Non-reimbursable Workload in Pediatric Diabetes Care – the Providers' Perspective

Objective: In this study, we quantified the amount of time that pediatric diabetes care providers spend in non-reimbursable activities and evaluated the predictors related to clinic structure and educational and behavioral care diabetes support. Methods: We distributed an anonymous electronic survey via email to Pediatric Endocrine Society (PES) members and requested information about their practice and about non-reimbursable time spent during an average week not on call. Results: A total of 96 diabetes providers completed the survey. Most providers spent 1-2 hours a day on non-billable activities and 60% of them worked on weekends. Providers from medium sized programs and those without fellowships saw more patients than providers from small and large programs and those with fellowships. The same groups had the least assistance from certified diabetes care and education specialists (CDCES) and social workers. Providers from practices allowing CDCES to review blood glucose data and adjust insulin spent significantly less time on this activity themselves. Conclusions: We call for the development of new reimbursement models, noting increasing demands of technology, need for longitudinal care between visits and ensuring sustainability and equity of pediatric diabetes care.