Guest guest Posted October 29, 2005 Report Share Posted October 29, 2005 The care manager concept we're going to explore in the grant is an individual who supports more than one practice. This individual will not be on-site. Gordon At 06:53 AM 10/28/2005, you wrote: Our CDEs do not make med changes such as adding meds. But they will suggest adjusting insulin up or down after a close review of the home BGs. Also, they will come to us, or at least leave the chart for review, if the numbers are not improving enough and it is time to add new meds or consider significant changes. All along they are spending the time educating about diet and exercise as well as keeping track of whether the patient has had an eye exam, etc. Partly I like them because they keep me aware of the recent improvements in glucometer models -- it's frustrating if the patient asks me something and I can't advise about benefits of this model or that. I do think a review of the note is a good idea though we only see the note if they are alerting us to problems that might need to be addressed. If a patient is seen at an outside center we may, or may not, see any report. But honestly that is mostly just for my insulin pump patients. 90+% are seen in-house I'd estimate. I'll try to ask about coding. Unfortunately I don't know how that works -- recall I'm still in a traditional office and have been shielded from such details. This list is not just important but it is timely. I'm evaluating space in my town for a possible office in the spring. This week I saw a 725sqft office that is bare and can be shaped into whatever I want it to be (not yet started negotiation of prices/build out, etc). My wife, kids and I have been sketching out ideas and then Gordon announced the grant which might include a chronic care nurse manager. So I had to think of space -- where might she see patients if I'm in the office at the same time? So I made a smaller waiting area, took a few sqft from my main space and made an additional 8x10 " extra " room. Now you mention the CDE... hmm, I've got 11% of my space available... hmm, later, could I have a chronic care manager there a bit, a CDE there some half days, a mental health counselor there some half days, a social worker there some half days, etc, etc?. I really wonder if I could use that space like that -- I won't need it for clinical care. And perhaps those people could bill/charge for their services themselves, not be hired by me... and perhaps I could wave any space usage charge, it could be a " value added " service for patients which would help me by helping them. So, new question, is that a pipedream that would have too many hassles to want to consider? A reasonable idea that would help all involved? Or worthy of a Nobel prize? (I'm only sipping my first coffee of the AM, so this brain ain't working yet. I need help with eval of this idea) Thanks Tim > Do your CDEs make medication adjustments? Do you think there should be > some sort of process whereby I review what t he CDE does after the visit > vs. my reviewing things at a follow up visit with the pt? Also, are you > familiar with how to code for the visits? > > > > Lowell > > > > _____ > > From: > [ mailto: ] On Behalf Of > Malia, MD Sent: Thursday, October 27, 2005 9:21 PM > To: > Subject: Re: Certified Diabetes Educator > > > > I agree with you about the office being an epicenter for care. In my > current multispecialty office we have CDEs and they really help in the > care of the patients. That's especially true early after diagnosis. I'll > meet with patient to discuss the labs that made the diagnosis and spend > 20-30 minutes reviewing a variety of issues and outlining recommended > plans. Then I give prescriptions for lancets and test strips and the > patient follows up with the CDE to learn glucometer use (CDE give a free > model and writes in the name on Rx so patient gets correct TS and > lancets). They then continue seeing the patient and pass the general > info to me until I see the patient in about 2-3 months. I know this > procedure well... had two newly diagnosed diabetics today, total of > three this week! > > Overall, CDEs are great in my mind. And, even after I leave for a new > office, I'll likely be sending my patients back to my current office for > CDE work. > >> I called the local diabetes education center to see how they ran >> things. They do groups for basic education and 1:1 for labs, med >> changes, etc. I put an ad in the local Certified Diabetes Educator >> chapter and am going to start with 1 day to see how this will all work >> out. The good CDEs are able to handle the labs, the nutritional issues >> and the medication management. Some are RNs, some are RDs and some are >> CDE without other degrees. >> >> >> >> Interestingly, the center asked why I wanted to do this in my office >> vs. send the patients to them. I think the main reason is that I see >> the office as the epicenter of care. It's the office where we best >> know the patients and their families and it's where they go for their >> other care needs. In other words, the relationship patients have with >> their docs seems to be additional leverage for improving DM care.plus >> I think we can do a better job locally vs. outsourcing. >> >> >> >> Thought? >> >> >> >> Lowell > > > > > > > Quote Link to comment Share on other sites More sharing options...
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