Financial Viability Eludes Diabetes Educators

ST. LOUIS — Diabetes education programs are struggling to achieve financial viability, according to results from a large national survey of diabetes educators.

In addition, such providers hail from a diverse range of professional backgrounds and practice in as many different types of settings.

The American Association of Diabetes Educators' (AADE) National Practice Survey was launched in 2005 with the aim of laying the groundwork for creating evidence-based practices, Mary M. Austin and Malinda Peeples explained in a joint presentation at the association's annual meeting.

The challenge is to define core elements of successful diabetes education programs and to standardize them in a way that will still allow providers to use their creativity and customize their programs, said Ms. Peeples, a certified diabetes educator and immediate past president of the AADE.

Earlier National Practice Survey (NPS) results have been published (Diabetes Educ. 2007;33:424-33), but the 2007 data, which are currently being analyzed by a health economist, are significant because they are the first to illustrate trends, noted Ms. Austin, who also is a certified diabetes educator and past president of the AADE.

From 2005 to 2007, there was an increase in the number of programs serving multiple locations (38% to 43%, respectively), with a corresponding decrease in the proportion serving a single location (62% to 57%). In 2007, 26% of the programs were serving 2 locations, and 24% were serving more than 10 locations. These findings are not surprising because there have been reimbursement initiatives that encourage programs to serve multiple sites, Ms. Peeples said.

Hospital outpatient settings were the most common venues for delivery of diabetes education (33%), followed by hospital inpatient settings (15%), and physician's offices (12%). Beyond those, there was a range of venues, including health system ambulatory clinics (5%), community education centers (4%), offices run by self-employed/independent educators (3%), and work site health clinics (2%). At least some of the respondents worked in each of the 17 types of settings listed in the survey, and 9% listed their setting as “other.”

Equally diverse was the list of disciplines from which diabetes educators emerge. Registered nurses topped the list at 51%, a significant increase from 45% in 2005. Registered dieticians were second, at 33%, also significantly up from 30% in 2005. Pharmacists dropped from 4% in 2005 to 3% in 2007. Those numbers closely reflect the entire AADE membership, Ms. Peeples said.

But also on the list in small proportions were professionals such as exercise physiologists, social workers, psychologists, and physicians (primary care and endocrinologists). A majority (79%) had earned a CDE credential, whereas only a small percentage (3%) had a board certification in advanced diabetes management. Sixty-two percent worked full-time (66% in 2005) and 37% part-time (34% in 2005).

The programs were divided almost equally among urban, suburban, and rural settings. “This is important when you hear about how rural areas are underserved. … We're already there. We just need to understand better how we can maximize the efforts of educators in some of those areas,” Ms. Peeples said.

Of concern was the fact that most of the programs reported just 4–20 patient visits a week. “We need to get more data on staff/patient ratios. Some educators may be seeing as few as four patients a week. If that's the case, then there's a real challenge to financial viability,” she remarked.

The results highlighted an area for improvement in the proportion of visits for newly diagnosed patients, which remained at about 45% throughout the 3 years since the last survey.

Only half of all patients with diabetes in the United States are currently meeting recommended diabetes management goals. Ms. Peebles suggested that diabetes educators have an opportunity to improve diabetes care by seeing patients on an ongoing basis and not just when they're newly diagnosed. “There may be limits in terms of reimbursement, but these data allow us to talk about these issues,” she said.

Results also showed that payment sources for diabetes education included 29% from Medicare, 18% from managed care (HMO, PPO, or IPA), 16% from private (indemnity) insurance, and 9% from Medicaid.

Of concern was the finding that only about 10% of the 484 program managers reported that their programs were operating at a profit, which was down from 14% in 2005. At the same time, 44% of programs were operating at a loss, compared with 42% in 2005. Also worrisome was that 15% of program managers in 2007 (16% in 2005) said they didn't know whether their programs were making a profit, operating at cost, or losing money.

The survey also tried to correlate profitability with the number of patient visits. The data were not easy to interpret. In general, it seemed that the small proportion of programs (0.3%, or 17) that had more than 5,000 patient visits a year were the most likely to be making a profit, but even then only 18% were doing so. Of programs with 2,001–5,000 patient visits a year, 10% were making a profit; 48% were operating at a loss, Ms. Austin reported.

