Contents
Report on the percentage of patients 18-75 years of age with diabetes who had who had a glycemic status assessment (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) > 9.0% during the measurement period. This is a reverse measure; the goal is to ensure patients keep their A1c < 9%. Practices should try to lower their percentage for this reverse measure.
Patients whose most recent glycemic status assessment (HbA1c or GMI) (performed during the measurement period) is >9.0% or is missing, or was not performed during the measurement period.
Denominator
Patients 18-75 years of age with diabetes with a visit during the measurement period.
- Exclude patients who are in hospice care for any part of the measurement period.
- Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time during the measurement period.
- Exclude patients receiving palliative care for any part of the measurement period.
- Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who meet any of the following criteria:
- Advanced illness diagnosis during the measurement period or the year prior
- OR taking dementia medications during the measurement period or the year prior
Elation Workflows
ℹ️ NOTE
Elation has implemented dedicated workflows that reflect standardized requirements we do not control for certification to ensure structured and reportable tracking of measure specifications for supported electronic Clinical Quality Measures. To optimize performance per the specifications, please adhere precisely to the workflows outlined in the referenced Help Center article.
Documenting diabetes diagnosis in the patient's chart
Patients must have an active diagnosis of diabetes recorded in their chart during the measurement period. Elation looks for a diabetes ICD-10 code in either a visit note for the measurement period or in the Problem List.
To add a diabetes diagnosis to the Problem List:
| 1 | Go to the Problem List and click + Add Problem. |
| 2 | Search for the appropriate diabetes diagnosis and then select it from the results. |
| 3 | Adjust the Title and Dx Date as needed. |
| 4 | Click Save. |
| 1 |
Click Address in the Hemoglobin A1c is undocumented or uncontrolled (>9%) reminder at the top of the visit note.
- This reminder will automatically appear if ALL of the following denominator requirements are met:
- Patient is 18 years of age or older at time of visit.
- Patient has an active diagnosis of diabetes either recorded:
- in a visit note dated on or prior to December 31, 2026 OR
- in the Problem List with a start date on or prior to December 31, 2026.
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| 2 |
To immediately address Numerator requirements by recording an existing HbA1c result:
- Click Enter A1c.
- Update the Title, Collected and Resulted fields as needed.
- Click Hemoglobin A1c.
- Enter the HbA1c result into the % field.
- Click Sign or Sign & Export to Note to save the record.
|
| 3a | If the result is <9% then the patient will not appear in the Numerator. This is the desired result for this reverse measure. |
| 3b | If the result is >9% then the patient will automatically appear in the Numerator. |
All other selections in the Clinical Reminder do not impact numerator or denominator requirements and are provided solely for follow-up purposes.
Clicking Dismiss will dismiss the reminder and the reminder will not appear again until a new visit note draft is opened.
Meeting measurement requirements through an electronic lab report
When HbA1c lab results come into Elation through an electronic lab interface, Elation automatically reviews each result and determines whether it satisfies the measure requirements.
If you receive HbA1c lab results via paper or fax, you must record the result as structured data in order for Elation to determines whether it satisfies the measure requirements.
| 1 | Open the patient's chart. |
| 2 | Click Notes -> Point-of-Care Labs. |
| 3 | Update the Title, Collected and Resulted fields as needed. |
| 4 | Click Hemoglobin A1c. |
| 5 | Enter the HbA1c result into the % field. |
| 6 | Click Sign or Sign & Export to Note to save the record. |
Documenting exclusions/exceptions
| Exclusion/Exception | Step(s) |
|
Exclude patients who are in hospice care for any part of the measurement period.
|
Click + Tag at the bottom of the visit note draft and add the appropriate document tag from this list:
- EXCLUSION: HOSPICE CARE
- EXCLUSION: IP DISCHARGE STATUS TO HEALTH CARE FACILITY FOR HOSPICE CARE
- EXCLUSION: IP DISCHARGE STATUS TO HOME FOR HOSPICE CARE
|
| Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time during the measurement period. |
Click + Tag at the bottom of the visit note draft and add the following document tag - EXCLUSION: Living Long Term in a Nursing Home
|
| Exclude patients receiving palliative care for any part of the measurement period. | Click + Tag at the bottom of the visit note draft and add the following document tag - EXCLUSION: PALLIATIVE CARE |
|
Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who meet any of the following criteria:
- Advanced illness diagnosis during the measurement period or the year prior
- OR taking dementia medications during the measurement period or the year prior
| See below. |
Documenting frailty
To document frailty in Elation using
- Frailty diagnosis, advanced illness codes and/or medications
- Add a frailty diagnosis to the Problem List. You must select from one of the frailty codes listed here.
- Record one of the following:
- an advanced illness diagnosis in 2 outpatient encounters using one of the codes listed here.
- an advanced illness in 1 inpatient counter using one of the codes listed here.
- a dementia medication in the patient's chart.
- A frailty device code
- Click + Tag at the bottom of the visit note draft.
- Create/add the appropriate document tag for the relevant frailty device from this list of frailty device codes.
- If you are creating the document tag for the first time for a frailty device, make sure the document tag has the device's HCPCS code listed.
Diabetes is the seventh leading cause of death in the United States. In 2017, diabetes affected approximately 34 million Americans (10.5% of the U.S. population) and killed approximately 84,000 people (Centers for Disease Control and Prevention [CDC], 2020a). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC, 2020a). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney damage, and amputation of feet or legs (CDC, 2018).
In 2017, diabetes cost the U.S. an estimated $327 billion: $237 billion in direct medical costs and $90 billion in reduced productivity. This is a 34% increase from the estimated $245 billion spent on diabetes in 2012 (American Diabetes Association [ADA], 2018).
Controlling A1c blood levels helps reduce the risk of microvascular complications (eye, kidney and nerve diseases) (ADA, 2020).
Reference: Measure Information from CMS
Although this measure can be satisfied by manually entering lab results, we recommend getting interfaced lab results, if possible. Electronic lab results directly from the lab will also count towards this measure, limiting the need for additional documentation.
If there are 2 HbA1c results for the patient for the same date, which result will the patient use for the measure?
If there are 2 HbA1c results for the patient for the same date, the lowest result will be used for the measure.
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