AADE has been a National Accrediting Organization of diabetes self-management education and support (DSMES) programs for seven years and has received successful audit outcomes from CMS in each of these years, including a full six-year renewal in 2015.
Application Trends for 2016
As of December 31, 2016, AADE’s Diabetes Education Accreditation Program (DEAP) has accredited 783 programs at 1,951 sites. In 2016 alone, we added 147 programs and renewed 73. As for trends, we have seen a steady growth in pharmacies, hospitals and physician offices.
Unfortunately, we have also seen more than 100 programs close. The most common reasons for these closures were a lack of reimbursement and lack of referrals. In response to this, AADE has created a live workshop, Reimbursement Boot Camp to assist programs with these struggles.
AADE Site Audit Results for 2016
Audits are never an easy thing, but AADE strives to make the audit process as stress-free as possible. We utilize program coordinators and experts in the field to provide face-to-face audits. This makes it more of a peer-to-peer experience, and program coordinators have a captive audience who are able to offer guidance and support. We audit 10 percent of our programs on an annual basis, with a cap at 70 programs. In 2016, we conducted 70 total audits (65 annual and five initial). Here are the results:
- All five initial audits passed.
- Of the 65 annual audits:
- 41 passed on the first attempt.
- 16 passed after correcting minor details that were missing. The most common issue was not having their patients’ bill of rights or patients’ concerns posters posted.
- Three refused the audit request due to program closure (without having notified AADE) and are no longer accredited.
- Five annual audits had major deficiencies:
- Four passed after submitting additional supporting documents.
- One did not pass the audit because the program did not submit the missing supporting documentation by the required date.
- Most common issues among these five include:
- Insufficient charting, particularly a support piece for patients who have completed their program.
- Lack of advisory board meetings.
- Missing CEs for program coordinators/instructors.
2016 Clinical Data Outcomes
Every year our programs submit an annual status report that gives us a unique look into each program. Collectively, the 614 DEAP programs that submitted Annual Status Reports in 2016 saw 182,489 diabetes patients. Some of the aggregate clinical and behavioral outcomes are detailed below.
- HbA1C: 577 programs tracked A1C. The pre-DSMES average A1C across these programs was 8.6, and post-DSMES average A1C was 7.3.
- Blood Pressure: 269 programs tracked blood pressure. The pre-DSMES average blood pressure across these programs was 127/78, and post DSMES average blood pressure was 123/73.
- BMI: 325 programs tracked BMI. The pre-DSMES average BMI across these programs was 33.7, and post-DSMES average BMI was 32.7.
- Foot Exams: 311 programs tracked foot exams. Pre-DSMES, 9,725 patients received foot exams, and post-DSMES, 10,754 patients received foot exams, for a total of 20,479 patients.
- Dilated Eye Exams: 318 programs tracked eye exams. Pre-DSMES, 10,827 patients received eye exams, and post-DSMES, 9,489 patients received eye exams, for a total of 20,316 patients.
2017 Behavioral Goal Outcomes
- Healthy Eating: 599 programs had patients who selected Healthy Eating as a behavioral goal; 76% of these patients reported success with this goal.
- Being Active: 571 programs had patients who selected Being Active as a behavioral goal; 67% of these patients reported success with this goal.
- Monitoring: 566 programs had patients who selected Monitoring as a behavioral goal; 77% of these patients reported success with this goal.
- Taking Medications: 527 programs had patients who selected Taking Medication as a behavioral goal; 74% of these patients reported success with this goal.
- Reducing Risks: 509 programs had patients who selected Reducing Risks as a behavioral goal; 63% of these patients reported success with this goal.
- Problem Solving: 431 programs had patients who selected Problem Solving as a behavioral goal; 60% of these patients reported success with this goal.
- Healthy Coping: 466 programs had patients who selected Healthy Coping as a behavioral goal; 60% of these patients reported success with this goal.
Unique insights into our programs gives us the ability to share best practices, lessons learned and issues with which programs struggle. We often develop workshops based on insights gained from audits. It is also good to share these common themes because you are not alone.
Best practices identified by program coordinators:
- Flexible scheduling based on patient needs
- Contact in-between appointments, even if not reimbursable
- Expanding programs into other services (CCM, DPP, Insulin pump training, etc.)
- Measuring provider and patient satisfaction
- Building relationships within the community to help support patients
Issues and barriers noted during accreditation process and/or with certified entities:
The biggest program barrier identified by program coordinators remains reimbursement. Programs struggle with coding and provider type. AADE hosts at least two webinars a year on reimbursement, and recently developed a Reimbursement Boot Camp for 2017.
Other program barriers include:
- Pharmacies still have issues with the Medicare Administrator Contractors (MAC) while applying to be providers of DSMT. Oftentimes this takes up to nine to 12 months.
- MACs misinterpreting reimbursement. In 2016, we had several issues that needed to be brought to Medicare.
- The 2017 Physician Fee Scheduled opened the door to discuss the low-utilization rate of the DSMT benefit. Medicare did not make adjustments in the November final rule. We have had several calls with Medicare and hope to see more in the 2018 Physician Fee Schedule.
Barriers or issues during the application process:
- Continuing education submission: This is often missed during the application process.
- Community Health Workers (CHW): There is confusion on how to best train CHWs. AADE now has a Level 1 certification program that programs can use to train them about diabetes.
- Properly using the Educational Record Review to provide a thoroughly documented de-identified patient chart.
We have many exciting opportunities coming throughout the rest of 2017. AADE recently hired Jodi Lavin-Tompkins, MSN, RN, CDE, BC-ADM as the Director of Accreditation in the DEAP department. She comes to us with extensive experience with AADE accreditation, as she was previously a program coordinator at one of our largest programs with 25 branch locations. Learn about all the diabetes education and prevention workshops that are focused on supporting programs.
Please do not hesitate to reach out to the DEAP department at DEAP@aadenet.org with any questions. Our staff Jessica Hunter and Magdalena Biedron are always willing to help.
I would be remiss if I did not thank you for all you do every minute of every day to enhance the lives of the people at risk for and with diabetes. Thank you!