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Millions of diabetes patients are missing out on Medicare’s nutrition help

LOUISIANA WEEKLY — The estimated 15 million Medicare enrollees with diabetes or chronic kidney disease are eligible for the benefit, but the federal health insurance program for people 65 and older and some people with disabilities paid for only about 100,000 recipients to get the counseling in 2017, the latest year billing data is available. The data does not include the 20 million enrollees in private Medicare Advantage plans.

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Glucose meter with result sugar level, healthy food, dumbbells and centimeter, diabetes (Photo by: Ratmaner)

By Phil Galewitz

(Special from khn.org) — Louis Rocco has lived with diabetes for decades but, until he met with a registered dietitian in August, he didn’t know eating too much bread was dangerous for him.

“I’m Italian, and I always eat a lot of bread,” he said. After two hour-long visits with a dietitian — including a session at his local grocery store in Philadelphia — Rocco, 90, has noticed a difference in his health.

“It’s helped bring down my sugar readings,” he said of changes in his diet including eating less bread. “I wish I knew I could have had this help years ago.”

After getting a referral this summer from his doctor, Rocco learned that Medicare covers personal nutritional counseling for people with diabetes or kidney disease.

The estimated 15 million Medicare enrollees with diabetes or chronic kidney disease are eligible for the benefit, but the federal health insurance program for people 65 and older and some people with disabilities paid for only about 100,000 recipients to get the counseling in 2017, the latest year billing data is available. The data does not include the 20 million enrollees in private Medicare Advantage plans.

Health experts say the little-used benefit represents a lost opportunity for beneficiaries to improve their health — and for the program to save money by preventing costly complications from the diseases.

An estimated one in four people 65 and older have diabetes and one in three have chronic kidney disease. Kidney disease is often a complication of diabetes.

The prevalence of diabetes has risen markedly in the past 20 years and the condition is more common as people age.

Nationwide, there are 100,000 registered dietitians — more than enough to meet demand, said Krista Yoder Latortue, executive director of Family Food in Philadelphia, which employs about 50 dietitians including the one who visited Rocco. Medicare data showed about 3,500 dietitians billed the program for nutritional counseling in 2017.

The problem may be that not enough physicians know about the Medicare benefit. Doctors have to refer patients to a dietitian.

Congress approved the benefit, which began in 2002, after studies found medical nutrition counseling leads to improved health outcomes and fewer complications for older patients. Under the preventive health provisions of the Affordable Care Act, the counseling has been available without out-of-pocket costs to Medicare beneficiaries since 2011.

Medicare pays for three hours of dietary counseling during the first year the benefit is used and two hours in subsequent years. A doctor can appeal to Medicare for additional nutritional therapy if the physician believes it is medically necessary.

Larry Lipman, 70, of Falls Church, Va., said he was shocked to learn he had diabetes earlier this year because he’s relatively thin and is an avid cyclist.

When his doctor recommended meeting with a dietitian, he not only said yes but also brought along his wife, who does most of the cooking.

“It was great because I could ask specific questions and get into the nitty-gritty about how I eat, what I eat and when I eat,” said Lipman, a retired journalist.

“I’ve learned I needed to cut down on portion sizes of rice and other things to keep my carbohydrates down,” he said. “I’m thinking more about what I eat every time and staying away from Doritos and ice cream.”

Doctors shoulder some of the blame for patients not getting dietary counseling by failing to refer them to dietitians.

“It’s a lot easier to prescribe a medication than it is to discuss the importance of nutrition and get patients to meet with a registered dietitian,” said Dr. Holly Kramer, a Chicago nephrologist and president of the National Kidney Foundation.

“I don’t understand how we have this burgeoning obesity and diabetes epidemic and we are not using dietitians in our clinics for all these patients, yet we are paying for all these things that mediate from the disease process such as arthritis, dialysis and amputations,” she said.

Jennifer Weis, a registered dietitian in Philadelphia, said the limited hours Medicare covers is frustrating given how difficult it is to change behaviors in older adults.

“It’s better than nothing, but in my mind is not sufficient,” she said.

Doctors might not be aware of the Medicare option since “it’s a challenge to keep up with what is a covered benefit and what is not,” said Dr. Michael Munger, chairman of the American Academy of Family Physicians who practices in Overland Park, Kan. He said that many doctors who don’t practice with a large health system may not be familiar with dietitians in their community.

For convenience, Munger said, he refers his diabetes patients to a nurse practitioner in his office for nutritional counseling. But only registered dietitians are covered under the Medicare benefit, so his Medicare patients face a copayment for that service.

