Nutritional Resources & ACO Documents/ACO... · •BC/BS Medicare Advantage –Some plans only...

" Nutritional Resources & ACO Standards…How do they Intersect?"

August 2015

©2011 Proprietary and Confidential

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ACO Announcements

• Reminders:

– May Specialty meetings-Video available

– ACO Notifications

– Save the date 9/22/2015 – Primary care meeting


Agenda

• ACO Adult Weight Screening and follow up measure

• Epidemic…why?

• Weight management approaches

• Resources available

• Q&A section


Obesity Epidemic

• By 2010, in the United States, 35.7% of adults were obese, and another 33.1% were overweight.

• Obesity rates have doubled worldwide since 2010

• Without any change, by 2030 nearly 45% of Americans will be obese, and 13 states will have an adult obesity rate of over 60%.

“Aligning Communities-How Four Cities are Preventing Obesity” US Chamber of Commerce

Corporate Citizenship Center, http://www.uschamberfoundation.org/sites/default/files/USCCF_AligningCommunities_0.pdf


Obesity in Western New York… Erie County

• Obesity and Related Illnesses:

• The percentage of Erie County adults who are overweight or obese is 64.8%, which is higher than the New York State rate (60%). Nearly 30% are obese. As illustrated in the chart, Erie County’s adult obesity rate is higher than in New York State but lower than in the rest of the country.

• http://www.health.ny.gov/statistics/chac/general/g75.htm

Erie County Community Health Assessment 2014-2017., www2.erie.gov/health/sites/www2.erie.gov.health/files/.../pdfs/cha.pdf

http://www.health.ny.gov/statistics/chac/general/g75.htm

http://www.health.ny.gov/statistics/chac/general/g75.htm


Quality Measurement: Domains

33 quality measures are separated into the following four

key domains that will serve as the basis for assessing,

benchmarking, rewarding, and improving ACO quality

performance:

1. Patient/Caregiver Experience

2. Care Coordination/Patient Safety

3. Preventive Health

4. Clinical Care for At Risk Population


ACO Preventive Health

Domain Measure Name

14 Preventive Health Influenza Immunization

15 Preventive Health Pneumococcal Vaccination

16 Preventive Health Adult Weight Screening and Follow-up

17 Preventive Health Tobacco Use Assessment and Tobacco Cessation Intervention

18 Preventive Health Depression Screening

19 Preventive Health Colorectal Cancer Screening

20 Preventive Health Mammography Screening

21 Preventive Health

Proportion of Adults 18+ who had their Blood Pressure Measured within the preceding years


PREV-9: Preventive Care and Screening:

Body Mass Index (BMI) Screening and

Follow-Up • Description

– Percentage of patients aged 18 years and older with a documented BMI during the encounter or during the previous six months AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the encounter

Normal Parameters: Age 65 years and older BMI ≥ 23 and < 30

Age 18 – 64 years BMI ≥ 18.5 and < 25

• What are the DOCUMENTATION REQUIREMENTS relative to the Quality Action? – The patient’s medical record must contain:

BMI screening date and results; and

If a follow-up plan is required, documentation of discussion of the plan. The follow-up plan must be specified as an intervention that pertains to the BMI outside of normal parameters

" Quality Measure and Performance Standards". Available online at

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Quality_Measures_Standards.html. Accessed May 2015


PREV-9: BMI Assessment and Follow-Up

• WHEN must the Quality Action be performed? – The BMI screening may take place during the most recent visit within the measurement

period or within the 6 months prior to that visit.

– If a follow-up plan is needed, it must be documented during the visit in which the abnormal BMI is documented.

• Guidance

– Follow-up may include, but is not limited to: documentation of education, referral (such as, a registered dietician, nutritionist, occupational therapist, physical therapist, primary care provider, exercise physiologist, mental health professional, or surgeon), pharmacological interventions or dietary supplements, exercise counseling or nutrition counseling

– Follow-up plan is not required for normal BMI

" Quality Measure and Performance Standards".Available online at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/sharedsavingsprogram/Quality_Measures_Standards.html. Accessed May 2015

ADULT WEIGHT SCREENING


Body Mass Index (BMI) Weight Screening

BMI Weight Status

Below 18.5 Underweight

18.5 – 24.9 Normal or Healthy Weight

25.0 – 29.9 Overweight

30.0 and Above Obese


Underweight Facts

• Underweight individuals: – may be more prone to infection due to weak and

easily compromised immune systems

– tend to have low muscle mass, hair loss, and in some cases disrupted hormone regulation

– may have disruptions in intake and absorption of vital nutrients, including amino acids, vitamins, and minerals

