February 22, 2014

Pharmacists Are Ready and Qualified

The biggest challenge pharmacist's face is obtaining provider status. As a profession, pharmacists are equipped with the knowledge needed to make the change, but other medical professionals are unwilling to let this happen. With the changing of law under Obamacare, the medical professions may have to allow pharmacists to be considered medical providers and capable of billing Medicaid, Medicare, and other insurance companies. Or, Congress may have to step up and mandate that pharmacists be given provider status.

With shortages already occurring in primary care and family medicine, the wait times for doctor appointments are increasing and many are reducing the number of times per year they are seeing patients. With the increasing number of people being diagnosed with diabetes, care for this chronic disease is being strained to the breaking point in some areas of the United States.

These same areas are short on doctors and other professionals capable of helping people with diabetes. This also applies to people capable of providing education for people with diabetes. A shortage of pharmacists does not seem to be happening on the same level. There may not be an abundance, but there is no extreme shortage of pharmacists. Yet the state medical boards stand in the way of pharmacists obtaining provider status.

As the number of people with diabetes grows, so does the need for health care providers to give optimal care, and so does the amount of money it takes to do so. Diabetes is a complicated disease. It takes a lot of effort on both the patient and physicians part to maintain control. It's tough to see your doctor when you are sick, and it's even tougher to see them on a regular basis. Doctor visits every other month are not enough for most diabetic patients. Things fluctuate and need regular attention. Often, poor people, Medicaid patients, and people without their own transportation have the most trouble with getting care.”

Pharmacists can be more accessible and they can provide optimal care for patients between visits to the doctor. It is possible for pharmacists to monitor insulin pump data, check glucose readings, look over carbs/diets, and make recommendations for therapy adjustments. The benefits of this type of work can help improve care, optimize control, and save money in the end. Yet the state medical boards stand in the way of pharmacists obtaining provider status.

How many times will I have to say the last sentence? State and national medical groups apply pressure to state medical boards who then lobby state legislators to prevent pharmacists from obtaining provider status.

February 21, 2014

Diabetes and Your Rights on the Job – Part 2

Part 2 of 2 parts

#3. Do I Have a Right to Medical Leave to Take Care of My Diabetes?

The answer is a qualified 'Yes.' The Family and Medical Leave Act (FMLA) requires
most private employers with more than 50 employees and most government employers to provide up to 12 weeks of leave per year because of the worker's health needs, or an immediate family member's, serious health condition. This time does not need to be taken all at once, but can be taken in small blocks of time. This will allow for short-term problems caused by managing blood glucose levels or for doctor's appointments.

#4. Can My Employer Require Me to Undergo a Medical Examination Because of My Diabetes?

Yes, under certain situations, employers are permitted to inquire about an employee’s disability and can require that the worker undergo a medical examination. Generally, these situations are limited to employment physicals, requests for reasonable accommodation, and when a worker returns to work following an extended medical leave. This also applies when a worker has experienced a problem on the job, like severe hypoglycemia, that raises safety issues for the employer.

#5. Can I be Disciplined for Having Diabetes?

Yes, if your employer has workplace conduct rules that are applied uniformly to all employees, you can be disciplined if your conduct violates these rules. This applies even if that conduct was because of diabetes, for example, your behavior was caused by hypoglycemia. This is one reason secrecy of diabetes is not a good policy.

#6. Can I Be Fired Because My Employer Believes I am a Safety Risk?

This and the following are probably the most contentious problems for a person with diabetes. “A common problem in diabetes discrimination cases is that the employer claims that the person with diabetes creates a safety risk to other employees.
Sometimes this is due to the worker experiencing hypoglycemia on the job – but sometimes it is based in the employer’s ignorance about diabetes. You may need to dispel myths and stereotypes about diabetes and educate your employer or a court about your ability to be a safe and responsible worker.”

#7. What are My Rights if I am Terminated From My Job Because of my Diabetes?

If you are fired from your job because of your diabetes, the first thing to do is to contact the American Diabetes Association so they can help you understand your rights and the legal processes available to you.

