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Pay for Performance: the role of the diabetes educator
Skills of diabetes educator emphasize preventive care and benefit physicians in P4P programs.
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 Virginia Zamudio Lange |
Over the past few years, pay for performance has been a hot topic of discussion and controversy for physicians across the United States. But is it even on the radar screen for most diabetes educators?
Diabetes educators may not be directly paid for their performance in this structure, but they can play a key role in the success of physicians who will be impacted by pay for performance (P4P). The team approach has long been recognized as beneficial to the care of patients with diabetes. The P4P system is another arena in which the team approach will pay off for physicians and diabetes educators as well.
The impact of chronic conditions on the U.S. health care system demands that it change from an acute care focus to a preventive mode. Technological advances and medical science breakthroughs, as wonderful as they are, have greatly outpaced the ability of the current health care delivery system to consistently provide quality care.
The diabetes educator possesses skills that are of great value to the physician who is enrolled in a P4P program. Through individualized training and applied behavior change techniques, the educator helps the patient adjust their lifestyle to manage their diabetes. The educator helps them identify obstacles that hinder their progress and trains them in the problem-solving skills they will need to be successful over a lifetime of managing diabetes. This change in behavior leads to clinical improvement, which improves overall health status.
Since 2003, the American Association of Diabetes Educators has promoted the use of seven Self-Care Behaviors, called the AADE7, as a standardized framework for measuring behavior change, which is the ultimate outcome of diabetes education. The seven behaviors include healthy eating, physical activity, taking medications, monitoring, problem-solving (especially around high or low blood glucose or sick days), reducing risk and healthy coping. One advantage of this framework is that it can be applied to the care of patients with other chronic health conditions, such as cardiovascular disease.
The same behaviors that are advocated and tracked in the AADE7 also positively impact blood pressure, lipid levels and overall cardiovascular status. The diabetes educator is uniquely positioned to be an effective change agent for patients with many chronic conditions, not just diabetes.
Progressive diabetes educators track their patients’ clinical and behavior outcomes using information technology. One example of this technology is AADE7 IMPACT, a free benefit to members of the AADE. IMPACT is a suite of internet-based tools that allows the educator to electronically track and monitor behavior change and clinical indicators. Summary reports can be generated for individual patient information, as well as for the program as a whole.
Individual patient reports would prove useful to the physician participating in P4P, particularly the trending of diabetes risk reduction behaviors, such as whether or not the patient has had their annual dilated retinal exam, flu vaccines, or other diabetes standards of care. Physicians in a P4P system will receive higher reimbursement if they meet chronic care standards.
Despite the burgeoning diabetes epidemic, only a small percentage of patients with diabetes are ever referred for diabetes self-management training. At this point in time when many diabetes education programs are still challenged with basic reimbursement issues, P4P is certainly not an immediate concern for diabetes educators. But if physicians who are impacted by P4P will systematically collaborate with quality diabetes education programs, all parties will benefit in this win-win arrangement.
More patients will be served in a multidisciplinary team approach to care, leading to improved outcomes. Educators will have the capacity to expand their programs, remain economically viable, and contribute to the data collection and tracking that physicians need to financially succeed in a P4P environment.
As P4P becomes more mainstream, diabetes educators and the institutions that employ them should invest more energy in marketing the value of their diabetes education programs to physicians.
Virginia Zamudio Lange, RN, MSN, CDE, is a diabetes educator at Alamo Diabetes Team in San Antonio, Texas, is Chief Medical Editor of Diabetes Vital and is a member of the Endocrine Today Editorial Board.