– may be at increased risk of osteoporosis and anemia


Causes of Underweight

• Physical

– Genetics

– Illness – wasting diseases, medication side effects

• Psychological

– Eating disorders

– Stress


Obesity Facts

• More than one-third (34.9% or 78.6 million) of U.S. adults are obese

• Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death

• The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars

• The medical costs for people who are obese were $1,429 higher than those of normal weight


Causes of Overweight/Obesity

• Lack of energy balance – calories in vs. out

• Genetics

• Health conditions/ medication side effects

• Inactive lifestyle

• Environment


Treatment Approaches

• Coordination of interdisciplinary team

• Structured diet and physical activity

• Setting realistic goals

• Based on individual’s wants and needs


Addressing the Weight Issue

• Set an effective tone for communication

• Assess patient’s readiness/ motivation

• Build a partnership with the patient


Set an Effective Tone for Communication

• Establish rapport

– Communicate a non-judgmental attitude

– Address your patient’s main health concerns first

• Solicit permission

– Ask the patient if they are comfortable discussing their weight

• Use preferred terms

– “weight”, “unhealthy body weight”, “BMI”


Assess the Patient’s Readiness/ Motivation

• Reasons and motivation to lose/ gain weight

• Previous attempts at weight loss/ gain

• Support from family and friends

• Understanding of risks and benefits

• Attitudes toward health behaviors

• Potential barriers


Build a Partnership with the Patient

• Ask patients how ready they are to adopt healthier eating/ exercise habits

• Work as a partner to develop a plan – 2-3 specific, realistic goals

• Some questions to ask: – What are your goals regarding your weight?

– What kind of changes would you be willing to start with?

– What kind of help would you like from me about your weight?


Helping Patients Stick with Goals

• Acknowledge patients’ progress

• Offering praise can help boost self-esteem and keep them motivated

• Note changes in related risk factors, not just weight

– Blood sugar, BP, cholesterol

• Discuss any setbacks

– Help them overcome challenges and set new goals


Insurance Resources

• Many companies will pay for health/ fitness related expenses

– Gym memberships

– Silver Sneakers

• Insurance reimbursement for Medical Nutrition Therapy (MNT)


Insurance Coverage - Medicare

• Medical Nutrition Therapy

– CPT Codes – 97802, 97803, 97804

– Covered for beneficiaries with – DM, Renal Disease, or Kidney Transplant in past 3 years

– Covered for 3 hours total in first year, 2 hours in later years

– Covered with $0 copay


Insurance Coverage - Medicare

• Intensive Behavioral Therapy for Obesity

– RDs may not bill directly for this service – may provide service if billed “incident to a physician service”

– HCPCS code – G0447

– Covered for:

• 1 visit per week in month 1

• 1 visit every other week for months 2-6 (patient must have lost 3kg at 6 months to continue)

• 1 visit every month for months 7-12

– Covered with $0 Copay


Insurance Coverage – Managed Medicare

• Very individualized

• IHA Medicare

– Most plans – all diagnoses, no visit limits, $0 copay (some self funded – PCP level copay)

• BC/BS Medicare Advantage

– Some plans only cover Diabetes, others cover MNT


Catholic Health Resources

• CMP In-office Nutrition Program

• Catholic Health Nutrition Services


In-office Nutrition Program

• RD sees patients within physician’s office

– One-on-one nutrition counseling

– Group classes

• Services billed directly to patient’s insurance

– For patient’s without nutrition coverage – office can set their own cash price

• RDs chart directly into EMR


Catholic Health Nutrition Services

• Private nutritional counseling services are available by appointment at several locations

Before You Make Your Appointment:

• To receive counseling, you must have a prescription or referral from your doctor indicating your diet order and diagnosis code

• Check with your insurance carrier determine coverage

– If your insurance plan does not cover this service, you will be billed


Catholic Health Nutrition Services

• Kenmore Mercy Hospital 2950 Elmwood Avenue Kenmore, NY 14217

• Mercy Comprehensive Care Center 397 Louisiana Street Buffalo, NY 14204

• Mercy OB/GYN Center 515 Abbott Road Suite 302 Buffalo, NY 14220

• Mount St. Mary's Hospital 5300 Military Road Lewiston, NY 14092

• OLV Family Care Center 227 Ridge Road Lackawanna, NY 14218

• Sisters of Charity Hospital 2157 Main Street Buffalo, NY 14214

• St. Joseph Campus

2605 Harlem Road Cheektowaga, NY 14225

http://www.chsbuffalo.org/Facilities/Hospitals/KenmoreMercyHospital

http://www.chsbuffalo.org/Facilities/PrimaryCare/MercyComprehensiveCareCenter



http://www.chsbuffalo.org/Facilities/PrimaryCare/MercyOBGYNCenter

http://www.chsbuffalo.org/Facilities/Hospitals/MountStMarysHospital

http://www.chsbuffalo.org/Facilities/PrimaryCare/OLVFamilyCareCenter

http://www.chsbuffalo.org/Facilities/Hospitals/SistersofCharityHospital

http://www.chsbuffalo.org/Facilities/Hospitals/StJosephCampus


Community Resources

• Stay Fit Dining (Erie County)