Nutritional counseling is not the only underused Medicare benefit that can prevent health complications.

Fewer than five percent of Medicare beneficiaries use their 10 to 12 hours of diabetes self-management training benefit, which can cover individual and group sessions providing tips for eating healthily, being active, monitoring blood sugar, taking drugs and reducing risks.

Part of the problem, said Yoder Latortue in Philadelphia, is there is a lot of misinformation about whom the public can trust on nutrition advice.

“Everyone eats and everyone has an opinion,” Yoder Latortue said.

Lauri Wright, a Jacksonville, Fla., registered dietitian and spokeswoman for the Academy of Nutrition and Dietetics, said the federal Centers for Medicare & Medicaid Services sends out notices to health providers once a year but more information is needed.

About 10,600 registered dietitians have enrolled to treat Medicare patients, a CMS spokeswoman said. She said the agency has been advising health providers about the benefit and promoting it to enrollees on its website and its annual handbook that it sends to beneficiaries.

Still, “I think because only two diseases are covered by Medicare and the rest aren’t, it falls off everybody’s radar,” Wright said.

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

This article originally published in the September 16, 2019 print edition of The Louisiana Weekly newspaper.

This article originally appeared in The Louisiana Weekly.

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Black Artists in America, Installation Three Wraps at the Dixon Gallery and Gardens

TRI-STATE DEFENDER — With 50+ paintings, sculptures and assemblages, the exhibit features artists like Varnette Honeywood from Los Angeles, whose pieces appeared in Bill Coby’s private collection (before they were auctioned off) and on “The Cosby Show.” Also included are works by Alonzo Davis, another Los Angeles artist who opened one of the first galleries there where Black Artists could exhibit. 

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By Candace A. Gray | Tri-State Defender

The tulips gleefully greet those who enter the gates at the Dixon Gallery & Gardens on an almost spring day. More than 650,000 bulbs of various hues are currently on display. And they are truly breathtaking.

Inside the gallery, and equally as breathtaking, is the “Black Artists in America, From the Bicentennial to September 11” exhibit, which runs through Sunday, March 29. This is the third installment of a three-part series that started years ago and illustrates part of the Black experience through visual arts in the 20th century.

“This story picks up where part two left off,’’ said Kevin Sharp, the Linda W. and S. Herbert Rhea director for the Dixon. “This era is when we really start to see the emergence of these important Black artists’ agency and freedom shine through. They start to say and express what they want to, and it was a really beautiful time.”

With 50+ paintings, sculptures and assemblages, the exhibit features artists like Varnette Honeywood from Los Angeles, whose pieces appeared in Bill Coby’s private collection (before they were auctioned off) and on “The Cosby Show.” Also included are works by Alonzo Davis, another Los Angeles artist who opened one of the first galleries there where Black Artists could exhibit.

“Though [Davis] was from LA, he actually lived in Memphis for a decade,” said Sharp. “He was a dean at Memphis College of Art, and later opened the first gallery in New York owned and operated by black curators.”

Another featured artist is former NFL player, Ernie Barnes. His work is distinctive. Where have you seen one of his most popular paintings, Sugar Shack? On the end scene and credits of the hit show “Good Times.” His piece Saturday Night, Durham, North Carolina, 1974 is in this collection.

Memphis native James Little’s “The War Baby: The Triptych” is among more than 50 works featured in “Black Artists in America, From the Bicentennial to September 11” at the Dixon Gallery & Gardens, the final installment of a three-part series highlighting the impact and evolution of Black artists through 2011.

Memphis native James Little’s “The War Baby: The Triptych” is among more than 50 works featured in “Black Artists in America, From the Bicentennial to September 11” at the Dixon Gallery & Gardens, the final installment of a three-part series highlighting the impact and evolution of Black artists through 2011.

The exhibit features other artists with Memphis ties, including abstract painter James Little, who was raised in a segregated Memphis and attended Memphis Academy of Art (before it was Memphis College of Art). He later moved to New York, became a teacher and an internationally acclaimed fixture in the art world in 2022 when he was named a Whitney Biennial selected artist at the Whitney Museum of American Art in New York.

Other artists like Romare Bearden, who had a Southern experience but lived up North, were featured in all three installments.

“During this period of time, he was a major figure,” said Sharp. “He wrote one of the first books on the history of African American art during a time when there were more Black academics, art teachers, more Black everything!”