You have a right to file a charge of discrimination with the Equal Employment Opportunity Commission (EEOC) or your state fair employment agency.

You also may have other options available, depending on the situation, such as filing a union grievance or negotiating a return to work with your employer.”

Just because you manage your diabetes extremely well does not mean that you might not face the questions above. It can take only one case of hypoglycemia to cause an employer to take action against you. This is true especially for employers that do not understand diabetes. The more dangerous the job is that you have, the more important it is that you discuss diabetes with your employer. Some employers are often able to move you to jobs that are less dangerous. If you are a valued employee, the employer may want to keep you and be very willing to move you.

Just remember that not all employers are sympathetic and will look for any excuse to terminate an employee. This is when the American Diabetes Association may be a valued ally.

February 20, 2014

Diabetes and Your Rights on the Job – Part 1

Part 1 of 2 parts

If you have diabetes, do you consider yourself having a disability? Many people with diabetes do not and that is part of the reason for secrecy among many people with type 2 diabetes. Many are horrified when told they have a disability. Well, suck it up; the American Diabetes Association (ADA) says you have a disability.

As a person with diabetes, you are a person with a disability and as such, you are protected from discrimination. This means that your employer -
  1. Cannot fail to hire or promote you because of your diabetes.
  2. Cannot terminate you because of your diabetes – unless you post a direct threat to yourself or others – think hypoglycemia.
  3. Must provide you with reasonable accommodations that help you perform the necessary functions of your job.
  4. Must not discriminate in employer provided health insurance

For more information, read this PDFfile from the ADA. If is well written and a bit legalese, though understandable. This ADA article has many links to specific definitions and discussions affecting a person with diabetes. I may cover some of them. If you are a person that has repeat episodes of hypoglycemia, there are several concerns about employment – more on this below.

There are both federal and state laws that offer protection from workplace discrimination.

#1. The Americans with Disabilities Act applies to private employers, labor unions, and employment agencies with 15 or more employees, and to state and local government.
#2. The Rehabilitation Act of 1973 generally covers employees who work for the executive branch of the federal government, or for any employer that receives federal money.
#3. The Congressional Accountability Act covers employees of Congress and most legislative branch agencies.
#4. All states have their own anti-discrimination laws and agencies responsible for enforcing those laws. Some state anti-discrimination laws provide more comprehensive protection than do the federal laws.

The cause for concern by many people with diabetes is they don't want to be classified as a person with a disability. Secrecy then becomes a problem, as many do not want to inform their employer that they have diabetes. I would urge everyone that has diabetes to read the two links above

Then for those interested in reading the Americans with Disabilities Act (1990) click on the link above. I would strongly urge you to read the September 25, 2008 Americans with Disabilities Act Amendments Act (ADAAA) at this link. This is hyped by the American Diabetes Association, but helps explain the importance of the ADAAA. It has some important links to follow.

This is one of the disadvantages of having a few of the members of our diabetes support group visit while I am in the middle of a blog. They wanted to make this part of our next meeting and Tim and I had to say that stress was the topic for the meeting and by putting this out before our meeting was not a good idea. Posting this after our meeting and giving them the links will help people be prepared for the next meeting. After some grumbling, they agreed that stress was what everyone was aware of and that if this could be our topic for March.

Important points to remember -

#1. What is a 'Qualified Person with a Disability?'

Before the Amendments Act, the Supreme Court and most lower courts often disallowed people who managed their diabetes extremely well to claim discrimination under the Americans with Disabilities Act. The 2008 Amendments Act clarified this and some other problems needing clarification.

This discussion will be quoted.
In order to be protected by federal anti-discrimination laws, a worker must show that he or she is a "qualified individual with a disability."

The first step is establishing that the worker has a disability, "a record of" a disability, or is "regarded as having" a disability.

A disability is defined in these laws as a mental or physical impairment that substantially limits one or more major life activities – such as eating, walking, seeing, or caring for oneself, or a major bodily function such as endocrine function.

