My comment to CMS’ proposed Medicare regulations that will impact DSMT

Today at 5pm Eastern is the deadline for submitting comments to CMS on their proposed Medicare regulations that will impact DSMT (Diabetes Self-Management Training) and DPP (Diabetes Prevention Program). I submitted the comment below.

My name is Manny Hernandez. I have lived with diabetes since 2002, at age 30. Since then, I have engaged in diabetes advocacy, co-founding the Diabetes Hands Foundation (where I now serve as a Board Member), and always looking to bring the voice of people with diabetes anywhere there’s a policy or decision made on our behalf.

Since I was diagnosed, Diabetes Self-Management Training has given me the tools to take the best care of myself as I live with diabetes, and I have gone back for more training over the years, as I have changed therapies, changed providers, changed plans… as life has gone on. I have been fortunate to have access to DSMT when I needed it, but copayments and deductibles get in the way of scores of people who need it (and could see their long term outcomes improve drastically) but cannot afford it.

Having met hundreds of Diabetes Educators over the years as part of my advocacy work, I have become painfully aware of the challenging and limiting circumstances in which they operate, always putting the patient’s needs first. We should make their work easier, not harder. They should be able to deliver Diabetes Self-Management Training in a sustainable way, which they often cannot do given the reimbursement structure faced today and even the proposed one (G0108 and G0109).

The journey of people with diabetes is not linear: it’s full of valleys and peaks, as the condition evolves, life happens (with its challenges), and you need to adjust to new realities, in- and outside of diabetes. While you may not need Diabetes Self-Management Training all the time, or every year, beneficiaries should not lose their initial 10 hours of DSMT if it is not completed within the first 12 months after referral. You will ALWAYS have things to learn and adjust with diabetes, and not acknowledging this reflects an approach that overlooks the realities of people living with diabetes.

Similarly, people with diabetes should be able to access Diabetes Self-Management Training in their communities, not HAVE to be constrained as to the setting in which they can receive it. How do you best impact people you want to help? Meeting them where they are: so constraining options for them limits access too. Let’s not do this.

Diabetes Self-Management Education needs to become a benefit that ALL people with diabetes have access to. It has the potential to turn the tides of this epidemic in the US, and its associated cost, by empowering people with diabetes with the tools to make the best possible decisions about their day-to-day care, AS they go about their lives. But this can only happen if we effectively remove barriers to it, and make it affordable to patients throughout their entire diabetes journey, sustainable to providers, and accessible in as many possible formats and settings as possible.

As a result, I appeal to CMS to consider the above elements from the perspective of the person with diabetes and I express my full support of the proposals of AADE, ADA, and Academy of Nutrition and Dietetics, AADE to help increase access to Diabetes Self-management Education for people with diabetes in the United States.

Pokesteps? Poke-yes!

A few weeks ago, I was lured into playing a game that has become quite popular. Of course, I am referring to Pokemon Go. Our 12-year old son had been quite a dedicated fan of Pokemon for years now, and since I missed this phenomenon growing up, half the time I didn’t understand what he was saying when he spoke about it. But I decided to give the mobile game a try.

Since I started playing, I don’t cease to be tremendously impressed about the way the game succeeds at getting you to go out and about. Not only is this amazing for kids and young adults (who grew up on Pokemon) alike, since it gets them back outdoors, the way most of us who were born in the 70s and 80s grew up. This game motivates people to get more active…

You are not told you have to put in X number of steps, you have to walk off to hatch eggs that will eventually turn into Pokemons that you can play with in the game. You are not invited to walk for 30 minutes, but without doing so you really cannot hit the Pokestops where you get the pokeballs and other items you need to catch Pokemons and make the most of your catches. The BYPRODUCT of doing all these fun things is that you put in steps that otherwise you may have not taken… As I call them, POKESTEPS!

SO this has officially become the first game since the early days of the Wii, where moving got you points and helped you advance, that I am truly excited about. Gotta catch them all!

Share your thoughts on Pokemon Go in the comments, below.

Repeating herself. Repeating herself. Repeating herself.

If you read this blog (though I wouldn’t blame you if you don’t), you probably know that my mother has Alzheimer’s. She was diagnosed several years ago, and I would like if I said it’s been an easy road: it hasn’t.

Along this journey, before yesterday, she has had at least three “leaps” we’ve been able to observe:

  1. That “OMG” moment, when it became obvious to me that something was off: I had dropped her off in church, to pick her up an hour later. After mass was over, I kept waiting and waiting for her, to be surprised by her phone call… from her home. She had gotten a ride back home, because she had forgotten I was outside. Soon after that day, she was diagnosed with Alzheimer’s.
  2. She had been living for nearly two years in an Independent Living facility, and some things pointed at the need for her to get more assistance in her day-to-day, things that resulted in her taking less care about herself than we were used to see her do. When I spoke with the Executive Director at her residence, she told me we needed to find my mom a place where she could get Memory Care… she was taking a “leap” into a new level of care.”
  3. For a few months now, more often than not she doesn’t remember I am her son. She still associates me with someone “familiar” (a kind gentleman, and at times, she is sure I am her younger brother). The first time that this happened, it was very hard to accept…

Yesterday, a new “leap” happened. I was used to her repeating herself: conversations with my mom have been cyclical for quite some time. The same topic comes back over and over. But yesterday, she started repeating words and short phrases, over and over. For example, she would tell me:

“Señor, señor, señor, señor, señor…” (“Sir, sir, sir, sir, sir…”)

This is all very fresh, and not easy. We will continue to be there for her. But it’s not easy… it’s not easy… it’s not easy…