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Giant Foods'pharmacies diabetes program gets Medicare provider status.
How can a pharmacy chain obtain Medicare provider status for diabetes education? Ask Giant Food, the Landover, Md.-based supermarket pharmacy chain that recently became the first of the pharmacy chains to receive Medicare provider status for its diabetes education program.
Giant launched the Diabetes Outpatient Education program in partnership with the University of Maryland School of Pharmacy. Magaly Rodriguez de Bittner, associate professor at the University of Maryland School of Pharmacy and coordinator of the program, told Drug Topics that for a program to be considered for Medicare provider status, it must first be recognized by the American Diabetes Association (ADA). The ADA also requires educational policies and procedures to be in place and a written curriculum that covers specific topics. In addition, the program's staff and advisory committee personnel have to meet certain qualifications.
Armed with ADA recognition, which was awarded to Giant in 2000, the chain then filled out a lengthy application and paid an $850 application fee. The application involved sending one year's worth of data on care provided, including samples of patient records. "We took out the names of patients but showed what kind of care we provided," Rodriguez de Bittner said, adding that the application required Giant to interpret a lot of complex information. Once the application was completed, Giant sent it along with the ADA recognition certificate to its regional Medicare carrier, Trailblazers. "Receiving a Medicare provider number means that the pharmacy can provide educational services to a Medicare-eligible patient, bill Medicare, and be paid by Medicare for those services," she explained.
How much does Medicare pay the chain? According to Rodriguez de Bittner, the pharmacy receives approximately $65 per one-hour session. Patients pay $300 for the eight-session program, which enables them to meet privately with a Giant pharmacist. After a free initial consultation, the sessions cover the following topics: overview of diabetes; complications of diabetes; coping with diabetes; food, skin and dental care; monitoring diabetes; medications; nutrition and physical activity; and a wrap-up session. There are also three- and six-month follow-up sessions.
"When we developed the educational program in 1998, we wanted to develop a program that was rigorous, comprehensive, and that met the ADA's standards for a recognized program," Rodriguez de Bittner said. Pointing out that final regulations weren't issued until February 2001 for a 1997 Medicare bill that called for payment for diabetes education, she said, "They had some interim regulations they were using to pay hospitals because hospitals were Medicare providers. Pharmacies were not Medicare providers for services except for durable medical equipment products.
"The only way we have been able to become a provider is through diabetes education. We've opened doors for pharmacy. We became the first ADA-recognized program in chain pharmacy, and now there are about 15 programs that have been ADA-recognized, and a lot of them are in chain pharmacies, including Ukrop's, Dominick's, CVS Healthcare Connections, and Eckerd. Now, Medicare does not discriminate between an education program that takes place in a hospital and one that takes place in a pharmacy, as long as it's ADA-recognized."
She said that becoming the first pharmacy chain to get a Medicare provider number took about nine months and involved educating Trailblazers, its regional Medicare carrier. "We had to struggle and educate everybody. Hopefully, those who apply will benefit because carriers will understand what it's about and it will be an easier process," she said.
What does the future hold for Giant? The chain's diabetes program is in place at sites in Maryland, New Jersey, and Virginia. An additional site is slated to open in Delaware by December.
The chain recently partnered with US Wellness, formerly Medica, with a goal of opening 50 Wellness Centers throughout the Giant chain by the end of this year. There are six to seven Wellness Centers in Giant stores in Maryland and Virginia. "Our goal as a partnership is to expand [the diabetes program] throughout the chain. We will work in collaboration with US Wellness to provide the diabetes education program. We will blend our services with theirs, and their dietitians and nurses can become part of our program," she said.
Russell B. Fair, R.Ph., v.p. of pharmacy operations at Giant, said, "Giant is committed to the growth of Wellness programs. The diabetes patient care centers are having a positive impact on our customers by assisting them in their overall understanding of the disease state."
Sandra Levy. Diabetes education program takes a Giant step forward.