Blog / Aug 15, 2016 11:00:00 AM

The Utilization of Telehealth for the Diabetes Prevention Program

Written by John Kornak

Telehealth

shutterstock_155304488-lightbulb_002.gifThe Center for Medicare & Medicaid Services (CMS) is currently accepting comments until September 6th on a proposed rule to expand current Medicare Diabetes Prevention Program to allow “service delivery in-person or virtually.” If finalized, the rule incentivizes medical suppliers to enroll in Diabetes programs and be able to bill Medicare immediately after the furnished services take place. Having worked for a large academic medical center whose emphasis was 1-1 time with the patient and providing excellent patient care, I have seen firsthand that there is a lack of direct connection between patients and their providers often due to time and geographic constraints. This rule would boost the time allocated for direct interaction to cover many issues related to multiple chronic conditions as well as mental and behavioral health issues.

The Center for Medicare & Medicaid Services (CMS) is currently accepting comments until September 6th on a proposed rule to expand current Medicare Diabetes Prevention Program to allow “service delivery in-person or virtually.” If finalized, the rule incentivizes medical suppliers to enroll in telehealth programs and be able to bill Medicare immediately after the furnished services take place. Having worked for a large academic medical center whose emphasis was 1-1 time with the patient and providing excellent patient care, I have seen firsthand that there is a lack of direct connection between patients and their providers often due to time and geographic constraints. This rule would boost the time allocated for direct interaction to cover many issues related to multiple chronic conditions as well as mental and behavioral health issues.

The effort to incentivize healthcare suppliers and providers to adopt telehealth as their standard practice to improve patient care is progressive and step in the right direction. However, while CMS recognizes the importance of prevention, wellness, and mental health and chronic disease management, they specify that “virtual services would not be considered part of current telehealth benefits.” It is hard to imagine successful adoption of telehealth programs by healthcare providers with stipulations that preclude reimbursement in effect.

The Diabetes Prevention Program (DPP) was first derived from a pilot from CMS in March 2016 with the aim of preventing the start of diabetes of those patients presenting pre-diabetic diagnosis. The DPP consists of clinical oversight for 16 “core” sessions that focus on long-term dietary change, increasing physical activity, and weight control strategy sessions that are focused primarily on behavior change. These DPP meetings are classroom-style and group-based with the primary goal being at least 5% average weight loss among participants. The benefits of these group sessions could be even further reaching with the help of telehealth resources such as virtual video meetings. Unfortunately, as it stands now The Community Health Outreach Program which oversees The DPP cannot be reimbursed for group therapy sessions and is forced to rely on grant funding and internal budgets to cover the cost.


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With the use of telehealth, these DPP core sessions could take place in the patient’s home or at a local hospital where group-therapy sessions can be held remotely. All of the education material needed for the sessions can be shared electronically. The success of behavioral health over telehealth is proven – ask the school systems, Department of Defense, and the Department of Veterans Affairs. Telehealth is a faster and cheaper solution for diabetes prevention.

Personally, I have attended and presented at many departmental and tumor board/grand round meetings over video. While I am sure that there is nothing like being there in person, these meetings were highly successful and more engaging when groups of providers are speaking over video rather than on a simple telephone conference. In fact, many of the practitioners eliminated weekly conference calls altogether and switched to video telehealth collaboration sessions. Many of the physicians that I know face difficult time constraints that made conducting research and studies as well as seeing patients on a daily basis in the clinic challenging. Many nurses face similar issues in balancing their normal case load of patients with the normal amount of emergencies that occur throughout the day. Community Health workers are few and far between, so health systems need to utilize their time wisely.

In today’s technical landscape, most individuals have access to some form of technology (smartphones and tablets) as well as access to broadband, high-speed internet. For those who do not, many public locations that can be used for this telehealth group-therapy DPP session. My hopes on this proposed Medicare Diabetes Prevention Program rule is that any barrier to the use of telehealth is removed so that anyone, no matter urban or rural setting, can get access to physical and mental health care to prevent diabetes and keep more people healthy.


 

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John Kornak

Written by John Kornak

John Kornak is Ellumen's Client Solutions Technical Strategist offering our clients and partners the benefits of his 20+ years guiding clinicians and administrators on innovative approaches for improving healthcare's delivery. John's sage advice and expertise for telehealth and telemedicine is informed by his prior experience as Director of Telehealth at University of Maryland Medical Center (UMMC). Share your comments with John on Twitter or read more about John's career accomplishments on LinkedIn.

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