Speaking of Black educators, Sharp said the head curator behind this tri-part series and Dixon’s partner in the arts is Earnestine Jenkins, Ph.D., an art history professor at the University of Memphis, who also earned a Master of Arts degree from Memphis State University (now UofM).  “We began working with Dr. Jenkins in 2018,” he said.

Sharp explained that it takes a team of curators, registrars, counterparts at other museums, and more, about three years to assemble an exhibit like this. It came together quite seamlessly, he added. Each room conjured up more jaw-dropping “wows” than the one before it. Each piece worked with the others to tell the story of Black people and their collective experience during this time period.

One of the last artists about whom Sharp shared information was Bettye Saar, who will turn 100 years old this year. She’s been working in Los Angeles for 80 years and is finally getting her due. Her medium is collages or assemblages, and an incredible work of hers is on display. She’s married to an artist and has two daughters, also artists.

The exhibit catalogue bears some of these artists’ stories, among other scholarly information.

The exhibit, presented by the Joe Orgill Family Fund for Exhibitions, is culturally and colorfully rich. It is a must see and admission to the Dixon is free.

Visit https://www.dixon.org/ to learn more.

Fun Facts: An original James Little design lives in the flooring of the basketball court at Tom Lee Park, and he makes and mixes his own paint colors.

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Grief, Advocacy, and Education: A Counselor Reflects on Black Maternal Health

SAN DIEGO VOICE & VIEWPOINT — Last month healthcare leaders, birth workers, and community members gathered to honor the legacy of Charleston native Dr. Janell Green Smith, a nurse-midwife and doctor of nursing practice who died in January from childbirth complications. She had participated in more than 300 births and specialized in helping Black women give birth safely.  

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By Jennifer Porter Gore | Word-In-Black | San Diego Voice and Viewpoint

In 2024, the number of U.S. mothers who died as a result of pregnancy or childbirth dropped compared to 2023. But while slightly fewer Black mothers died that year, they still had three times the mortality rate of white women.

South Carolina’s rates of maternal deaths outpaced even the national rates. In fact, the state’s overall rate of maternal deaths between 2019 and 2023 was higher than all but eight states and the District of Columbia.

Last month healthcare leaders, birth workers, and community members gathered to honor the legacy of Charleston native Dr. Janell Green Smith, a nurse-midwife and doctor of nursing practice who died in January from childbirth complications. She had participated in more than 300 births and specialized in helping Black women give birth safely.

Her death shocked the community and her colleagues who are determined to address concerns about Black maternal health. The event also covered the importance of protecting mental health during grief and of men’s role in solving the maternal health crisis.

As both a therapist and a father, Lawrence Lovell, a licensed professional counselor and founder of Breakthrough Solutions, discussed ways the event’s attendees could process their grief over Green Smith’s death. He also shared ways male partners can advocate for women’s maternal health during pregnancy and childbirth.

Lovell spoke not just as a therapist but also as a father whose own family had briefly crossed paths with Green Smith. The event, he said, emerged organically from a moment of collective mourning.

Despite the grief, “it was still, like, a really beautiful event, a much-needed event, and it almost felt like we were all giving each other a collective family hug,” says Lovell.

His connection to Green Smith, Lovell says, was brief but meaningful during his wife’s pregnancy with their second child. Green Smith was practicing at the same birthing center where they had their child. She began practicing in Greenville a short time later.Even that short connection carried significance for Lovell, given the small number of Black maternal health professionals.

Lovell did not initially plan to become a mental health practitioner; he chose the career path after graduating from college, when someone suggested he consider psychology. His interest deepened when he noticed how few Black men work in mental health.

“Being Black man and playing football in college, there weren’t a lot of people that look like me talking about mental health,” says Lovell. “[I wanted] to give people that look like me an opportunity to work with someone that looks like them.”

Working with Expectant and New Parents

Lovell often counsels couples preparing for parenthood by, helping partners understand what a successful pregnancy, childbirth, and postpartum recovery look like. That often means helping women manage postpartum depression.

As a man, Lovell says, it’s “humbling” that a woman “just trusts me enough to work with me through their pregnancy or their postpartum recovery.”

In his work, Lovell has noticed how few men understand pregnancy before they experience it with their partner. Because early pregnancy symptoms are often invisible, he says, men may underestimate how much support a mom-to-be actually needs.

“Sometimes they may not realize they don’t know much about pregnancy and what to expect in those three trimesters,” Lovell says. “I tell a lot of the men that just because you can’t see [she’s pregnant] doesn’t mean that she won’t appreciate your intense support in that first trimester.”

Education about pregnancy and postpartum recovery, he says, can change how men support their partners.

