Contents
Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or diabetics with no diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or in the 12 months prior to the measurement period
Numerator:
Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following:
- Diabetic with a diagnosis of retinopathy that overlaps the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period
- Diabetic with no diagnosis of retinopathy overlapping the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period or the year prior to the measurement period
Denominator: Patients 18-75 years of age by the end of the measurement period with diabetes with a visit during the measurement period.
Exclusions/Exceptions:
- Exclude patients who are in hospice care for any part of 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 who are living a nursing home any time on or before the end 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 also meet any of the following advanced illness criteria:
- Advanced illness with two outpatient encounters during the measurement period or the year prior
- OR advanced illness with one inpatient encounter during the measurement period or the year prior
- OR taking dementia medications during the measurement period or the year prior
How to document frailty in Elation:
To document frailty in Elation, both conditions below have to be met:
- add a frailty diagnosis to the patient's Problem List
- meet one of the following criteria:
- record an advanced illness diagnosis in 2 outpatient encounters
- record an advanced illness in 1 inpatient counter
- record a dementia medication in the patient's chart
User Tip: Attachments with frailty codes and advanced illness codes can be found in the
Attachments section of this article.
You can also document the use of a frailty device to claim the first part of the exclusion. To do so, please add a document tag that represents the frailty device to a visit note from the reporting year. The document tag should have the device code and description and can be created directly in the visit note or within your Document Tags Settings page in Elation. Attachments with device codes are also in the
Attachments section of this article.
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Elation's Clinical Reminders Feature allows you to easily document screenings.
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When a patient is due for a Diabetic Eye Exam, an alert will report at the top of the patient's visit note:
- After selecting address, relevant options for documenting or addressing the Eye Exam will be given.
- For patients who do not have an office visit:
- Ensure the patient has a diagnosis of Diabetes (E11.9, etc):
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Scroll to the bottom of their clinical profile, where their Health Maintenance items appear.
- Click on Diabetes Eye Exam, indicate the date of the patient’s most recent Eye Exam and click Save New.
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Tag a report in the patient’s record with the result-corresponding one of the following document tags. This alone will meet the health maintenance requirement (Reference: Tag Reports and Notes with Document Tags):
- EYE EXAM (NEGATIVE FOR RETINOPATHY)
- EYE EXAM (POSITIVE FOR RETINOPATHY)
Diabetes is the seventh leading cause of death in the United States. In 2017, diabetes affected approximately 34 million Americans (10.5 percent 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, 2020b). 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, and premature death (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 percent increase from the estimated $245 billion spent on diabetes in 2012 (American Diabetes Association, 2018).
Diabetic retinopathy is progressive damage to the small blood vessels in the retina that may result in loss of vision. It is the leading cause of blindness in adults between 20-74 years of age. Approximately 4.1 million adults are affected by diabetic retinopathy (CDC, 2020c).
Reference: Measure Information from CMS
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