In making this determination, you are viewed as you would be without the help of mitigating measures such as insulin.

In addition, you must establish that you are qualified for the job in question.

A qualified worker is one who satisfies the skill, experience, education, and other job-related requirements of the position held or desired, and who—if given reasonable accommodation—can perform the essential functions of that position.”

#2. What are 'Reasonable Accommodations?'

A reasonable person would think this would be easy, but this was part of the problems thwarted by the Supreme Court. Generally, accommodations for people with diabetes are easy and inexpensive; however, the courts until the Amendments Act have mostly ruled against people with diabetes.

Employers are required to make a reasonable accommodation if requested by an employee, unless the accommodation would cause an 'undue hardship' on the employer because of significant difficulty or expense.

Throughout the discussion the American Diabetes Association makes the following statement and I will just make it here - Contact us to discuss a specific issue with a Legal Advocate.”

Continued in part 2 of 2 parts.

February 19, 2014

2014 Type 2 Blogger List

I have adapted the current list of type 2 bloggers to attempt to have more listed. Instead of getting permission for an expanded listing, I am starting with a URL listing. If you see your site listed and would appreciate an expanded listing like I have in my blog here, please contact me via my email on my profile page.

The only thing I am limiting is that the blogger must have type 2 diabetes or pre-diabetes. I will continue to search for other type 2 bloggers and add them to my listing. I am planning to start a new list each January. When I notice a blogger not blogging for over a year, the listing will be removed. I will also remove a listing when I see that a blogger has taken the site down.

Because of the number of people with type 2 diabetes, I will appreciate receiving information about a new site. We need more bloggers that are type 2 and you do not need to be afraid to write in a technical style or a personal style. There is so much bad information available on the internet, that there is room for more bloggers telling it like it is or covering news items.

In the 2014 type 2 blogger listing, there are many good bloggers and you should be able to discover those that you like to read. Some are very serious, a couple are mildly humorous, and a couple can make you roar with laughter.

February 18, 2014

Proper Disposal of Sharps

How do you dispose of your syringes, pen needles, and other sharps equipment? The time is coming when you may be forced to pay more for this disposal. Tom Erickson, CEO, UltiMed, a manufacturer of insulin syringes and pen needles for the Canadian and U.S. markets wrote an article laying out his observations about what is happening in both countries on regulations for sharps disposal. He thinks that pharmacists will be affected by the changes.

Surveys indicate that less than 5 percent of the more than 3 million sharps devices sold in the United States in a year are disposed in some type of closed container. The rest ends up unprotected in household trash. The influential group promoting sharps disposal regulations is the companies that handle household trash. Their workers are being accidentally stuck with the used needles and each needle stick creates more than $3,000 in testing and sick leave expenses for each employee and some cause serious illness.

Yes, and the frequency of needle-stick injuries is going up. As more waste disposal companies expand into sorting lines to recycle and reduce landfill loads, the injuries are going up. The workers are wearing protective gloves, but this doesn't prevent all needle-stick injuries. This is causing waste companies to lobby heavily to remove sharps devices from the household waste stream.

Pressure is now coming from another direction. The global environmental movement has been actively promoting the safe disposal of all hazardous products. An ever growing number of countries is enacting rules regulating the proper disposal of waste, including batteries, electronics, tires, paint, and pharmaceuticals. The safe disposal of medical sharps devices, such as syringes, and pen needles, is part of the objective of the movement.

Tom Erickson says, “There are two generally accepted ways to transport used needles to a collection point:

1. The user returns the needles in an approved sharps container to an authorized collection point (for example, a pharmacy or hospital).
  1. The user mails the needles to the collection point, called "mail-back." Due to postal regulations and much higher expense, the mail-back option is rarely used.”

The United States currently has no national laws about the safe disposal of sharps waste. The Environmental Protection Agency (EPA) has published new guidelines for the disposal of home-generated sharps waste. To encourage sharps waste removal from normal household waste, the EPA recommends six disposal options, and the use of sharps containers is mandatory in all six.

