Advocate: one that defends or maintains a cause or proposal.
AADE believes diabetes educators are advocates.
Am I an advocate? Thirty years ago this month someone dear to me was diagnosed with type 1 diabetes. That was the beginning of the path that led me here today.
Through it all I have been an advocate:
- for the person with diabetes and those persons who care for them;
- for access to evidence-based and outcome driven diabetes self-management education / training;
- for the professional preparation of credentialed diabetes educators; and
- for diabetes educators to participate in AADE activities as it is the only organization in the country who exists for the sole purpose of advocating for the diabetes educator.
At the federal level, AADE advocates for the correction of the Balanced Budget Act of 1997 (BBA). You may remember that the BBA recognized diabetes self-management education / training (DSME/T) as a reimbursable expense by Medicare. This was an important chapter in the history of diabetes educators as it defined the criteria for reimbursement and supported sustainable DSME/T.
The original BBA included diabetes educators as Medicare providers of DSME/T. During the reconciliation of the legislation between the House and Senate, the diabetes educator provider piece was lost. AADE has worked to correct this oversight ever since.
At the local level, AADE supports the diabetes educator. Today we find ourselves transitioning toward the Affordable Care Act (ACA) implementation. Within the ACA is a mandate for state health exchanges. The state health exchanges are required to include coverage of ten broad areas. The required coverage includes:
“...preventive and wellness services and chronic disease management...”
Preventive and wellness services and chronic disease management presents a real opportunity for health care professionals that can meet this need -- we are one of those healthcare professionals that has an opportunity here. Unfortunately, diabetes educators are not ready for this opportunity.
Insurance policies or payment plans define “who” is a recognized healthcare provider - that is, who is eligible to receive reimbursement under that plan. Persons who are licensed will most likely become recognized providers. Unfortunately, because diabetes educators do not have a LEGAL definition or scope of practice, they will not become recognized providers.
I know you may be a licensed health care professional, but your scope of practice under that license does not include everything you are expected to cover as a diabetes educator (www.diabeteseducator.org/ProfessionalResources/AADE7/). For example, this means a dietitian can speak to physical activity as it relates to medical nutrition therapy. The dietitian’s scope of practice does not give authority to provide an exercise prescription (includes frequency, intensity, type of activity and time / duration of activity). Unless you are an exercise physiologist, you have gone beyond the limits of your license.
If you are a Certified Diabetes Educator (CDE), you may be surprised to read the limitations position statement on the NCBDE website (http://www.ncbde.org/about/posstatements/limitations/ ). You may act beyond your license if your employer authorizes it, but the advanced certification does not expand your scope of practice.
The absence of a LEGAL scope of practice is the foundation of the diabetes educator licensure initiative. Licensure will give the diabetes educator access to opportunities within health care.
AADE has taken advantage of the MYAADE Network communication platform to create a place for us to take our advocacy skills as diabetes educators and develop us into political advocates for the profession and larger diabetes community. AADE’s role in the licensure initiative is not to tell you what to do, but rather to serve as a resource to support your efforts. The Advocacy Forum will serve as a “one stop shop” for your advocacy questions, discussions, conversations and tools necessary for the task.
So, yes, I am an advocate for my patients, my providers, my educators and you!.
Welcome to the Advocacy Forum!