9 Ancillary Services That Can Boost Practice Revenue

Leigh Page


August 07, 2014

In This Article

9. Diabetes Counseling Services

Practices with large numbers of diabetic patients can receive payments for counseling them on managing their condition, but your counselors must meet strict guidelines in order to be paid. These counseling sessions have been shown to improve compliance and reduce hospitalizations, and they are required to qualify as a patient-centered medical home.

"This is a great opportunity for physicians' offices, and we're seeing a great deal of growth in this sector," said Leslie E. Kolb, RN, Director of Accreditation and Quality Initiatives at the American Association of Diabetes Educators (AADE) in Chicago.

However, whereas AADE's membership includes many outpatient hospital facilities, nursing practices, and large physician groups, very few small physician practices are on the list at this time. This may be due to a relatively small reimbursement for this service, a challenging accreditation process, and lack of knowledge about this opportunity, said Linda Sicard, RN, Managing Partner of New York Diabetes Care, a nurse practice in the Bronx, New York, that is paid for diabetes counseling.

Sicard said Medicare pays New York Diabetes Care $73.17, along with a $16.63 patient copay, for a 1-hour individual visit with an accredited counselor for introductory diabetes counseling. Kolb said this amount is part of a total of almost $500 that Medicare typically pays a provider for introductory counseling. These same rates apply to physician practices.

What's Required

Introductory counseling is broken down into 1 hour of one-on-one training and 9 hours of training in groups of 2-20 patients. After that, Medicare pays almost $75 for 2 hours of group training per year for each diabetic patient. Kolb said private insurers are also required to cover diabetes counseling in at least 45 states and tend to use the Medicare requirements.

To qualify for Medicare reimbursement, a counseling program must be recognized either by the AADE or the American Diabetes Association. Kolb said the recognition programs examine the structure, processes, and outcomes of a counseling program. Counselors have to have a background in diabetes education and take 15 hours of relevant coursework each year. You also have to compile a patient education curriculum, Sicard adds.

Vivian R. Bossong, a diabetes counselor at Primary Care & Hope Clinic, a group of 6 nurse practitioners in Murfreesboro, Tennessee, said her practice started with fewer than 20 diabetes patients when it was first recognized in June, and now it has 50 patients. She said there is enough volume now for a full-time educator.

Bossong, who is a dietitian, said that when dietitians are used as diabetes counselors, they can switch-hit for 2 other patient services. First, they can provide 3 hours of medical nutrition therapy for diabetes patients every year, which is also reimbursed by Medicare. Second, they can provide weight-loss therapy, which is generally out of pocket, but some insurers cover it.

Bossong said her practice decided it could offer diabetes counseling after carefully examining patient records. "We looked over our patient population and identified who had diabetes," she said. "We also let providers know we can see these patients -- anyone with elevated A1c or a diagnosis of diabetes."

Aburmishan said physicians need to evaluate their practice before launching this service. "There is an advantage to doing it in-house, but you need high volume to make this work," she said. Although most PCPs have a large population of diabetes patients, "Will they come in for this?" she asked. "The diabetes patient is not in pain and could postpone these services indefinitely."

Diabetes Counseling Scorecard

Start-up costs: Minimal. No extra equipment is needed, and when dietitians are used as diabetes educators, they can also cover other reimbursable activities.

Potential income: No figures have been reported, but the amount is said to be quite small.

Pros: This is a welcome new source of revenue for practices with large numbers of diabetes patients.

Cons: The accreditation process is challenging, reimbursement is fairly low, and diabetes patients may not want to use the service.


If you're not interested now, reexamine this list in another 6 months. Aburmishan predicted that as reimbursements shrink, alternative sources of income will become more crucial. "In the next 5-10 years," she said, "the whole way medicine in which is delivered will change. You will need to think outside the box."

However, none of these services is a slam-dunk. Before deciding on a new service, you should carefully examine the needs of your own patients as well as your own areas of interest. Do you really want to get into med spa or pill dispensing? Are you ready to be challenged by specialists, such as radiologists or allergists, who feel that others may not be qualified to provide the service?

And most of all, are you willing to invest funds and put in extra hours to get your new line of service started? All of these questions should be addressed before you start, rather than when you are rolling out your new venture.


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