“We're trying to [determine] whether it's size or number of visits that makes a difference in terms of profitability. Right now we're having a difficult time figuring it all out, but it looks like nobody is really operating at full profit with no loss. Everyone's operating at some loss, but once you get over 5,000 [patients a year], you're losing less than everyone else.”

Another worrisome trend was a slight downturn in the amount of clinical data collected and reported since 2005, with 12% of programs not collecting any outcome measures.

In 2007, the survey was mailed to 10,865 AADE members. The 30% return rate was a significant increase from the 21% of 9,322 members who responded in 2005. Educators from every state in the union responded, with the greatest numbers from Texas, California, New York, Illinois, Ohio, and Florida. Ms. Peeples acknowledged that a limitation of the survey was that it was sent only to AADE members.

Most (92%) of the 2007 respondents reported they are currently “providing, supervising, or coordinating” diabetes patient education. A total of 73% described their role as “diabetes educator,” and 28% described it as “diabetes program manager/director/coordinator.”

The survey consisted of 33 questions on program structure, 7 questions on process (interventions, program services, and activity), and 8 questions pertaining to outcomes. A diabetes education program was defined as “any structured, organized delivery of diabetes education occurring in any practice setting.”

ST. LOUIS — Diabetes education programs are struggling to achieve financial viability, according to results from a large national survey of diabetes educators.

In addition, such providers hail from a diverse range of professional backgrounds and practice in as many different types of settings.

The American Association of Diabetes Educators' (AADE) National Practice Survey was launched in 2005 with the aim of laying the groundwork for creating evidence-based practices, Mary M. Austin and Malinda Peeples explained in a joint presentation at the association's annual meeting.

The challenge is to define core elements of successful diabetes education programs and to standardize them in a way that will still allow providers to use their creativity and customize their programs, said Ms. Peeples, a certified diabetes educator and immediate past president of the AADE.

Earlier National Practice Survey (NPS) results have been published (Diabetes Educ. 2007;33:424-33), but the 2007 data, which are currently being analyzed by a health economist, are significant because they are the first to illustrate trends, noted Ms. Austin, who also is a certified diabetes educator and past president of the AADE.

From 2005 to 2007, there was an increase in the number of programs serving multiple locations (38% to 43%, respectively), with a corresponding decrease in the proportion serving a single location (62% to 57%). In 2007, 26% of the programs were serving 2 locations, and 24% were serving more than 10 locations. These findings are not surprising because there have been reimbursement initiatives that encourage programs to serve multiple sites, Ms. Peeples said.

Hospital outpatient settings were the most common venues for delivery of diabetes education (33%), followed by hospital inpatient settings (15%), and physician's offices (12%). Beyond those, there was a range of venues, including health system ambulatory clinics (5%), community education centers (4%), offices run by self-employed/independent educators (3%), and work site health clinics (2%). At least some of the respondents worked in each of the 17 types of settings listed in the survey, and 9% listed their setting as “other.”

Equally diverse was the list of disciplines from which diabetes educators emerge. Registered nurses topped the list at 51%, a significant increase from 45% in 2005. Registered dieticians were second, at 33%, also significantly up from 30% in 2005. Pharmacists dropped from 4% in 2005 to 3% in 2007. Those numbers closely reflect the entire AADE membership, Ms. Peeples said.

But also on the list in small proportions were professionals such as exercise physiologists, social workers, psychologists, and physicians (primary care and endocrinologists). A majority (79%) had earned a CDE credential, whereas only a small percentage (3%) had a board certification in advanced diabetes management. Sixty-two percent worked full-time (66% in 2005) and 37% part-time (34% in 2005).

The programs were divided almost equally among urban, suburban, and rural settings. “This is important when you hear about how rural areas are underserved. … We're already there. We just need to understand better how we can maximize the efforts of educators in some of those areas,” Ms. Peeples said.

