Health promotion and patient education benefits for employees.

One step that employers can take to assure that employees receive such education services is pursuing coverage of education as a separate service. For some time now, insurers have shown interest in patient education services (15-17, 61), but patient education "integral to care" is typically covered only as a part of the "per diem" in the case of hospitals or as part of the visit fee in the case of outpatient visits. Education for patients with diabetes is being covered experimentally as a separate service in at least 17 states. Physicians whose practice is composed largely of "cognitive services" rather than "procedures" are also interested in education as a reimbursable service. The same arguments as described in relation to coverage of risk reduction services generally apply to this case. Education programs for employees who are under medical care can improve their adherence to the recommended regimen and hence can improve the effectiveness of care. Education and counseling prior to surgical and other stressful procedures decrease stress and the need for pain medications, and they can shorten the length of hospital stays. Education is an important component of programs to substitute home care for hospital care or expensive outpatient care. Currently, however, a patient cannot rely on usual providers of medical care to offer adequate education. Reimbursement for patient education on a selected, experimental basis is probably warranted for chronic conditions requiring complex adjustments and regimens. Cases of asthma where there is a history of hospitalization or emergency room visits is an excellent possibility. The experience of covering diabetes education should be monitored to help resolve the debate.