• Eat Well Stay Well (Niagara County)

• Meals on Wheels

• Niagara County Home Delivered Meals

• Tops Market Grocery Delivery Services

• Food Pantries/ Soup Kitchens


Stay Fit Dining

• Erie County’s congregate dining program.

• Includes nutritious hot lunch meals, providing 1/3 of vitamin, mineral, and protein requirements for people >60 years old.

• Locations also offer free nutrition counseling and education by a registered dietitian.


Stay Fit Dining

• Many Stay Fit Dining sites offer Group Senior Fitness exercise programs


Stay Fit Dining

• The program is open Monday – Friday

• Must be 60 years of age or older

• Advanced reservations are required

• Suggested confidential contribution of $3, but no one is denied a meal if they are unable to contribute


Stay Fit Dining

• This program is brought to you by the Erie County Department of Senior Services

(716) 858-8526

• To Find out more about the program or a site near you, call (716) 858-7639

• http://www2.erie.gov/seniorservices/index.php?q=nutrition-amp-dining-stay-fit-dining-program

http://www2.erie.gov/seniorservices/index.php?q=nutrition-amp-dining-stay-fit-dining-program















Stay Fit Dining Program Locations

Akron-Newstead Sr. Citizen 5691 Cummings Rd., Akron

14001 542-6645

Exercise, Exercise Classes,

Cards, Social Events, Speakers

Alden Community Center 13116 Main St., Alden 14004 937-4280

Social Events, Bingo, Cards,

Transprt To Shop. Mall Trips

(T, W & R only)

Amherst Senior Center 370 John James Audubon

Pkwy., Amherst 14228 636-3050

Exercise, Travel Club, Social

Events, Classes

Autumnwood Senior Center 1800 Clinton St., Buffalo 14206 826-7895

Aerobics, Exercise Classes,

Exercise Equipment,

Entertainment



Baptist Manor (Senior

Apartments)

276 Linwood Ave., Buffalo

14209 819-1820

Exercise Classes, Meditation,

crossword puzzles, walking

program, bible study, PACE

program, guest speakers,

movies, weights

The Belle Center 104 Maryland Ave., Buffalo

14201 845-0485 x35

Shopping, Transportation,

Bingo, Exercise, Swimming

Pool

Blasdell (Lilly Housing Dev.) 36 Arthur Ave., Blasdell 14219 827-0245 Exercise Classes, Painting &

Craft Classes, Social Clubs

Boston Senior Citizen Center 8500 Boston State Rd., Boston

14025 941-5773

Bingo, Exercise Classes, Pool

Table, Arts & Crafts, Cards



Buffalo Urban League 86 Pine St., Buffalo 14206 847-8951 Exercise Classes, Travel,

Picnics, Arts & Crafts

Cayuga Village Apartments 100 Hutchens Dr.,

Cheektowaga 14227 668-3109 Bingo, Cards, Parties

Cheektowaga Senior Center 3349 Broadway, Cheektowaga

14227 686-3930

Cafeteria style lunch daily at

noon, fun activities all the

time!

Clarence Senior Citizen Center 4600 Thompson Rd., Clarence

14031 633-5138

Ceramics, Yoga, Cards, Exercise

Classes, Social Events

Concord Nutrition Site 405 West Main Street,

Springville 14141 592-4487 Holiday Parties


Stay Fit Dining Program Locations Edward Saunders Community

Center/CAO

2777 Bailey Ave., Buffalo

14215 332-4380

Exercise classes, Movie night,

Line Dancing, and more!

