COMPREHENSIVE DIABETES CARE
Measure definition:Percentage of patients with diabetes (type 1 & 2) ages 18-75 years old in compliance with HbA1c, retinal eye exam, and medical attention for nephropathy.
HbA1c
- Medicare patients: HbA1c must be less than or equal to 9%
- Commercial patients: HbA1c must be less than 8%
Best practices and tips for talking to patients
- All lab values for HbA1c should be documented in the medical record as they provide valuable quality information and directly impact patient care.
- Submit CPT Category II Codes to ensure results are documented.
- Outreach to patients to schedule follow-up appointments and lab tests.
Retinal eye exam
One of the following must be met for compliance for a retinal eye exam:
- Retinal or dilated eye exam in 2021
- Negative retinal or dilated eye exam (negative for retinopathy) in 2020
- Bilateral eye enucleation any time during the patient’s history through 31 de diciembre de 2021
Best practices and tips for talking to patients
- Talk to patients regarding the importance of an annual retinal eye exam, as diabetes can cause impaired vision.
- Discuss with your patients what to expect at the eye exam screening.
- Ensure the patient shares their diabetes diagnosis with their eye care professional.
Nephropathy screening
- A urine test for albumin or protein
- Evidence of treatment for nephropathy or ACE/ARB therapy
- Evidence of stage 4 chronic kidney disease
- Evidence of end-stage renal disease or dialysis
- Evidence of nephrectomy or kidney transplant
- A visit with a nephrologist
- At least one ACE inhibitor or ARB dispensing event
Best practices and tips for talking to patients
- Coordinate care with a specialist such as an endocrinologist, nephrologist, or cardiologist.
Exclusions
- Patients who do not have a diagnosis of diabetes, in any setting, in 2020 or 2021 and have a diagnosis of polycystic ovarian syndrome, gestational diabetes, or steroid-induced diabetes, in any setting, in 2020 or 2021
- Patients on palliative care or in hospice care/services in 2021
- Age 66 or older with advanced illness and a frailty diagnosis in 2021