Teaching Advocacy in the Delivery Room

Another major focus of Lovell’s counseling is preparing men to advocate for mothers during labor.

“Helping men understand what pregnancy looks like: what delivery is going to look like, and what are the realistic expectations that I should have of myself in postpartum,” he says.

Lovell encourages partners to be honest about their expectations for what will happen during delivery. He helps them prepare for the big day by discussing the birth plan and knowing how to quickly recognize problems. Clear communication, he says, prevents misunderstandings.

He regularly trains men to ask their partners detailed questions about their expectations during and after pregnancy. Advocacy in medical settings can be especially important and requires attention to details the mother may not be able to address.

“It’s always important to fine-tune things and truly understand what helps your partner feel most supported,” Lovell says. “Instead of guessing, you should ask.”

Lovell recalls a moment during the birth of his first child when he had to take that role.

During the delivery, “I felt like something wasn’t as sanitary as I’d like it to be,” he says. “I asked, ‘Hey, can you switch those out? Can you change your gloves?’”

Lovell has a succinct but powerful message he regularly shares with clients’ families, and he shared it with attendees at last month’s event.

“Just to believe women,” he says. “I’ve worked with different couples, and sometimes I’m not really sure that there’s enough empathy from the men.”

That includes how women express pain.

“If a woman says, ‘my pain is at a nine,’ just because how you would express yourself at a nine is different than how she’s expressing herself at [that level] doesn’t mean you shouldn’t believe her,” he says.

Empathy, he says, can change outcomes far beyond the delivery room.

“We’ve got to believe women when they’re talking about their experiences and their feelings and their pain,” he says. “I think there’s a lot that we can prevent if we empathize better.”

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Future of Florida’s Black History Museum in Limbo

JACKSONVILLE FREE PRESS — A proposal sponsored by Tom Leek, a Republican from Ormond Beach, has now passed the Senate in back-to-back legislative sessions. But the House version, filed by Kiyan Michael, a Jacksonville Republican, did not receive final approval in either year, effectively stalling the effort.

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Jacksonville Free Press

Plans to establish a long-awaited Black history museum in Florida are once again on hold after legislation needed to advance the project failed to clear the state House for a second consecutive year, despite repeated approval in the Senate.

A proposal sponsored by Tom Leek, a Republican from Ormond Beach, has now passed the Senate in back-to-back legislative sessions. But the House version, filed by Kiyan Michael, a Jacksonville Republican, did not receive final approval in either year, effectively stalling the effort.

Under Florida law, identical or similar bills must pass both chambers before heading to the governor’s desk. Without House approval, the legislation has been unable to move forward, leaving the project in limbo. Long journey, contested location.

The proposed museum, formally known as the Florida Museum of Black History, has been years in the making, with lawmakers and community leaders framing it as a long-overdue institution to preserve and showcase the state’s African American heritage .A central point of contention has been the museum’s location. St. Augustine — widely recognized as the nation’s oldest city and a site deeply tied to both slavery and early Black history — emerged as the leading contender. Supporters argue the city’s historical significance makes it a natural home for the museum. However, competing interests and regional considerations have fueled debate, slowing consensus among lawmakers.

While the Senate-backed measure has consistently advanced, the lack of alignment in the House has underscored ongoing divisions about how and where the project should take shape.

The holdup in the Florida House appears to be less about opposition to the museum itself and more about a combination of procedural bottlenecks, unresolved structural issues, and lingering disagreements over how the project should be formalized and governed.

Despite the legislative setbacks, Republican Gov. Ron DeSantis has publicly voiced support for the museum. Speaking last month during the unveiling of a statue of abolitionist Frederick Douglass in St. Augustine, DeSantis said the project would move forward “one way or another,” signaling an intent to see the museum built regardless of legislative hurdles.

The anticipated museum has already cleared several hurdles. St. Johns County signed an agreement last year with Florida Memorial University to use the land that once housed its campus last year’s legislative session netted $1 million in funding for St. Johns County to work on planning and design for the museum. However, its anticipated that a million $3 million is needed.

Still, without statutory approval to finalize key components — including governance, funding mechanisms and site selection — the project remains largely conceptual.
With the House bill failing again, the timeline for the museum’s development is unclear. Lawmakers could revisit the proposal in the next legislative session, but any further delays risk pushing the project back several more years. Advocates warn that continued inaction could stall momentum for a museum many see as critical to telling a fuller, more accurate story of Florida’s past. For now, the effort remains paused — caught between political support at the top and legislative gridlock within the Capitol.

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