Why I'm in Orlando in August

Hey Dad,

It was disheartening to get the news last week that you were having more problems with your kidneys again.  It's so disappointing that after you've changed over to a kidney diet that you're still forming stones and getting infections more and more frequently.  Has it even been two months since the last round?  It's unfair and disappointing to see no benefit from making substantial dietary changes the way you have.  When I asked you about your diabetes care and you told me that you had bigger things to worry about, I couldn't argue the point. I'm so glad we had a couple of days together before I drove up to Orlando for the American Association of Diabetes Educators conference.

This AADE conference feels very different from the other two that I've attended.  I'm sure part of it is a matter of finding my own place in the diabetes world, but there's also been a huge political shift with the implementation of the Affordable Care Act and the ways it is changing reimbursement and the goals for health care organizations.  I've got a lot more information to share about this, but I have some questions to follow up on before I write a whole lot more about that.

What I can say, though, is this is an interesting time for health care professionals. Historically, nurses, dietitians, physicians and pharmacists, etc. have each had their own turf marked by the things they're licensed to do and the clear delineation of their roles in health care delivery.  Now, though, its in the best financial interests of hospitals, clinics, etc. to take a more collaborative team approach to patient care, such as in Accountable Care Organizations and the Chronic Care Model in patient-centered medical home organizations.  This is a hard shift for practitioners and the organizations they work for, much less for patients who are so used to dealing with the system the way it has been.

Diabetes educators have been doing collaborative work all along.  Because they don't have their own state licensure that's required for billing insurance for their services (generating revenue), they've had to work under the supervision of a recognized provider or as a part of an ADA recognized or AADE accredited program.  It makes a lot sense that the AADE is urging their members to become more vocal leaders where they work and to be more involved in the politics of health care in order to gain their own licensure and to exert pressure on states to expand Medicaid where it has not been expanded.  Basically, if diabetes educators gain recognition as providers, then they would be more valuable to health care organizations in terms of revenue.  This would theoretically expand access to diabetes education for patients through increasing the number of available educators and removing some barriers to accessing their services.  One hopes that this would actually improve the quality of care in the process, but in our patchwork health care system what matters most is revenue and cost containment.

I'm really enjoying that so much macro-level analysis is being presented and that so many sessions are dedicated to educating the educators about the new political and economic climate for their work.  I've talked to a lot of people outside of the sessions and very few had any idea about these issues or how their work fits into the larger organization of health care.  I don't usually talk about my own work as much as I have been this conference, but I think it's better understood on the tail of a macro-oriented session.

You asked me why I was going to this conference if I'm finished with data collection and well into the writing phase of my dissertation.  A few days ago I said something like "because this is actually the last of my data collection."  Today, though, I know that it's also because being at a conference full of people who are so committed to improving diabetes care reminds me that the type of research I do is important and can make a substantial contribution to the field.  I am definitely feeling recharged in my drive for this work even if I'm running short on rest.

Seeing you and being surrounded by diabetes care workers has made it okay that I'm in Orlando in August.  At least it's not supposed to rain for the next hour.

Love,

Mel