Will They Ever Learn?

Hospital charge for heart bypass surgery—$85,000*


Hospital charge for a leg amputation—$47,000*

One year’s worth of kidney dialysis—$75,000**

Cost of the education that could have prevented the above—PricedLess.

Much less. In his book, “Cheating Destiny: Living With Diabetes, America’s Biggest Epidemic,” author James S. Hirsch discusses the phenomenon in a chapter called “Rewarding Failure, Punishing Excellence.” He discusses the “punishment” of relatively low pay given to diabetes educators and endocrinologists as opposed to the monetary “rewards” gained for treating diabetic complications.

“Poorly controlled diabetics generate an unusual number of referrals to well-paid specialists,” he writes in reference to a medical center in New Jersey at which the diabetes education center operates in the red, but helps the parent organization bring in the bucks by referring patients to its more lucrative areas. Like the cardiac center.

In other words, the system won’t pay for prevention (or, at least, delay) of diabetic complications, but will shell out the big bucks when the complications arise.

“I don’t get it,” Hirsch quotes the diabetes center’s director as saying. “I really don’t get it. We are rewarding poor care.”

The director of the diabetes education center in my city says that Medicare pays $40 to $50 per hour for diabetes self-management education. For private pay consumers, the cost is $100 an hour for individual lessons or $75 per hour for group classes. (Hey—somebody has to make up for the low Medicare reimbursement costs.)

“We still don’t fully support ourselves,” she said. “It’s not a money-making venture.” And, she adds, “a lot of insurance doesn’t cover education at all.”

Hmmmm…payers will shell out big bucks without blinking for bypass surgery, but balk at shelling out, say, $300 to teach people what they can do to avoid the surgery?

Ironically, while I live in a state where payment for diabetes education is mandated, my husband’s employer is exempt because it’s self-insured. So, education isn’t covered. Even more ironically, my husband is a university professor. Yep, you got it: His employer sells…education.

In an age when the incidence of diabetes is increasing, education becomes even more important. While the focus is on the increase in Type 2 diabetes, the incidence of Type 1 diabetes is also growing—at a rate of about 3% per year worldwide, according to the International Diabetes Federation. You can check it out yourself at www.eatlas.idf.org/Incidence. Is it just me, or does the focus for funding seem to be on research, prevention, and cure? While those are good goals, there’s one thing missing: 20 million or so of us have diabetes right now and we need to know how to handle it right now.

On a personal note, my HbA1c before education (and after knowing for nine years that I had diabetes) was 17.4%. After I had some knowledge knocked into my head, my HbA1c dropped and now usually runs in the 6th percentile. It cost me about $300 and was worth every penny. I can’t say for sure that it’s prevented any complications since I have no way of knowing otherwise, but I’m sure that keeping my HbA1c below double-digit range hasn’t hurt.

It’s somehow ironic that the powers that be scream about the rising cost of diabetes, but devalue the very thing that could help hold those costs down. A study released in 2005 by the Centers for Disease Control and Prevention (CDC) shows that, for every $1 spent on diabetes training and education, $8.76 is saved on healthcare costs. (Thanks for that info, Ann.) I’m hardly a financial genius, but I’d say that’s a darned good return on investment.

Ann adds that diabetes programs in her area “are closing, not hiring, in spite of the fact that Ohio has one of the highest rates of diabetes in the country. You see, Ohio is one of the four states that has not yet passed a bill requiring insurance to pay for diabetes education and supplies. Many programs have been unable to stay afloat financially.” (For the curious, the other three states are Alabama, Idaho, and North Dakota.)

I’m going to go out on a limb here and suggest that the government either put up or shut up. Either properly fund diabetes self-management education—and make it available to everybody—or stop yelling about the rising costs.

The publication Voice of the Diabetic quotes former House Speaker Newt Gingrich as saying, several years ago, “Why will we pay to cut your leg off, but not to teach you how to avoid needing to have it cut off?”

Why, indeed?

*Source: Agency for Healthcare Research and Quality (2004 figures)
**Source: National Kidney Foundation

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  • annemoyers

    I couldn’t agree with your blog more!! When I was diagnosed (type 2) prediabetes, my A1c was 6.4. My insurance does cover diabetes ed., but only if the A1c is over 8.0. In other words, I wasn’t “bad” enough yet! My doctor did fight the insurance, and finally I was approved. After 2 1/2 years, my A1c runs about 5.3. I am able to maintain this through the knowledge I attained and vigilent monitoring of my glucose levels. Without the help of my doctors, and the diabetes education I would have been well on the way to poor health. That would cost many times what the classes did.

  • Ephrenia

    Anne – feel lucky your Dr is on your side.

    Mine have been fighting me. I’ve been her patient for a year and since my last HbA1c was 5.6 (from the Dr prior to her) she hasn’t seen the need for another test in over a YEAR! Nor did either of those Drs feel I needed an education class so wouldn’t refer me!

    Not only this, but she just decided I DON’T NEED TO TEST BUT TWICE A DAY (I’ve been testing 4) even though she has NO IDEA what my current HbA1c is!

    Yes I have already gotten a new appointment with a different Dr since changing insurances recently, so things should improve! Wish me luck that my next Dr knows more than my last two!

  • Ann

    Jan, you are so right. The insurance companies act as if the cost of diabetes education will be an ADDITIONAL cost to what they are already paying — not a small investment that will PREVENT costs.

    In fact, numerous studies show that diabetes education begins saving money in the first year, even BEFORE long-term complications develop. Out of every hundred people with diabetes who attend education, a few will avoid going to a hospital emergency room with high or low blood glucose in the first year following education. That saves enough to pay for the education and start the savings for the whole group, without even waiting for the BIG savings of preventing long-term complications.

  • Bernard Farrell

    I’m seeing a lot of posts about this issue on the D-blogosphere. So why don’t we organize ourselves and create an advocacy movement?

    We can try to raise awareness at the Federal level (though I think it might be a State level thing) and see whether we can’t get real insurance coverage for diabetes education.


  • Anna

    I have been reading a lot in the media about how millions of people have undiagnosed diabetes, how it will bankrupt the healthcare system, how a looming epidemic is hanging over us. Yet doctors are screening when they should or with effective tests.

    I diagnosed my own diabetic condition. My doctor woudn’t believe me, despite a history of gestational diabetes, because my weight was fairly normal, even when I told him I used a glucose meter and high carb foods gave me diabetic glucose readings. He finally ordered a 3 hr GTT and was shocked at the results! He admitted that he never would have expected it because my labs were ok (high normal) and my weight/BMI was fine. The endo said the same. But that’s because I was already treating my condition with a carb restricted diet. If I ate like everyone else I would have alarmingly high BG.

    If I hadn’t started testing my BG on my own, how many years before a doctor noticed it? How many complications? How much money to treat i