Friends to the Elderly 118 E. Utica St., Buffalo 14209 882-0602

Gloria Parks Community

Center 3242 Main St., Buffalo 14214 832-1010x226

Line Dancing, Swimming,

Exercise Classes

Hamburg Dining Site

(Creekbend Heights

Apartments)

25 Buffalo St., Hamburg 14075 648-2414 Exercise Classes, Church

Service, Bingo

Hispanics United of Buffalo 254 Virginia St., Buffalo, NY

14201 856-7110

Music, Dancing, Games &

Crafts



Infant of Prague 921 Cleveland Dr., Buffalo

14225 632-9632/632-9574 Bingo, Social Functions, Cards

Kenmore Senior Nutrition

Program

135 Wilber Ave., Kenmore, NY

14217 873-7500

Lots of activities in bright and

cheerful setting - plenty of

parking, Van for shopping,

Exercise Classes

Lackawanna Senior Center 230 Martin Rd., Lackawanna

14218 827-6669 Exercise Classes, Line Dancing

Lancaster Senior Center 100 Oxford Pl., Lancaster

14086 685-3498

Games, Travel, Computer

Classes, Bingo, Cards/ Pinochle

Maryvale East Senior Complex

(Moorman)

100 Moorman Dr.,

Cheektowaga 14225 583-1190 Bingo, Parties, Cards & Dinner



Moot Senior Center 292 High St., Buffalo 14204 882-4637

Table Games, Bingo, Card Club,

Exercise, Exercise Classes,

Chorus, Bowling, Bible Study,

Crafts

North Buffalo Community

Center 203 Sanders Rd., Buffalo 14216 874-6133 ext. 14

Bingo, Cards, Line Dancing,

Swimming, Exercise Classes

Northwest Buffalo Community

Center 155 Lawn Ave., Buffalo 14207 876-8108, X17

Exercise, Bingo, Cards, Social

Events, Swimming, Ceramics,

Crafts

Orchard Park Senior Center 70 Linwood Ave., Orchard Park

14127 662-8378

Weight Management, Yoga,

Dancing, Exercise, Pool Tables,

Crafts, Trips, Computer Classes



Salvation Army Headquarters 960 Main St., Buffalo 14202 883-9800, ext 259

Free Chiropractic Treatments,

Arts & Crafts, Exercise Rm.,

Trips

Salvation Army-Tonawanda

Branch

46 Broad St., Tonawanda

14150 693-3110

Free Breakfast Tues &Thurs,

Bible Study, Social Events,

Exercise, Bingo

Schiller Park Senior Center 2057 Genesee St., Buffalo

14211 895-2727

Exercise Classes, Line Dancing,

Movies

Seneca Babcock Community

Center

1168 Seneca St., Buffalo,NY

14210 822-5094

Cards, Wednesday Bingo,

fitness program with state of

the art equipment, ceramics,

computer room, occasional

trips

Sloan Senior Center 140 Halstead St., Sloan 14212 897-1389 Bingo, Exercise Classes,

Pokeno, Raffles, Social Events



Southwind Landing 5074 Transit Rd., Depew 14043 206-0281

Affordable senior housing

units managed by Belmont

Shelter Corp.

Tosh Collins Center 35 Cazenovia Ave., Buffalo

14220 828-1093 Bingo, Ceramics, Cards, Travel

Town of Aurora Senior Center 101 King St., Suite A, East

Aurora, NY 14052 652-7934

Exercise, Computers, Ceramics,

Fitness Center, Yoga, Tai Chi,

Cards, Movies, Trips

Town of Evans Senior Center 999 Sturgeon Rd., Derby, NY

14047 947-0974

Bingo, Cards, Billiards, Theme

Parties, Exercise, Line Dancing,

Trips

Town of Hamburg Sr. Ctr. 4150 Sowles Rd., Hamburg

14075 646-0096 For info call 646-0665


Stay Fit Dining Program Locations United Church Manor

50 North Ave., West Seneca

14224 668-5804 Tai Chi, Bingo, Tea Socials

Violet Housing Complex 11 Haley

Lane Ckeektowaga 14227 534-6486

Bingo, Cards, Club 99 Exercise

Classes

Walden Park Senior Complex 101 Bakos Dr., Buffalo 14211 892-9070 Bingo, Shopping, Travel

West Seneca Senior Center 4620 Seneca St., West Seneca

14224 675-9288

Dance, Exercise Classes,

Fitness Center, Bingo, Tai Chi,

Trips, Arts & Crafts, Ceramics

William-Emslie Senior Center 585 William St., Buffalo 14206 845-5440

Social Events, Games, line

dance, fitness, state of the art

exercise equip., Olympic size

swimming pool, cards, travel,

social, ceramics, knitting,

sewing


Eat Well Stay Well Program

• Niagara County’s congregate dining program for seniors.

• For adults 60 years of age and older, as well as

their spouse, as well as disabled, dependent child of any age

• Contact the nutrition site between 10am-1pm Monday through Friday, and make reservations at least 24 hours in advance to order a meal


Eat Well Stay Well Program

• Site Locations: Contact Niagara County Office of the Aging (716) 438-4020 or (716) 438-4030

• Contributions are recommended, but not mandatory - $3 per meal for persons over 60, $4 per meal for persons under 60.


