America 's Health. Mississippi has a diabetes prevalence rate of 11.3% as opposed to 8.2% nationally.

CMS is heading up a collaborative (Health First) to address this problem. The goal is to provide increased access to diabetes education for people in Mississippi.

The American Association of Diabetes Educators (AADE) is honored to be a partner in this critically important initiative, along with an impressive list of stakeholders, and stands ready to support the effort in any way that we can.

AADE is particularly supportive of the program’s aim of increasing access to diabetes education and the services of diabetes educators because we know that relationship is the key to a patient’s successful management of their diabetes.

Not only is providing diabetes education the right thing to do, but diabetes education has been proven to lower average health care costs, improve clinical outcomes and reduce the need for costly health care associated with diabetes-related complications.

In fact, AADE just completed a study that showed that Medicare patients who participated in diabetes education cost the healthcare system 14 percent less than those who didn’t participate.

We are in the process of recruiting diabetes educators throughout Mississippi to participate in the program so that we can ensure the maximum number of Mississippians achieve optimal health status and a better quality of life with their diabetes.

AADE is also looking to recruit educators throughout Mississippi and the surrounding counties in other states to establish accredited DSME/T programs that can serve the people of Mississippi. We also would like to ensure that all local and surrounding diabetes educators are informed about the program and opportunities for them to participate in it. 


Administration on Aging (AoA)
American Association of Diabetes Educators (AADE)
Centers for Medicare & Medicaid Services (CMS)
Health Resources and Services Administration (HRSA)
Housing and Urban Development (HUD)
National Association of State Health Policy (NASHP)
National Institutes on Health (NIH)
Office of Minority Health (OMH)


Health News Spotlight

AADE Advocacy is spotlighting an article from the Kaiser Health News website.

The article, written by Frank Browning on Novemeber 13, 2009, can be found here.