When speaking with health plans about the Diabetes Eye Exam, this quality measure is commonly referred to as one of the most difficult measures to close. Since up to 50% of diabetic patients lack documentation of a retinal eye exam1, health plans and practices spend a significant amount of administrative time each year chasing charts to close this measure. The main reasons for this care gap are the existing patient workflow, patient compliance and access to transportation. In my conversations, most health plans and physician groups are interested in bringing HEDIS compliant eye exams directly to the patient.
Here are two solutions that I help payers implement:
1. Mobile initiatives. Payers and their mobile partners can close this measure during in-home patient assessment visits with a handheld fundus camera. Images are captured on the camera, remotely sent to an eye care specialist who will interpret the images and generate a diagnostic report based on the findings.
2. Partner with primary care physicians to implement point of care screening for diabetic retinopathy. Most practices will make an investment in a fundus camera when they know their payers will provide reimbursement for the service. Since these exams meet the HEDIS specifications, payers can easily document this measure when a practice provides the proper documentation. I recently worked with a large payer to establish the optimal billing process that will provide CPT reimbursement for the practice, while documenting the Diabetes Eye Exam for the health plan.
Both solutions reduce barriers to care that impact patient access and the practice’s ability to implement this type of solution. By bringing this technology to the patient, health plans can reduce the administrative work around closing this care gap while also improving patient care. Just send us a message and I can help with your initiative to close this quality measure.
Manager, Healthcare Economics and Reimbursement
Peter Boomer works with with Health Plans and Health Systems to improve HEDIS documentation while closing care gaps.
1 Lee DJ, Kumar N, Feuer WJ, et al. Dilated eye examination screening guideline compliance among patients with diabetes without a diabetic retinopathy diagnosis: the role of geographic access. BMJ Open Diabetes Research and Care 2014;2:e000031.doi:10.1136/bmjdrc-2014-000031
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