Niagara County Nutrition Assessment, Education, and

Counseling Program

• Individual nutrition assessment and counseling on any topic and for individuals with chronic diseases such as: – diabetes, heart disease, hypertension, chronic obstructive

pulmonary disease, renal disease, malnutrition, weight reduction or weight gain, cholesterol, etc.

• Group educational programs are also available – Group counseling can be in-home, at the Office for the

Aging or at any nutrition site location


Niagara County Nutrition Assessment, Education, and

Counseling Program

• Must be 60 years of age or older, proof of age will be required

• Transportation may be available for some site locations

• Free service, donations are excepted

• 8am-4pm Mon-Fri

• Call Niagara County Office for the Aging at (716) 438-4030 for more information


Congregate Dining Sites Chautauqua County

• The Taft Center (ADC) Christ First United Methodist Church 663 Lakeview Avenue, Jamestown

– (716) 664-9759

• Chautauqua Colony Apartments 2109 Southwestern Drive, Lakewood

• First United Methodist 3594 Church Street, Kennedy

– (716) 661-7845 (OFA)



• Dunkirk Senior Center

45 Cliffstar Ct., Dunkirk

• Dunkirk/North County ADC Center

St. John's United Church of Christ

733 Central Avenue, Dunkirk – (716) 366-8786

• Fredonia Dining Site

32 Moore Street, Fredonia

• Steger Apts

15 North Main Street, Dunkirk



• Forestville Fire Hall

18 Chestnut Street, Forestville

• Herbert Star Apartments

54 Central Avenue, Brocton

– (716) 363-4845 (OFA)

• Portage Hill Apartments

40 Evans Street, Mayville

– (716) 753-3475

• Westfield YWCA

58 South Portage St, Westfield

– (716)326-6842



• Findley Lake Comm. Bldg. 2883 North Road, Findley Lake

– (716) 769-7204

• Westfield Adult Day Care Center 58 South Portage, Westfield

– (716) 326-6842

• Sinclairville Fire Hall 30 Main Street, Sinclairville

– (716) 962-3455


Meals On Wheels (MOW)

• An option for patients 60 years of age and older, and are unable to take care of meal preparation

• Call Erie County Department of Senior Services at (716) 858-8526 to set up a free in-home evaluation



• Once it is determined the patient qualifies for home delivered meals, they will also be evaluated for any other services or benefits they may be eligible for

• A doctor’s note indicating a specific diet is required (ie. Low Salt, Diabetic, etc.)



• Volunteers deliver 2 meals mid-day Monday through Friday: lunch and dinner

• Menus are planned by registered dietitians and provide 2/3 of RDA nutritional requirements

• A confidential contribution of $3.50/meal ($7.00/day) is suggested to maintain the meal program, but no one is denied meals if they are unable to contribute


MOW of WNY Locations Served

• Buffalo, Lackawanna, Angola, Brant, Derby, Evans, Eden, Hamburg, Farnham, N. Collins, Collins, Clarence, Akron, Newstead, Lancaster, Depew, Cheektowaga, Sloan, West Seneca, Orchard Park, Elma, East Aurora, South Wales, parts of Marilla, parts of Amherst, Williamsville, Snyder, Boston, Colden, Concord, Holland, parts of Sardinia


Other MOW Contacts

• Amherst MOW: (716) 636-3065

• Ken-Ton MOW: (716) 874-3595

• Alden MOW: (716) 937-7105

• North Tonawanda MOW: (716) 693-1663

– Also serves City of Tonawanda

• East Aurora Portable Meals (village only): (716) 652-4858

• Grand Island MOW: (716) 773-9682


Niagara Co. Home Delivered Meals

• For home-bound individuals who are unable to provide meals for themselves

• Must be 60 years of age and older

• Phone screening and a full assessment by the county are required

• Call Niagara County Office for the Aging (716) 438-4031


Niagara Co. Home Delivered Meals

• Contributions are recommended but not mandatory - $2.50 per meal

• Hours of operation are 6am-2pm Mon-Fri


Tops Market Home Delivery Services: Dimino’s

• Dimino’s Lewiston Tops Market – 906 Center St., Lewiston, NY, 14092

• Orders taken 8am-2pm Mon-Fri, deliveries 8am-

4pm Mon – Fri

• They will shop for and deliver your groceries

• Must be a resident of Lewiston, Youngstown, Ransomville, Porter, or Deveaux


Tops Market Home Delivery Services: Dimino’s

• For more info or to set up service, call (716) 215-1350

• Shopping service fee is 10% of total bill

• Delivery fee can range from $3-$8 depending on location of delivery

• Private Pay (cash, check, credit)


