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DSMT Sessions Completed: What's next for the patient?

Jul 12, 2010

What are you doing for diabetes follow-up self-management training?

As most of us know, Medicare will reimburse for 10 hours of diabetes self-management training in the first year. And, most of the other insurers follow these guidelines. DSMT is generally done in a group format (for 9 of the 10 hours) unless the patient has special needs which support the need for individual training.  We have made the transition from individual to group sessions (in spite of our early fears that this would not work). There are so many different types of classes, sizes of class, methods of teaching, etc. Those are great topics for other blogs.

What I am interested in is what we are doing in the subsequent years. Medicare, and many other insurers, supports 2 hours of follow-up training each year after the initial training. This may be done in a group or as one-on-one sessions. What are you doing for follow-up sessions?

When people come to our group classes in the first year, they seem to gain a great deal of information and enjoy the social interaction and camaraderie of the other class participants. Based on this, we have created group classes for the follow-up years. But, no one signs up!

We offer this to patients within our practice (a very big, busy diabetes practice). The class is about blood glucose checking and pattern management including the impact of food and activity. We make it sound more fun than “pattern management,” but still, no one signs up. We know that many people struggle with blood glucose fluctuations and frequently high and low blood glucoses. The diabetes education team spends a great deal of time working with patients individually managing this, often on the phone where there is no reimbursement.

But, it feels like we are constantly putting out fires rather than preventing the fires from starting. We may need to go back to the drawing board and revise the idea of the class or re-do some marketing.

So, what are you doing for the follow-up years? Individual? One-on-one? Or some combination of both?

If you are doing group classes, do you focus on certain topics or open it up to see what people need? How do you advertise your classes? What types of topics do you focus on or include? If you do group sessions, how many participants do you aim for in each session? What have you found works the best for you and the participants?

If you do individual sessions, how long do you spend for each visit and what is the frequency of visits? What type of format do you follow for the sessions? What areas do you find you spend time on?

Do you have any cool ideas for group classes that would help the rest of us? I am sure we aren’t the only ones struggling with this but also expect that some of you are having great success. I would love to have you share these successes.

There are so many that benefit from our services. Once we see people, they generally appreciate all we have to offer them. But, we can’t do that until we get them in to see us. Medicare and the other insurers support these follow-up hours so we should make the best of them! I am looking forward to some great comments from you on this topic.


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  1. Aug 12, 2010

    Karen, we have the same problem, even to get them to complete our 6 month group, so I have started scheduling appointments, as someone else suggested. I have an appointment card on the back of my business cards and give them to patients on last visit. This is followed up with a reminder call or postcard from my secretary. It has helped some. It is an ongoing battle!
  2. Aug 10, 2010

    I attended the Navigating the Maze seminar on Tues. at AADE and was told that all annuals after the initial 10 hrs. had to be in group> Does anyone know if this is accurate. We have been dooing annuals 1:1 after the initial 10 hrs. Thanks for any info on this..
  3. Jul 20, 2010

    We had a lot of requests in our DSME class for a cooking class. It is always something I have wanted to do but never had time. I think food would bring people back for follow ups. We did do a "Dine with the Docs" series which was very popular. It was a free dinner and presentation with a different doctor each month. I would love to hear from anyone that has done a cooking class.
  4. Jul 14, 2010

    Perhaps it will take their physician giving them a prescription/referral and scheduling them one year out just like a MD follow-up apt. This sends the message that ongoing education is just as important as getting a follow up MD apt, annual labs done, eye exams, etc. Also, there may be some concern on their part regarding co-pay cost--but again if they are given a prescription/referral they will see it as a priority--because after all, it is a priority if they want to maintain good health :-) I am an inpatient CDE and have experienced frustration in seeing the needless patient complications due to poor BG control. There doesn't seem to be a message of urgency to the patient with Diabetes on the importance of taking appropriate diabetes self-management action steps. After looking at the research, I recently felt compelled to volunteer to hold pre-diabetes classes in a PCP office 2x a month (of course they are gratis and no charge to the patient at this point since insurance doesn't cover the service. Referrals are made by the physician if patients have a FBG >99mg/dl and less than 125mg/dl). The secret to attendance, I believe, is that the MD discusses the importance of the class to the patient, informs the patient that she is making the referral and walks out with the patient to inform her staff to schedule the patient for the class. The staff also performs a courtesy reminder call to the patient about 24-48 hrs in advance. It is my opinion that a diabetes class (pre or post diagnosis) should not be optional and the best person to instill that attitude to the patient is first and foremost--their physician--and second, their Diabetes Educator. Hope these thoughts are helpful-- --Kathy

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