Special Guest Blog from Hope Warshaw, MMSc, RD, CDE, BC-ADM, Owner, Hope Warshaw Associates, LLC, Alexandria, VA, and Immediate past AADE member Board of Directors
On March 13, 2014, I had the privilege of representing AADE on Capitol Hill for a congressional briefing presented by the Health IT Coalition (link), of which AADE is a member. The goal of this briefing, The State of Technology Enabled Care, was to highlight the need for modernized telemedicine regulations. Other panel members were a Parkinson’s patient using telehealth with a distant provider and a psychiatrist who’s used telehealth for a decade. View an abridged version of the briefing.
The following summarizes my key points. Read them in their entirety here. Also, consider reading Update Health IT Policy Now, an article by Joel White, executive director of HealthITNOW published in Roll Call.
- To offer examples of the use of novel communications in diabetes care I shared my experiences as an online weight management coach using a research-based intensive lifestyle intervention based on the Diabetes Prevention Program (DPP) with a population of people with and at risk of diabetes and weight related diseases. I also shared my experience as an insulin pump trainer and diabetes educator working with intensively managed clients virtually. I reinforced the point that research continually demonstrates that frequent clinician interaction with patients, including with a diabetes educator, increases successful outcomes.
- I reviewed key statistics: the numbers of Americans with diabetes, according to CDC estimates, and the American Diabetes Association estimates for diabetes-related cost expenditures. I then emphasized that research shows providing people with Diabetes Self-management Training (DSMT) can bend the healthcare cost curve.
- I described DSMT in detail including the common settings, the National Standards, accrediting bodies and Medicare reimbursement. I mentioned that CMS has recognized significant underutilization of the DSMT benefit and due in part to this factor has added DSMT to the list of available telehealth services.
- I then segued to the point that delivering DSMT using telehealth should be a natural evolution of healthcare delivery innovation noting it could address some of the hurdles people with diabetes currently have obtaining DSMT in person.
- I provided the three common sense actions AADE is encouraging Congress to consider to embrace teleheath and bring healthcare delivery into the 21st century:
1. Remove the geographic and provider barrier limitations. Today, under current law, Medicare can only reimburse DSMT delivered using telehealth for beneficiaries located outside city limits or in areas with a provider shortage. For people to make the critical and permanent healthy behavior and lifestyle changes they need frequent and continuous support. House bill (HR 3077) would help remove some of these barriers by facilitating interstate licensure for health care providers.
2. Remove the limitation of the physical setting for delivery. Today the list of sites where a service such as DSMT can be delivered via telehealth is a physician’s office, a hospital and a limited scope of other named facilities. Congress needs to widen the scope of approved venues for delivery of DSMT by telehealth.
3. Add federally qualified diabetes educators to the current list of practitioners for telehealth services. I requested support for our legislation, the Access to Quality Diabetes Education Act of 2013 (HR 1274/S 945)
I concluded by noting these three measures are what AADE members believe are very cost effective and efficient changes in telehealth regulations. These changes could increase utilization of DSMT which in turn could prevent and delay the costly complications of diabetes and improve the long term health and productivity of people at risk for and with diabetes.