Of concern was the fact that most of the programs reported just 4–20 patient visits a week. “We need to get more data on staff/patient ratios. Some educators may be seeing as few as four patients a week. If that's the case, then there's a real challenge to financial viability,” she remarked.

The results highlighted an area for improvement in the proportion of visits for newly diagnosed patients, which remained at about 45% throughout the 3 years since the last survey.

Only half of all patients with diabetes in the United States are currently meeting recommended diabetes management goals. Ms. Peebles suggested that diabetes educators have an opportunity to improve diabetes care by seeing patients on an ongoing basis and not just when they're newly diagnosed. “There may be limits in terms of reimbursement, but these data allow us to talk about these issues,” she said.

Results also showed that payment sources for diabetes education included 29% from Medicare, 18% from managed care (HMO, PPO, or IPA), 16% from private (indemnity) insurance, and 9% from Medicaid.

Of concern was the finding that only about 10% of the 484 program managers reported that their programs were operating at a profit, which was down from 14% in 2005. At the same time, 44% of programs were operating at a loss, compared with 42% in 2005. Also worrisome was that 15% of program managers in 2007 (16% in 2005) said they didn't know whether their programs were making a profit, operating at cost, or losing money.

The survey also tried to correlate profitability with the number of patient visits. The data were not easy to interpret. In general, it seemed that the small proportion of programs (0.3%, or 17) that had more than 5,000 patient visits a year were the most likely to be making a profit, but even then only 18% were doing so. Of programs with 2,001–5,000 patient visits a year, 10% were making a profit; 48% were operating at a loss, Ms. Austin reported.

“We're trying to [determine] whether it's size or number of visits that makes a difference in terms of profitability. Right now we're having a difficult time figuring it all out, but it looks like nobody is really operating at full profit with no loss. Everyone's operating at some loss, but once you get over 5,000 [patients a year], you're losing less than everyone else.”

Another worrisome trend was a slight downturn in the amount of clinical data collected and reported since 2005, with 12% of programs not collecting any outcome measures.

In 2007, the survey was mailed to 10,865 AADE members. The 30% return rate was a significant increase from the 21% of 9,322 members who responded in 2005. Educators from every state in the union responded, with the greatest numbers from Texas, California, New York, Illinois, Ohio, and Florida. Ms. Peeples acknowledged that a limitation of the survey was that it was sent only to AADE members.

Most (92%) of the 2007 respondents reported they are currently “providing, supervising, or coordinating” diabetes patient education. A total of 73% described their role as “diabetes educator,” and 28% described it as “diabetes program manager/director/coordinator.”

The survey consisted of 33 questions on program structure, 7 questions on process (interventions, program services, and activity), and 8 questions pertaining to outcomes. A diabetes education program was defined as “any structured, organized delivery of diabetes education occurring in any practice setting.”

ST. LOUIS — Diabetes education programs are struggling to achieve financial viability, according to results from a large national survey of diabetes educators.

In addition, such providers hail from a diverse range of professional backgrounds and practice in as many different types of settings.

The American Association of Diabetes Educators' (AADE) National Practice Survey was launched in 2005 with the aim of laying the groundwork for creating evidence-based practices, Mary M. Austin and Malinda Peeples explained in a joint presentation at the association's annual meeting.

The challenge is to define core elements of successful diabetes education programs and to standardize them in a way that will still allow providers to use their creativity and customize their programs, said Ms. Peeples, a certified diabetes educator and immediate past president of the AADE.

Earlier National Practice Survey (NPS) results have been published (Diabetes Educ. 2007;33:424-33), but the 2007 data, which are currently being analyzed by a health economist, are significant because they are the first to illustrate trends, noted Ms. Austin, who also is a certified diabetes educator and past president of the AADE.

From 2005 to 2007, there was an increase in the number of programs serving multiple locations (38% to 43%, respectively), with a corresponding decrease in the proportion serving a single location (62% to 57%). In 2007, 26% of the programs were serving 2 locations, and 24% were serving more than 10 locations. These findings are not surprising because there have been reimbursement initiatives that encourage programs to serve multiple sites, Ms. Peeples said.