Many states and cities are attempting to adapt to the EPA guidelines, but with little success. Some states now are requiring the storage and transport of used syringes and pen needles in sharps containers. California tried, but they omitted two critical components – free sharps containers and convenient authorized collection points. Two successful city programs are Sioux Falls, SD, and San Luis Obispo, CA. They included the two afore mentioned components.

In Canada, some pharmacies pay for disposal of home use sharps. When other pharmacies realized that they were losing their valued diabetic customers to this tactic, they countered with their own programs. Now some of the provinces in Canada are considering legislation to move the cost from pharmacies to sharps manufacturers.

Tom Erickson also says the next few years will be interesting. He says political pressure and EPA guidelines will cause nearly all 50 states to enact home-use sharps collection legislation. He comments that it is easy to predict the most controversial issue in this new legislation – who is going to pay the bill?

There are three alternatives:
  1. The Canadian model, where pharmacies pay the cost.
  2. The Sioux Falls and San Luis Obispo models, where government pays.
  3. The EPR model, where the sharps manufacturers pay for the safe disposal of their products.

It will be interesting to see which of the three options the 50 state legislatures take.”

This should mean that those of us with diabetes and using insulin will need to watch and take action to prevent all of the cost becoming an even bigger financial burden. In the town where I live, I have the entire financial burden for taking my sharps to the collection point and paying a fee to have them properly disposed of.

February 17, 2014

Why Is Optimal Diabetes Care Not Cost Effective?

This article in Diabetes-in-Control is perplexing in several ways. A study was performed to determine the obstacles to providing care and potential solutions to overcoming these obstacles. Yet the study could not recommend concrete solutions and how completely to resolve the cost ineffectiveness – only maybes.

Then in researching even farther, I discovered that the study was reported in March of 2012 and listed even more groups than are listed is the Diabetes-in-Control (DiC) article. The DiC says the roadblock to providing care is the cost. This is the reimbursement clinicians receive for providing optimal diabetes care. As a result, diabetes care is often limited, incomplete, or totally lacking. However, the original study found that providers considered patient adherence as the main roadblock to optimal diabetes care. The following is one of many charts from the survey.

This link is to the PDF file with the study details. The Diabetes Working Group, a collection of professional organizations and individuals, created an internet based survey to determine the demographics and practice patterns of diabetes care providers. Although they say that the survey was sent to members of five organizations, only four are listed by the DiC article.
The cost it took to provide care for these patients and reimbursement amounts was calculated using the average number of patients seen per week (as provided in the survey) multiplied by the average number of patients seen in a year based on national estimates. The results were unanimous in showing that provided costs exceeded reimbursements for all patient scenarios. The cost of treating adult patients would exceed reimbursement by over $750,000/year and pediatric patients by $471,000/year. Providers would require a 19% increase in overall reimbursement just to break even.”

The survey, conducted by the Endocrine Society, was the largest of its kind. The recommendations are based on three barriers health care providers thought. These were patient adherence, time with patients, and cost reimbursement. The following are some recommendations of the Diabetes Working Group -

In terms of payment reform, the working group recommended:

  • Appropriate reimbursement for providers meeting standards of care in treating their patients by paying adequately for all services delivered.
  • Testing and implementing payment models that reward providers for supplying optimal care to patients with diabetes.

The group also made the following recommendations to improve care management:
  • Increase use of shared decision-making opportunities with patients in the office setting to maximize patient engagement in self-management of diabetes.
  • Fully leverage existing health information technology tools to assist patients in diabetes self-management and track performance.
  • Create strong provider teams and share roles and expectations with patients.

Given the high and growing prevalence of diabetes, the chronic nature of the disease, lack of success in achieving desired patient outcomes, and the high cost of treating complications resulting from poor diabetes control, the barriers to providing optimal diabetes care must be brought to the forefront of the national health care discussion,” the working group wrote in the paper.”

I can only say that the Diabetes-in-Control article is not a proper reflection of the study
and the conclusions of the Diabetes Working Group.