Establishing and Operating a Third-Party Reimbursed Outpatient Diabetes Care Center

Abstract

In treating diabetic persons, busy practitioners traditionally prefer hospitalization because they lack the time to assess patient needs and to educate the patient and initiate an individualized treatment plan. Regulation and education of newly diagnosed diabetes patients on an outpatient basis is implemented on a narrow scale nationwide because of limited data on effectiveness and the reluctance of third-party payers to reimburse this mode of therapy. We report our experience in establishing and operating a diabetes care center that offers a weekly outpatient program and that is reimbursed by private insurers, Blue Cross/Blue Shield, Medicare and Medicaid. The program provides education, psychologic support, clinical evaluation of diabetes, and initiation or adjustment of medications. Factors that we found important in achieving reimbursement are discussed.