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Diabetes patient education programs. Quality and reimbursement
M L Wheeler1, E Warren-Boulton
1Diabetes Research and Training Center, Indiana University Medical Center, Indianapolis 46202.
Diabetes Care
|March 1, 1992
Summary
National quality assurance systems exist for diabetes education, but third-party reimbursement remains inconsistent. Clearer definitions are needed for outpatient diabetes education services to ensure predictable coverage.
Area of Science:
- Health Services Research
- Quality Assurance in Healthcare
- Diabetes Management
Background:
- Diabetes education is crucial for patient self-management and outcomes.
- Existing national quality assurance systems aim to standardize diabetes education programs.
- Third-party payer reimbursement significantly impacts access to these essential services.
Purpose of the Study:
- To inform healthcare providers and payers about national quality assurance for diabetes education.
- To assess current reimbursement coverage for recognized diabetes education programs.
- To highlight the need for consistent reimbursement of outpatient diabetes education.
Main Methods:
- Examination of quality assurance mechanisms for diabetes education.
- Survey of third-party carriers regarding reimbursement for American Diabetes Association (ADA)-recognized programs.
- Analysis of national standards and program evaluation processes.
Main Results:
- A national program to evaluate diabetes education programs against standards is operational.
- Many ADA-recognized programs receive reimbursement, with official recognition aiding the process.
- Reimbursement decisions by third-party carriers are inconsistent and unpredictable.
Conclusions:
- National quality assurance systems for diabetes education are established.
- Despite program recognition, inconsistent payer coverage hinders access to essential outpatient diabetes education.
- Clearer service definitions are required for consistent coding and coverage by third-party payors.