Tops Market Home Delivery Services: Perna Family

• Perna Family Lockport Tops – 5827 South Transit Rd, Lockport, NY, 14094

• Orders taken between 8am and 12pm Mon-Fri, deliveries are between 11am-4pm Mon-Fri

• Order your groceries in the morning for delivery that afternoon


Tops Market Home Delivery Service: Perna Family

• Must reside in city or town of Lockport, Wrights Corners, or Pendleton

• Delivery fee is based on distance from store. Will be waived for orders over $50 before shopping service fee

• Shopping service fee is 10% of total bill

• Private pay (cash, check (must be approved), credit, benefit card)

• Call (716) 439-4366 or (716) 799-5377 for more info or to set up service


Food Pantries/Soup Kitchens

• If you know someone in need, call the Department of Intake and Assistance Unit @ (716) 858-8526

• They will direct you to the nearest food pantry, dining room/soup kitchen, or assist with other programs conducted by the Salvation Army, Catholic Charities, and Federal Nutrition Programs (WIC, SNAP).


Food Pantries/Soup Kitchen

• There are over 160 pantries/soup kitchens in the WNY

• Food for All pantry locator:

http://www.foodbankwny.org/GetHelp/AgencyLocator.aspx




EMR Documentation


EMR Documentation

Preventive Medicine Counseling Care Goal Follow up plan Answer question(s)

QUESTIONS??


Announcements

• Next Lunch & Learn: 9/16/2015

• Topic: "Medicare Annual Wellness Visit- What should be documented?"

• Reminders:

– May Specialty meetings-Video available

– ACO Notifications

Sheree M Arnold

ACO Clinical Transformation Specialist

[email protected]

(716)862-2453

mailto:[email protected]

chsbuffalo.org

Lifeskills Diabetes Self-Management Education Program

Recognized by the American Diabetes Association*

2015 Schedule and Registration Form

Education is the key to successfully managing your diabetes. You are the most important member of the diabetes management team. We will provide you with the knowledge and skills to control your blood sugar and live a healthy life. This is a 4-part education program. Attendance at all 4 classes is recommended.

What Will I Learn

Lifeskills Diabetes Self-Management 4-Part Education ProgramRecognized by the American Diabetes Association

•What is Diabetes?•Nutrition & Meal Planning•Exercise & Physical Activity•Medications•Self Blood Glucose Monitoring•Dealing with High & Low Blood Sugars

Additional ServicesCall HealthConnection at (716) 447-6205 for details.• Individual Instruction available for:

• Insulin administration• Home blood glucose testing• Gestational diabetes

A prescription from your doctor is necessary for this service. Those with Medicare must have a physician referral.

•Continuing Your Journey • An optional follow-up session• Available for those who attended Lifeskills Diabetes

Self-Management classes

• Avoiding Long-term Complications• Foot Care• Goal Setting & Problem Solving• Emotional Adjustment & Stress Management• Healthy Lifestyle Changes

Attend This Program If You Are•Recently Diagnosed with Diabetes•Changing your Treatment or Nutrition Plan•Having Difficulty Controlling your Diabetes

Facility

Dates

Important Points•Your physician will be contacted to complete the required referral form.•A family member or friend may attend with you at no additional cost.• If you need specific assistance, please let us know when you register.•Program sites are handicapped accessible.

I registered for a Diabetes Education

class at

which will be held on .

Who Will Teach the ClassesSpecialists in diabetes education including certified diabetes educators, registered nurses, registered dieticians, physical therapists, and podiatrists.

Name: Last First Middle Date of Birth: Phone Number: Address: City: State: Zip: Marital Status: Race: Gender: Male FemaleYour Religion: Employer Name: Endocrinologist: Office Location:Primary Doctor’s Name: Office Location:Emergency Contact Name:Emergency Contact Phone Number: Please check if someone will be accompanying you.

Insurance Information No Insurance/Self PayPrimary Insurance: Policy Number: Group: Plan:Secondary Insurance: Policy Number:Subscriber: Subscriber’s Employer:Subscriber’s relationship to patient:Medicaid Number: Medicare Number:

Confirmation of class registration will be mailed to you at the address you provide.

2015 Diabetes Education Classes Registration Form

1. Please complete the form below and check the box next to the class session you wish to attend and in which you would like to enroll. 2. Submit the completed form to one of the following: Mail: Catholic Health’s HealthConnection Administrative & Regional Training Center 144 Genesee St., 5th Floor l Buffalo, NY 14203 Fax: (716) 706-2545 Email: [email protected]. If you need payment assistance, please call (716) 601-3600 for information.

