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How to make the most out of group education classes

May 26, 2015

For my first post, I decided to write about a familiar subject to me and to a number of diabetes educators--group education classes.

Currently, I’m enrolled in a Doctorate in Nursing Practice program at the University of Texas Health Science Center at Houston.  As part of the graduation requirements, I needed to implement a performance improvement project. I was interested in implementing DSME in the primary care setting but faced the challenges of making the program financially viable and sustainable.

Unfortunately, I don’t have much success convincing patients to attend DSME classes at the local outpatient diabetes program and the ones who do attend usually do not want to return for various reasons. Last August, I attended the Johnson & Johnson Diabetes Institute where I learned about the role of Shared Medical Appointments (SMA) in providing diabetes education. SMAs are also known as group medical appointments or group visits. I conducted a review of the literature to learn how other programs have been successful in implementing SMA. I was surprised to find several individuals had been successfully conducting SMAs to manage many chronic conditions.

So, for my project, I decided to implement 90 minute SMAs as a way to provide patients with DSME while improving process and measure outcomes. Billing for the services was an issue. However, we were able to justify the level of services provided by meeting the necessary billing elements. The experience was wonderful but exhausting. The endeavor had a positive impact on patient self-efficacy, outcomes, and patient and provider satisfaction.

A team approach was crucial in making the program succeed. Buy-in from the clinic staff was needed to make group education successful. Identification of an advocate who will ensure the classes are scheduled was important. Through trial and error, we discovered 8-12 patients attending a SMA was an appropriate number to ensure proper education and reimbursement. It was so rewarding to see patients return for a second or third class. We did so well with the project that we are now in the beginning process of applying for Physician Recognition through the National Committee for Quality Assurance.

Do you have experience with SMAs? What do you enjoy or find challenging about implementing group sessions? I highly encourage you to share your stories in providing DSME to a group of patients.


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  1. May 19, 2010

    Am I assuming correctly? A Diabetes Educator (CDE) can't conduct the SMA, it needs to be physician, etc? Or can the provider do part of the visit and CDE the rest?
  2. May 05, 2010

    Iris, I understand which billing codes you are using but can you tell me what part the medical provider plays in the visit? Does the CDE hold an education session and then the provider sees the patient for a period of time? What elements must the visit have to qualify for reimbursement? (i.e. vitals, foot exams etc.)
  3. May 03, 2010

    Lowell, what a great idea! I have done a lot of research on the topic already. I found a lot of journal articles but not any books. Interested in being a co-author?
  4. Apr 27, 2010

    I think there are many physician offices that would like to provide diabetes education to their patients if they could get reimbursed for the time they spend educating patients. There are many offices that I visit as a sales representative that have tryed and failed to start in-house diabetes education. They discontinued when they realized they would not be reimbursed for the extra time spent educating. If you put a how-to book together on how to successfully get reimbursed for group diabetes education sessions I know of several offices in my territory who would start providing education to their patients.
  5. Apr 24, 2010

    Carrie, I applaud your enthusiasm and commitment. There is definitely a gap in caring for women with gestational diabetes. You have already started on your future project; you have identified a clinical issue and a solution to fill the gap. There were many challenges and barriers along the way, but I found the Plan-Do-Check-Act cycle beneficial in addressing the barriers encountered. Buy in from stakeholders was crucial. In order to get buy in from the physician, I volunteered to do the project for free. The patients wanted to learn about diabetes management and were grateful SMAs were offered to them in a familiar environment. The program was financially vialbe but there was an obvious increase in provider and patient satisfaction. Passion and commitment are very important drivers to get buy-in from the team. I conducted a review of the literature in PubMed, CINAHL, and the Diabetes Educator.
  6. Apr 24, 2010

    Tammy, We use the evaluation and management codes (99211-99215), which are used by Nurse Practitioners, physicians, and physician assistants to bill for services rendered. There are currently no billing codes for SMA, which is why it is important this type of QI project be replicated and translated into practice. There are others conducting SMAs and I hope those who are, contribute to the discussion and share their experiences.
  7. Apr 24, 2010

    Iris, I am impressed you took on such a challenging performance improvement project. How did you even get started? Working out the logistics of insurance reimbursement is a project in itself! I commend your efforts and your success. Once I obtain my CDE, I would love to coordinate a trial DSME program specific to gestational diabetics, but also geared towards educating the nursing staff on how to provide consistent and comprehensive care to the GDM population. My primary specialty for the last ten years has been labor and delivery so there is a strong focus on gestational diabetes education. I would love to hear more about what you found especially difficult or stressful in developing your project and how you got people to buy into it. Implementing new programs is challenging, unless there are monetary rewards (lol), so please share what motivated you, your team, and the patients! Also, would you be willing to share what literature you found the most helpful when researching SMA's? Thanks! Carrie Carrie
  8. Apr 23, 2010

    I was curious as to how billing was done in a setting/situation like this.

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