March 26, 2008 Conference Call
Education Recognition Update- - Summary
Speakers: Terry Unger, BS, RD, CDE – Associate Director, ERP, ADA
Paulina Duker, MPH, APRN, BC-ADM, CDE; Director, ERP, ADA
New DSME standards and instructions were reviewed, are located on the ADA website ( This presentation’s slide set is posted on the website.
Highlites:
-the 7th edition instructions are posted and the new application is due to be posted on the ADA website in the next few weeks. Renewal of recognition for Joslin affiliates will be using the 7th edition.
-Joslin affiliates will continue to follow the Joslin minimum standards:
-An annual Face to Face Advisory group meeting is required- documented with written minutes.
- The coordinator is a CDE (or now, may also be a BC-ADM) as defined in the job description
- Two Disciplines are required for the education program: one RD, CDE or BC-ADM and one RN, CDE or BC-ADM. (resumes for new educators are reviewed by Joslin Affiliate staff prior to hire)
- Medical record audits are conducted annually, 5 per each educator.
Q and A:
Q-What form(s) needs to be used to document education?
A-Any format which identifies the Diabetes Self-Management Education (DSME) process of referral (form), assessment, development of an educational plan, patient objective, intervention, and reassessment is acceptable. (A sample Diabetes Education Record, is located in the Diabetes Educator Orientation Manual, Section-Enhancing Your Skills)
Upon completion of the program, a follow up support plan needs to be communicated back to the referring provider. This communication is documented on the, Diabetes Self-Management Support (DSMS). This document describes follow up planning (such as next medical appointment, plans for future education, phone follow up, community support group attendance, etc). A copy is given to the provider, patient and one remains in the medical record.
Q- Why do the physicians have to identify the number of hours for education on the referral? (they often are not aware or not accurate)-
A- This is a CMS requirement, just as a diagnosis by name (type1 diabetes) or by IDC-9 code (250.01) is required for justification of service.
Q- Can other services such as Bariatric referrals and MNT be listed on the DSME referral form?
A- Yes, as long as each service is distinguished from the other and exact referral for exact service is clear.
Q- Our affiliate was contacted by CMS- as ADA- ERP been audited recently? Will this affect our recognition?
A- Yes, CMS recently conducted an ERP audit and will do so periodically to assure quality service. Sites may be contacted by CMS to comment on service, provide documentation, and conduct a desk audit. This function is related to evaluation of the ERP process and the outcome will not affect a sites’ DSME recognition status.
Q- How can we document outcomes if the patient does not return for follow up?
A- According to the 2007 standards, it is expected that a plan of action for follow up be in place and if patients not are not returning or responding to contact, a CQI process be initiated to increase return. Phone contact counts as follow up.
Q- Can the Healthy I curriculum be used as a content curriculum?
A- The newest edition of the Healthy I materials includes a specific tabbed section with an acceptable minimum standard curriculum. It is expected that each site then tailor and update content to include topics and materials to meet the needs of their target population.
Q- Do charts need to be reviewed from each site in a multi-site program?
A- Yes, a chart from each site must be reviewed.
Q- With expansion sites in place, how will data be tabulated?
A- Each expansion site is an exact duplication of the original site, and aggregate data may be collected. A representative from each expansion site on the advisory group might be considered for consistency, but is not required.
Q- Joslin affiliates may consider adding sites, does each site have its own coordinator? What is the data period now? Affiliates are advised to contact Joslin staff for guidance when this is considered. The new data period is 3 months versus 6 months. Reminder that renewal data period and application for renewal must be completed well with in the 90 prior to end of recognition date.
Q- Are patients with prediabetes considered part of the data collection now?
A- Yes.
Q- Will auxiliary staff (LPN, Administrative support staff, Front desk staff, others) be listed on the application?
A- Yes, they are not required to have documented Continuing education (Joslin requires that all staff be oriented to the Joslin information)
Q- Can an Endo be the referring MD if there is no PCP ?
A- Yes, if insurance does not require a PCP referral, or if there is open access.
Q- Are patient data numbers counted by encounter (each visit) or by person?
A- Data is counted by individual patient only, not by each patient visit. A patient completing a class set of 4 visits is counted as one patient.
Q- Can you clarify exactly what outcomes are to be collected?
A- The standards indicate patient behavior achievement outcome, and program effectiveness outcomes, determining opportunities for improvement (CQI) planning.
(Note: Tab C of the, Diabetes Management and Education Planning Program Guide, is being revised to reflect these changes, and will be available in the near future)
For additional information contact: or 617 226 5864
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