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.

44 years, 44 lessons


I am turning 44 years old, tomorrow, July 15, 2016. Repurposing a theme I did when I turned 40, and adding to the list.

If you find any of these useful, please consider making a special donation on my behalf to Diabetes Hands Foundation.

Here are 44 random lessons I’ve learned, in no particular order:
1. Play peek-a-boo with crying babies in airplanes.
2. Always stay in touch with your childhood friends.
3. When you read a good book, tell others about it.
4. Share good jokes: the world needs more people smiling.
5. Adopt a dog: they are great companions.
6. Dance a lot! It’s good for your heart and your soul.
7. Gardening is good exercise and makes you love plants even more.
8. Grilled sandwiches are the best!
9. Learn to play an instrument: you will have a blast.
10. If someone compliments you, take the compliment.
11. Stare at the sky long enough to watch the clouds moving.
12. Take a deep breath… exhale. Repeat… repeat…
13. Rioja wine. Yep, that’s it.
14. Prog rock, for college years. Ambient and jazz, later in life.
15. When the opportunity opens up, travel: go places!
16. Some Sundays, wake up to baroque music.
17. A cup of black coffee in the mornings: hmmm!
18. Rogaine can help with baldness… if you put it on.
19. If your blood sugars are bad one day, try again the next day.
20. Learn a new language or two. You will discover new worlds.
21. When you travel, don’t take a tour bus: walk around the city.
22. When you are upset, get away from the keyboard, take a walk.
23. Embrace gray hairs: celebrate birthdays!
24. Go inside a photo booth and goof off with friends.
25. Buy local, even if it costs a little more.
26. Have a thick cappuccino every so often.
27. Go to Farmers Markets.
28. Praise in public. Criticize in private, one-on-one.
29. Once in a while, wander, don’t pick up a map.
30. Park as far as you can, don’t use the stairs: walk more.
31. It’s OK to feel afraid. Just don’t let fear control you.
32. Straight or gay: it’s all the same. Everyone is a person.
33. Minnesota and Venezuela are closer than you’d believe.
34. Smile when you are on the phone: other people can feel it.
35. Don’t take yourself too seriously… Seriously!
36. Give to at least one charitable cause every year.
37. Aisle is better than window by a long shot.
38. Once in a while, play a song you love real loud.
39. I have an accent, believe it or not: even in Spanish!
40. When in doubt, remember to tell people how much they rock!
41. Give surprise backrubs. People appreciate it.
42. Avocado with a touch of salt: you heard it here first. šŸ˜‰
43. Read audiobooks… Or listen to them. Just do it.
44. Karaoke with friends: priceless!