Antinori-Lent has 3 decades of career experience in diabetes and nursing that’s earned her an impressive “alphabet soup” of credentials behind her name: MSN, RN, ACNS-BC, BC-ADM, CDCES, FADCES.
In short, she’s a programmatic nurse specialist at UPMC’s nursing education and research department with a huge passion for relationship-based care.
Despite the technology hiccups, she says she’s proud of what the ADCES conference offered, and she has strong ambitions for the org going forward — in navigating telehealth, addressing access and affordability, and tackling diversity and inclusivity issues in healthcare.
Below is our conversation with her.
You must have been disappointed by the ADCES online conference issues.
You can blame it on 2020 when something goes wrong these days. It was definitely a new experience for many of us, but we made it through.
We’re a resilient and forgiving group, so once they fixed the platform everything went smoothly. Being virtual, the great thing is that it also allows you to go through the sessions at your convenience, and they’re open through November.
I felt the worst for the IT people, both those who work for Ugo as well as our ADCES team, working around the clock to fix everything.
Once we got everything worked out, members thought the programming was excellent. How many ADCES presidents can say they presided over the annual meeting as an avatar?
What were the big #ADCES20 themes and highlights that stood out to you?
We had something for everyone. We also were able to highlight what’s important for diabetes care and education specialists, but also what’s important from a clinical perspective.
There were some late-breaking sessions to make sure to give people what they needed now, given everything going on in the world with COVID-19, racial unrest, and telehealth.
We incorporated all of that. Overall, I don’t know if I can pick one thing — and I don’t know that it’s fair to — because there were definitely so many issues addressed.
What has ADCES seen in the past year during the org’s big rebranding effort?
It’s been an exciting past year, getting to the point of a name change not only for our organization but also for our specialists and moving forward with our new strategic initiative called Project Vision.
We were all ready to start moving forward on that wheel and begin putting it into practice, to continue being relevant and shining a light on diabetes specialists being the heart of the diabetes care continuum.
Then everything changed with COVID. It didn’t exactly go away. Our focus just became different than we had planned.
How would you describe the pandemic effect on telehealth?
Before COVID, some were allowed to do telehealth based on geography or the distance between you and a diabetes care and education program in rural areas.
But the rules and regulations on telehealth were so limiting, that didn’t work for most of us. The fact that it was only for a certain group of people, and not the greater good, meant that not everyone who needed to could take advantage of telehealth.
I think the pandemic pushed us further into the future faster… we were trying to protect ourselves from spreading the virus, but also in the process we realized this was efficient and really works.
And you helped lobby for big changes in telehealth policy and billing?
Yes, we have an amazing advocacy department that worked with our members and Centers for Medicare and Medicaid Services (CMS) to get the word out on adding nurses as well as pharmacists to the roster of those who can bill for diabetes care and education services.
That announcement from CMS came Aug. 12, just a day before the ADCES meeting began. That was a big change, because it had just been allowed for dietitians originally, and then hospital-based specialists. Now it’s across the board for everyone.
A large portion of our membership is nurses, followed by dietitians and then pharmacists within those accredited and recognized programs. So we want to make sure that all of our members have the training and can be reimbursed for those services.
We didn’t want to leave anyone out for telehealth. My understanding is we had over 700 members who wrote letters to CMS about this change. We hope that will continue on past COVID-19.
How much do you think lifting those telehealth restrictions will expand access to DCES care?
We certainly do know that requiring in-person visits can be a barrier, not just now but historically. Some people don’t have the transportation or can’t leave work to visit. The costs — gas, parking, the visit itself. The hope is that telehealth is addressing some of that.
We also know that a big barrier for diabetes education is that referral from physicians, and it’s such a small percentage of Medicare patients who see a diabetes care and education specialist.
With private insurance, it’s a little higher but still quite low. Seeing a DCES means patients are getting a foundational understanding of how to care for their diabetes, or help with support or resources that we can provide.