InsuranceAs a courtesy to you, Catholic Health (Kenmore Mercy Hospital, Mercy Hospital of Buffalo, Sisters of Charity Hospital, and Sisters Hospital, St. Joseph campus) will bill your insurance company for the classes that you attend. If your insurance does not cover the cost of the class, you will receive a bill and will be responsible for applicable co-payments, co-insurance, deductibles, or for services not covered. Contact your insurance carrier to find out if they cover all or part of your cost. You may need to pay for the class and submit a receipt to your insurance carrier for reimbursement.

Please remember to bring your photo ID and insurance card to class as a copy will be made.

* The American Diabetes Association recognizes this education service as meeting the National Standards for Diabetes Self-Management Education. Catholic Health’s Lifeskills program has been recognized by the American Diabetes Association for Quality Self-Management Education.

February 3, 5, 10 & 12 @ 1 p.m. March 17, 19, 25 & 26 @ 6 p.m. April 14, 16, 21 & 23 @ 1 p.m. May 12, 14, 19 & 21 @ 1 p.m. June 2, 4, 9 & 11 @ 1 p.m. July 21, 23, 28 & 30 @ 6 p.m. August 11, 13, 18 & 20 @ 1 p.m. September 15, 17, 22 & 24 @ 1 p.m. October 6, 8, 13 & 15 @ 1 p.m. November 10, 12, 17 & 19 @ 6 p.m.December 1, 3, 8 & 10 @ 1 p.m.

Kenmore Mercy Hospital2950 Elmwood Ave., Community Room l Kenmore, NY 14217

Mercy Hospital of BuffaloMarian Professional Building - Lower Level l 515 Abbott Rd. l Buffalo, NY 14220 January 14, 15, 21 & 22 @ 9 a.m. February 4, 5, 11 & 12 @ 9 a.m. March 4, 5, 11 & 12 @ 9 a.m. April 29, 30, May 6 & 7 @ 9 a.m. June 3,4, 10 & 11 @ 9 a.m. August 12, 13, 19 & 20 @ 9 a.m. September 9, 10, 16 & 17 @ 9 a.m. November 4, 5, 11 & 12 @ 9 a.m. December 2, 3, 9 & 10 @ 9 a.m.

January 7, 8, 14 & 15 @ 9 a.m. April 8, 9, 15 & 16 @ 9 a.m. July 8, 9, 15 & 16 @ 9 a.m. October 7, 8, 14 & 15 @ 9 a.m.

Sisters of Charity Hospital2157 Main St. l Buffalo, NY 14214

January 6, 8, 13 & 15 @ 2 p.m. February 16, 18, 23 & 25 @ 9 a.m. March 3, 5, 10 & 12 @ 2 p.m. April 20, 22, 27 & 29 @ 6 p.m. June 15, 17, 22 & 24 @ 9 a.m. August 17, 19, 24 & 26 @ 9 a.m. September 21, 23, 28 & 30 @ 6 p.m. November 30, December 2, 7 & 9 @ 6 p.m.

Sisters of Charity Hospital, St. Joseph Campus2605 Harlem Rd. l Cheektowaga, NY 14225

Check the box next to the class session you wish to attend and in which you would like to enroll.

3STEP ONE Make the Most of the Patient Visit

and Set an Effective Tone for Communication

Patients who are overweight or obese generally have a history of dealing with afrustrating and visible problem. They often experience discrimination fromstrangers, and even hurtful comments from health professionals. Many patientshowever, are comfortable discussing weight with their physician1. So setting aneffective tone for communication is critical. Providers need to establish rapportwith patients, solicit permission to discuss weight issues, and use preferredterms such as "weight," "excess weight," and "BMI" when describing obesity2.

Tips:

■ Ask the patient if he/she would be comfortable with discussing generalhealth including weight.

■ Ask about the patient’s weight history and how excess weight has affectedhis/her life.

■ Be careful to communicate a nonjudgmental attitude that distinguishesbetween the weight problem and the patient with the problem.

■ Express your concerns about the health risks associated with excess weightand how this is affecting the patient (review patient’s BMI, waist circumfer-ence, and health risks).

stepsTO I N I T I AT E D I S C U S S I O N

about weight managementW I T H YO U R PAT I E N T S

Effective treatment for obesity is based on skillful and empathetic communication

between practitioners and patients.

