40280382-5abd-fa46-015b-49956e7c383aDiabetes: Eye ExamCMS131131d90bdab4-b9d2-4329-9993-5c34e2c0dc666.2.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement periodThis Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). The Measure is copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses must be approved by NCQA and are subject to a license at the discretion of NCQA. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved.
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CPT(R) contained in the Measure specifications is copyright 2004-2016 American Medical Association. LOINC(R) copyright 2004-2016 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2016 International Health Terminology Standards Development Organisation. ICD-10 copyright 2016 World Health Organization. All Rights Reserved.
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Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].ProportionProcessNoneNoneNoneAs the seventh leading cause of death in the U.S., diabetes kills approximately 75,000 people a year (CDC FastStats 2015). Diabetes is a group of diseases marked by high blood glucose levels, resulting from the body's inability to produce or use insulin (CDC Statistics 2014, ADA Basics 2013). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death. (CDC Fact Sheet 2014).
In 2012, diabetes cost the U.S. an estimated $245 billion: $176 billion in direct medical costs and $69 billion in reduced productivity. This is a 41 percent increase from the estimated $174 billion spent on diabetes in 2007 (ADA Economic 2013).
In 2005-2008, of adults with diabetes aged 40 years or older, 4.2 million (28.5%) people had diabetic retinopathy, damage to the small blood vessels in the retina that may result in loss of vision. (CDC Statistics, 2014).American Diabetes Association (ADA) (2017):
- Adults with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes. (Level of evidence: B)
- Patients with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of the diagnosis of diabetes. (Level of evidence: B)Higher score indicates better qualityAmerican Diabetes Association. Microvascular complications and foot care. Sec. 10. In Standards of Medical Care in Diabetes 2017. Diabetes Care 2017;40(Suppl. 1):S88-S98American Diabetes Association. 2009. "Standards of Medical Care in Diabetes-2009." Diabetes Care 2009 32 (Suppl 1):S6-S12. doi:10.2337/dc09-S006.American Diabetes Association. 2013. Diabetes Basics. www.diabetes.org/diabetes-basics/?loc=GlobalNavDBAmerican Diabetes Association (ADA). April 2013. Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care. Vol. 36 no. 4 1033-46. http://care.diabetesjournals.org/content/36/4/1033.fullCenters for Disease Control and Prevention (CDC). 2014. National Diabetes Statistics Report.
http://www.cdc.gov/diabetes/pdfs/data/2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.pdfCenters for Disease Control and Prevention (CDC). 2015. FastStats: Deaths and Mortality. www.cdc.gov/nchs/fastats/deaths.htm.Centers for Disease Control and Prevention. 2014. CDC Features. Diabetes Latest. www.cdc.gov/features/diabetesfactsheet/.NoneOnly patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.
The eye exam must be performed by an ophthalmologist or optometrist.TBDPatients 18-75 years of age with diabetes with a visit during the measurement periodEquals Initial PopulationExclude patients who were in hospice care during the measurement yearPatients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following:
A retinal or dilated eye exam by an eye care professional in the measurement period or a negative retinal exam (no evidence of retinopathy) by an eye care professional in the year prior to the measurement periodNot ApplicableNoneFor every patient evaluated by this measure also identify payer, race, ethnicity and sexNone