How is ADCES addressing diversity, bias, and healthcare inequities in diabetes?
I know that ADCES has been working towards identifying how we can improve on diversity and inclusion of those entering into the specialty of diabetes care and education.
Personally, as I stated in my president’s address, I feel we have been moving too slowly. We started the conversation. Now we need to continue it with a more aggressive plan. It’s time to do more. Not simply talk about it. It is time for action.
On the topic of implicit bias in healthcare, it is unconscionable. Yet we are reminded that it still does exist. As an association, and as an individual, the first step moving forward is to learn more about biases, truly understand the issue, what our communities of color are experiencing, and its impact on diabetes care and education. We need to listen and gain trust.
Sometimes I feel we just don’t know what we don’t know. As a mostly white and female specialty, our understanding is limited. As such, we have plans to engage with those who can provide the insight and guidance we need to determine our next steps, which I believe must be actionable.
Second, we must begin to identify our role as DCES’s — and I believe we have a role to play in this — in improving health inequities.
How did ADCES address this at the annual meeting?
Cultural competency has long been a pillar of care we promote. We have a “community of interest” group dedicated to it, offering tools and tip sheets that get into specific issues and how to approach them, and many articles, blog posts, podcasts, etc., expanding on the topic for our members.
As a professional organization, we have programs and services that allow our members at the practice level to address the issues they see, including a subcommittee of our annual meeting committee on diversity and inclusion.
One of our goals… with the annual meeting as we pivoted to virtual was to ensure that the reality we were seeing out there in the real world was addressed within the framework of the sessions.
So, just as we have added COVID sessions, telehealth sessions, we also added racial equity sessions — including a general session — to highlight its importance.
What were other focus topics?
Technology is a focus going forward, to make sure that diabetes care and education specialists have the tools they need to work at the top of their practice from a technology perspective.
We had a lot of tech sessions, though we had planned to have more at the live conference with hands-on product training.
Behavioral health is also important, and we had some great sessions on that over the 4 days, allowing members to learn more about what they needed the most.
What about insulin affordability?
We’re all about insulin affordability, of course. It’s very important for our members to know what is taking place and all the resources that exist for patients to afford and access insulin.
ADCES has an insulin affordability resource online, breaking down the different programs and options that are out there. We of course support any type of legislative work that’s moving forward to improve on affordability and access, but as educators our role is to make sure DCES’s know what’s going on and how they can help patients who might need it.
Personally, for me, being in the hospital setting, I always tell the nurses and providers is that they need to put care management into place long before discharge… because we have to find out if what’s being prescribed, what the patient has gotten in the hospital, is something they can afford on the outpatient side.
A lot of times, even if someone has insurance, the copay is outrageous — and that’s not standard across all health insurers, as it varies by plan. It’s a huge issue, to make sure patients can get the insulin and meds they need to live.
As diabetes care and education specialists, we’re not just about teaching you how to use the insulin or a pen and checking blood sugars, but we’re also involved in making sure you have what you need to access those things.
Can you share your personal philosophy on diabetes care?
I am all about relationship-based care, and believe that a patient’s success of care — sticking to their regimen, ability to reach their care team — depends on that established relationship with their provider. It’s very powerful when they know we’re cheering them on.
When things do go wrong, they know we’re there to support and encourage them. So, yes, while I do think telehealth is efficient and can be used for many purposes in diabetes care, you can’t underestimate the power of that person-to-person relationship.
It puts more meaning into it, and that’s an area I would like to do more research on, to explore the benefits of that kind of relationship on care and outcomes. Relationships matter, but we don’t know just how much that really makes an impact.
Where do you see the future of diabetes care and education heading?
Without a doubt, we’re going to continue doing all we can to assure that healthcare systems and payers and providers know that we’re here. That they know about the great work DCES’s do, that we want to help them and their patients.
We need to let people know that we can do great work collaboratively, to be the heart, soul, and center of diabetes care.