Hospital outpatient settings were the most common venues for delivery of diabetes education (33%), followed by hospital inpatient settings (15%), and physician's offices (12%). Beyond those, there was a range of venues, including health system ambulatory clinics (5%), community education centers (4%), offices run by self-employed/independent educators (3%), and work site health clinics (2%). At least some of the respondents worked in each of the 17 types of settings listed in the survey, and 9% listed their setting as “other.”

Equally diverse was the list of disciplines from which diabetes educators emerge. Registered nurses topped the list at 51%, a significant increase from 45% in 2005. Registered dieticians were second, at 33%, also significantly up from 30% in 2005. Pharmacists dropped from 4% in 2005 to 3% in 2007. Those numbers closely reflect the entire AADE membership, Ms. Peeples said.

But also on the list in small proportions were professionals such as exercise physiologists, social workers, psychologists, and physicians (primary care and endocrinologists). A majority (79%) had earned a CDE credential, whereas only a small percentage (3%) had a board certification in advanced diabetes management. Sixty-two percent worked full-time (66% in 2005) and 37% part-time (34% in 2005).

The programs were divided almost equally among urban, suburban, and rural settings. “This is important when you hear about how rural areas are underserved. … We're already there. We just need to understand better how we can maximize the efforts of educators in some of those areas,” Ms. Peeples said.

Of concern was the fact that most of the programs reported just 4–20 patient visits a week. “We need to get more data on staff/patient ratios. Some educators may be seeing as few as four patients a week. If that's the case, then there's a real challenge to financial viability,” she remarked.

The results highlighted an area for improvement in the proportion of visits for newly diagnosed patients, which remained at about 45% throughout the 3 years since the last survey.

Only half of all patients with diabetes in the United States are currently meeting recommended diabetes management goals. Ms. Peebles suggested that diabetes educators have an opportunity to improve diabetes care by seeing patients on an ongoing basis and not just when they're newly diagnosed. “There may be limits in terms of reimbursement, but these data allow us to talk about these issues,” she said.

Results also showed that payment sources for diabetes education included 29% from Medicare, 18% from managed care (HMO, PPO, or IPA), 16% from private (indemnity) insurance, and 9% from Medicaid.

Of concern was the finding that only about 10% of the 484 program managers reported that their programs were operating at a profit, which was down from 14% in 2005. At the same time, 44% of programs were operating at a loss, compared with 42% in 2005. Also worrisome was that 15% of program managers in 2007 (16% in 2005) said they didn't know whether their programs were making a profit, operating at cost, or losing money.

The survey also tried to correlate profitability with the number of patient visits. The data were not easy to interpret. In general, it seemed that the small proportion of programs (0.3%, or 17) that had more than 5,000 patient visits a year were the most likely to be making a profit, but even then only 18% were doing so. Of programs with 2,001–5,000 patient visits a year, 10% were making a profit; 48% were operating at a loss, Ms. Austin reported.

“We're trying to [determine] whether it's size or number of visits that makes a difference in terms of profitability. Right now we're having a difficult time figuring it all out, but it looks like nobody is really operating at full profit with no loss. Everyone's operating at some loss, but once you get over 5,000 [patients a year], you're losing less than everyone else.”

Another worrisome trend was a slight downturn in the amount of clinical data collected and reported since 2005, with 12% of programs not collecting any outcome measures.

In 2007, the survey was mailed to 10,865 AADE members. The 30% return rate was a significant increase from the 21% of 9,322 members who responded in 2005. Educators from every state in the union responded, with the greatest numbers from Texas, California, New York, Illinois, Ohio, and Florida. Ms. Peeples acknowledged that a limitation of the survey was that it was sent only to AADE members.

Most (92%) of the 2007 respondents reported they are currently “providing, supervising, or coordinating” diabetes patient education. A total of 73% described their role as “diabetes educator,” and 28% described it as “diabetes program manager/director/coordinator.”

The survey consisted of 33 questions on program structure, 7 questions on process (interventions, program services, and activity), and 8 questions pertaining to outcomes. A diabetes education program was defined as “any structured, organized delivery of diabetes education occurring in any practice setting.”