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In terms of merchandising, you can stock items that diabetes patients need — from sugar-free over-the-counter medications to insulin pumps to diabetic shoes — and make sure they are aggregated into one display to make it easy for patients to find what they need. “If Joe’s Pharmacy wants to be a diabetic hub for their diabetic patients, they need to have these products,” says Canally. Some items are eligible for reimbursement to ac- credited providers. “If they’re just doing strips and meters, they need to think seriously about adding diabetic shoes, the insulin pumps, the other DME items. Before they can bill for those items they need to be accred- ited for those as well.”
Once you have the elements in place, it’s time to play the overture and make sure providers know what you can provide. “One of the things that we emphasize in using these value-based care programs is to add these things and take it to the prescribers, so the prescribers know that your pharmacy is specializing in diabetes and all the things you offer,” Canally says. “Having Joe the pharmacist go to the physician and outline all of the things that the pharmacy is doing, then Dr. Smith knows, ‘I’m going to send my diabetes patients to Joe.”
Another selling point to physicians is that new rules will rate them based on outcomes. “The physicians and the plans both have what CMS refers to as star ratings,” Canally explains. “One of the things kicking in
in 2020 is that the physicians will be scored according to how they per- form with various measurements. A few of those measurements relate
to diabetes. It’s another way the DME can go to the physician and say,
‘By better managing those patients with regard to medication therapy management, self-management training and the education component we offer, the products we have, it becomes a one-stop-shop for diabetes.’ If the Dr. Smith’s patients are managed and there’s good outcomes with those patients, Dr. Smith will get a good rating, which means that he gets more money.”
CMS also encourages DMEPs to do outreach in the community to make sure patients know where to find them.
If all this sounds daunting, the good news is that your accreditor, soft- ware vendor and distributor can help you manage different aspects of your hub (see “The Personal Touch” on page Rx 6).
CMS has resources to help DSMT providers market their services. The Diabetes Self-Management Education and Support Joint Position State- ment User Guide can be used as the basis for presentations to physicians, community groups, educators and others. Educators can use the Joint Po- sition Statement and algorithm to communicate with providers who refer as well as those who do not make referrals. The guide includes a sample provider letter, DMST business plan, and resources from the AADE, in- cluding a Tips for Reaching Providers sheet and PowerPoint presentation.
For more information about offering the DSMT benefit, visit the CDC website at www.cdc.gov/diabetes/dsmes-toolkit/reimbursement/medi- care.html. n
Holly Wagner is a freelance writer covering a variety of industries, including healthcare.
“It can be very overwhelming. You’re pushed through a lot of appointments with your doctor and then you go home. Patients are looking for someone to tell them how to do it; things their doctors are not telling them.”
— Lisa Anderson, Universal Software Solutions Inc.
WIHAT’S FOR LUNCH?
f you’ve noticed your diabetes patient population getting younger and fatter, you’re far from alone. Hardly a week goes by without a headline about childhood obesity or “e-sports” replacing actual
physical sports.
Doctors consistently urge better diets and more
exercise, even for non-diabetic patients. But they are
up against a fast-food industry that spent $11 billion
on advertising in 2017, $8.8 billion of that on the least healthy choices, according to the Rudd Center for Food Policy & Obesity at the University of Connecticut. And that was just on TV: most fast-food chains offer loyalty programs that send alerts directly to cell phones offering discounts and rewards based on purchase history. The study found that, on average, children are exposed to 10 fast-food ads a day.
As a result, poor food choices are always in your face. It’s not just ubiquitous advertising and store shelves stocked by chip and soda producers. A surpris- ing number of schools even contract cafeteria space to fast-food chains — a practice that’s been going on since the 1990s and is only now starting to fall out of vogue. It’s still common to find McDonald’s, Chik-Fil-A, Panda Express, Pizza Hut, Quizno’s and Taco Bell in cafeterias
from kindergarten to college.
In a study published in 2014 in JAMA Pediatrics,
researchers from the Institute for Social Research at the University of Michigan found 10 percent of elementary school and 30 percent of high school cafeterias served branded fast-food weekly, and 19 percent of high schools served it daily.
In addition, many major cities have “food deserts,” where there are no stores selling fresh produce and fast-food outlets are highly concentrated — often around schools. Youngsters not only don’t learn to cook fresh food, they may not even know what it looks like. Those palates have been trained practically since birth to eat junk.
Like home economics classes, P.E. programs
at many schools have fallen victim to budget cuts. Parents may not be able to spare the time or money for their children to play organized sports. Children may be less active because they’re playing Fortnite instead of soccer, or live in neighborhoods where it’s not safe to play outside.
All that unhealthy living is showing up in diabetes rates. According to the CDC National Diabetes Statistics Report for 2017, about 193,000 Americans under age
20 are estimated to have diagnosed diabetes, approxi- mately 0.24% of that population. In 2011-2012, the annual incidence of diagnosed diabetes in youth was estimated
at 17,900 with type 1 diabetes and 5,300 with type 2 diabetes. Many of those patients are minorities living in low-income areas. That means many of those patients are on Medicaid.
So now here you are, trying to help a generation that grew up thinking Gummi Bears are fruit and may only have eaten homemade food at grandma’s around the holidays. It’s a challenge for their health, but also an op- portunity to show them a better way.
The increase in diabetes across populations is behind the CMS’ efforts at prevention and management, includ- ing the Diabetes Self Management Training (DSMT) pro- gram. The opportunity for pharmacies and DMEs comes in the form of reimbursement for offering DSMT. Getting set up and accredited to offer DSMT can help your bot- tom line and your community at the same time.
If you’re used to thinking strictly in terms of pills, potions, salves and splints, it’s time to start thinking about behavior modification and breaking bad habits. Nutrition and exercise programs are an important component of diabetes self-management, so it’s more important than ever to cultivate relationships with community partners who can help your patients meet goals, including grocery stores, food co-ops, exer- cise programs and community centers. The market is there, and it’s clamoring for your help.
8 December 2019 | DME Pharmacy
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