Assessment of Barriers to the Delivery of Medicare Reimbursed Diabetes Self-Management Education in Rural Areas

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Project completed:
August 2003
The national prevalence of diabetes is estimated at 15.7 million people. African Americans and Hispanics are almost twice as likely to have diabetes than whites. To aid in the management of this disease, the 1997 Balanced Budget Act provides Medicare funding for American Diabetes Association recognized Diabetes Education programs. The purpose of these new reimbursement criteria is to expand diabetes education services, making them more accessible. Reimbursement requirements, however, may affect the accessibility of diabetes education services in rural areas. For instance, Medicare will not provide reimbursement if the recipient is also an outpatient in a rural health clinic or federally qualified health center. Additionally, in order to receive reimbursement, providers must meet a stringent set of quality standards that may exceed the limited resources of a rural practitioner. The purpose of this study is two-fold: To determine the availability of diabetes educators in rural areas, with particular emphasis on rural counties with high levels of poor and minority populations, and to explore barriers rural practitioners face in providing diabetes education services.