U . S . D E PA R T M E N T O F H E A LT H A N D H U M A N S E R V I C E SNat ional Inst i tutes of Heal thNat ional Heart , Lung, and Blood Inst i tute

STEP TWO Assess Patient’s Motivation/Readiness to Lose Weight

Evaluate the patient’s readiness to make the necessary lifestyle changes to loseweight. This should include: reasons and motivation to lose weight, previousattempts at weight loss, expected support from family and friends, understand-ing risks and benefits, attitudes toward physical activity, and potential barriers.

Tips:

■ Ask patient if he/she would consider lifestyle changes to lose weight andimprove health.

Example: On a scale of 1-10, with 10 being 100 percent ready to takeaction, how ready are you to lose weight?

• An answer between 1-4 means the patient has very little intention tolose weight, so you could followup with "What would have to happenfor you to be more ready?" or "What would it take to increase yourscore?"

• An answer between 5-7 means the patient is ambivalent about takingaction to lose weight, therefore acknowledge the patients ambivalence ina nonjudgmental manner and invite the patient to bring up the subject atany time in the future. You could also followup with, "What wouldhave to happen for you to be more ready?" or "What would it take toincrease your score?"

• An answer between 8-10 means the patient is very willing to takeaction about his/her weight.

■ Ask patient about previous attempts to lose weight. What were the mostsuccessful and least successful?

■ Ask about the patient’s physical activity level and attitude toward exercise.

■ Ask patient about the level of support he/she can expect from family andfriends.

■ Ask about potential barriers to success.

Adults who are overweight or obese have a greater chance of developing

high blood pressure, high blood cholesterol or other lipid disorders, type 2

diabetes, heart disease, stroke, and certain cancers. To determine your

patient’s relative risk for these diseases:

1. Calculate body mass index (BMI), by measuring weight relative to

height.

BMI = (Weight in pounds ÷ Height in inches ÷ Height in inches) x 703)or use the BMI Table on page 46 of the Practical Guide.

2. Measure waist circumference.

3. Use the table below to give you an idea of whether your patient’s BMI

combined with waist circumference increases his/her disease risks.

WEIGH YOUR PATIENT’S HEALTH RISKS

A weight loss of 5-10 percent of initial weight will lower the risk of disease.See pages 79-80 in the Practical Guide for a quick reference tool to help

assess, classify, and treat (ACT) your overweight and obese patients.

Underweight

Normal †

Overweight

Obesity

Extreme Obesity

<18.5

18.5–24.9

25.0–29.9

30.0–34.9

35.0–39.9

≥40

BMI(kg/m2)

–

–

Increased

High

Very High

Extremely High

Men ≤40 in. (≤102 cm)Women ≤ 35 in. (≤88 cm)

Disease Risk*(Relative to Normal Weightand Waist Circumference)

–

–

High

Very High

Very High

Extremely High

>40 in. (>102 cm)>35 in. (>88 cm)

I

II

III

ObesityClass

CLASSIFICATION OF OVERWEIGHT AND OBESITY by BMI, Waist Circumference, and Associated Disease Risk*

* Disease risk for type 2 diabetes, hypertension, and CVD.

† Increased waist circumference can also be a marker for increased risk even in persons of normal weight.

Adapted from “Preventing and Managing the Global Epidemic of Obesity Report of the World Health Organization

Consultation of Obesity.” WHO, Geneva, June 1997

STEP THREE Build a Partnership With the Patient

Set goals for behavior change together with the patient. A recent study showedthat most patients with a weight problem would like assistance with weightmanagement, specifically dietary and physical activity advice, and help with set-ting realistic goals.

Tips:

■ Discuss the collaborative effort needed for setting goals.

■ Ask what the patient’s weight goals are.

■ Explain that even a small weight loss of 10 percent of initial weight canlower health risks.

■ Ask patient if he/she would like help with diet and physical activity.

■ Select two or three measurable, achievable goals and discuss steps needed toachieve them.

■ Provide and discuss patient handouts in The Practical Guide and/or referpatient to dietitian or exercise specialist.

Sources:

■ The NHLBI Practical Guide: Identification, Evaluation, and Treatment ofOverweight and Obesity in Adults, NIH Publication No. 00-4084 or 02-4084

■ Materials from the Centers for Obesity Research and Education (C.O.R.E.)

■ Potter MB, Vu JD, Croughan-Minihane M. Weight management: whatpatients want from their primary care physicians. J Fam Pract2001;50(6):513-8

■ Wadden TA, Anderson DA, Poter GD, et al. Obese women’s perceptions oftheir physician’s weight management attitudes and practices.” Arch FamMed 2000;9(9):854-60

N AT I O N A L I N S T I T U T E S O F H E A LT HNational Heart, Lung, and Blood Institute

NIH Publication No. 02-5211November 2002

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