Top 6 Things to Know About the 2022 Revision of National Standards for DSMES
Jan 20, 2022, 14:00 PM
By Sacha Uelmen, RDN, CDCES, ADCES Director of Diabetes Education and Prevention Programs and member of the National Standards Taskforce
The Task Force has finished its work and the new 2022 National Standards for Diabetes Self-Management Education and Support (DSMES) has been published. I’m proud to say that this version brings more changes than ever before, all improvements! Here’s my rundown:
Reduction in standards from ten to six
Yes, you read that right – there are six National Standards for DSMES in 2022! But, they didn’t just squeeze ten standards into six. In some areas, practical concepts were combined. In other areas, concepts were eliminated where evidence was weak or non-existent. The changes may appear subtle on first read of the standards since many themes remain, but accredited and recognized DSMES programs will see the reduction in burden when reviewing their program binders for audits, and new programs will find the application process more practical, realistic and feasible given the challenges in today’s healthcare environment.
Quality coordinator and DSMES team combined into one standard
Quality coordinators: many of you serve as a sole instructor encompassing all roles on the team, but those of you leading multidisciplinary teams – you’re not alone – and the team has an important role to play in the success of your DSMES services. The 2022 National Standards maintain the importance of a quality coordinator, at the same time acknowledging that the team must also play their part in program planning, design, improvement and documentation. Qualifications and requirements for DSMES team members are more clearly defined. Solo practice settings are still included.
Where did the curriculum go?
Putting people first and focusing on delivery of DSMES is an important step toward improving health equity and access to these critical services. A stronger emphasis on personalizing DSMES and clarity on what that means is a welcome addition to ease the minds of many. It is certainly my hope that our DSMES services will see this as a license to do what led you to this specialty in the first place: Listen and support your participants through compassionate care and education.
Use your chosen curriculum as a base of knowledge to draw from but focus less on “checking the box” and more on the person with diabetes in front of you. DSMES is not a scripted event, and although the team should be delivering consistent concepts to ensure evidence-based continuity of care, meeting people where they are is at the core of Standard 4: Delivery and Design of DSMES Services. Though the concept is not new, the explanations are improved and easier to understand. The common conundrum of how to personalize when everyone needs to get the same information is better clarified. This section stresses the importance of thoughtful planning to guide implementation and ongoing delivery of DSMES services focused on your target population.
Ongoing support is highlighted as an essential part of DSMES and the 2022 National Standards emphasize the importance of follow up, highlighting that DSMES is an ongoing, lifelong relationship with the DSMES team and the person with diabetes. While at the same time acknowledging that ongoing support outside of DSMES should be encouraged, such as including family members and caregivers throughout the DSMES intervention, technology-enabled solutions other support resources are also encouraged between and beyond DSMES.
The “why” and “how” for DSMES documentation
Burdensome paperwork, complicated documentation that doesn’t align with other services, complex and confusing reporting and reimbursement requirements are all factors that distract from effective implementation of compassionate, quality DSMES interventions in today’s healthcare environment. This has been a key barrier in many communities with the greatest needs. The 2022 National Standards outline a clear documentation structure for DSMES services that can be implemented in any paper or electronic system. There is additional focus on the why: the importance of communication and collaboration across the care team. Busy primary providers need to be informed, but others on the team may have more frequent communications and be able to support and reinforce self-management behaviors.
A specific delineation between individual and aggregate outcomes is better described, with aggregate outcomes thoughtfully described in Standard 6 with the CQI.
Focus on administrative and/or stakeholder support for DSMES services at the organization and/or community level
Broad support for DSMES services is key to the success and growth of these critical services. In order to bill Medicare for DSMT, programs must identify a billing sponsor and be offering another billable service before they can get reimbursed for DSMES, yet previous iterations of the National Standards often implied that the programs could operate as a standalone business or unit within an organization. If programs within any care setting don’t have the financial and leadership support at the organizational level, they are challenged to support the ongoing needs of the people they serve in providing quality DSMES.
Despite the numerous benefits comparable and complementary with all other diabetes treatment options, strong and significant evidence that these services uniquely and directly reduce therapeutic inertia, growth of DSMES services has remained stagnant over the years. The pandemic has further hampered the growth of DSMES in many areas around the country. The importance of obtaining organizational support at the level equipped to ensure long term sustainability of the services, integration within the care team across the institution, inclusion and integration into EMR and telehealth resources that align with the DSMES team’s unique yet evolving role on the team are emphasized in the 2022 National Standards.
CQI is still there, but with more clarity and resources for the team.
Continuous quality improvement (CQI) is core to what we do every day, and the 2022 revision of the National Standards highlights more clarity around reporting metrics and outcomes. A thorough chart is included as part of Standard 6 that describes different types of outcomes and examples of each. An appendix is available online as a resource including assessment tools that may be used at the individual level to gather validated data that can inform CQI and encourage quality data reporting at the program level.
So, there you have the top 6 things to know about the 2022 revised National Standards for DSMES, now available through The Science of Diabetes Self-Management and Care. Check with your specific accrediting organization (ADCES DEAP or ADA ERP) to receive further guidance and timelines for programs applying for accreditation and existing programs to comply with 2022 National Standards.
The Huddle: Conversations with the Diabetes Care Team
Tune in to hear more about this major revision to the National Standards for DSMES from co-author Julie Valdes.
Want more on the history of the Standards? If so read on…
The “National Standards for Diabetes Patient Education Programs” were pilot tested around 1984 in response to both a mandate from Congress to “combat diabetes” and concerns about variability in the quality and quantity of diabetes education occurring nationally. The 1984 Standards highlighted 10 content areas that programs were encouraged to meet. In 1993, a task force was formed to review the standards and make recommendations for revisions and retention. In 1995, they became the National Standards for Diabetes Self-Management Education Programs and 22 standards were organized in 3 key areas: structure, process and outcomes.
The task force in 2000 reviewed and revised the standards, setting a 5-year review cycle in motion, and they became the National Standards for Diabetes Self-Management Education and were consolidated into 10 standards. Since that time, the National Standards have been updated and revised again in 2007, 2012 (when the “S” for support was added to DSME), and again in 2017 and 2021. Each task force faced was charged with ensuring the National Standards were relevant to the current healthcare environment but with an eye on the future.
Diabetes self-management training (DSMT) wasn’t reimbursed by CMS (Centers for Medicare & Medicaid Services) until 1997. The National Standards are now the basis for accreditation and recognition of DSMES services by ADCES DEAP and ADA ERP in order utilize the DSMT G-Codes. In 2021, the Task Force was focused on reducing administrative burden on programs implementing DSMES, while maintaining and increase quality of person-centered care. The 2022 National Standards update is meant to be a universal document that is easy to understand and can be implemented by the entire healthcare community.
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