| Title |
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care |
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|---|---|---|---|---|
| CMS eCQM ID | CMS142v14 | CBE ID | Not Applicable | |
| MIPS Quality ID | 019 | |||
| Measure Steward | American Academy of Ophthalmology | |||
| Description | Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once during the measurement period | |||
| Measure Scoring | Proportion | |||
| Measure Type | Process | |||
| Stratification | None | |||
| Risk Adjustment | None | |||
| Rationale | Diabetic retinopathy is a prevalent complication of diabetes, estimated to affect 28.5% of diabetic patients in the US (Zhang et al., 2010). Diabetic retinopathy is a key indicator of systemic complications of diabetes (Zhang et al., 2010). Coordination of care between the eye care specialist and the physician managing a patient’s ongoing diabetes care is essential in stemming the progression of vision loss. Communication from the eye care specialist to a primary care physician facilitates the exchange of information about the severity and progression of a patient’s diabetic retinopathy, adherence to recommended ocular care, need for follow-up visits, and treatment plans (Storey et al., 2016). Data from the Diabetes Control and Complications Trial showed that diabetic treatment and maintenance of glucose control delays the onset and slows the progression of diabetic retinopathy (Aiello & DCCT/EDIC Research Group, 2014). | |||
| Clinical Recommendation Statement | The ophthalmologist should refer patients with diabetes to a primary care physician or endocrinologist for appropriate management of their systemic condition and should communicate examination results to the physician managing the patient’s ongoing diabetes care (Lim et al., 2025).
A goal is to achieve optimal control of blood glucose, blood pressure, and other risk factors through close communication with the patient’s primary care physician on the status of the DR and the need for optimal metabolic control (Lim et al., 2025). Establishing a close partnership between the ophthalmologist and the primary care physician is an important step to ensure optimal patient care. Furthermore, it is important to help educate patients with diabetes as well as their primary care physician about the ophthalmologic implications of controlling blood glucose (as monitored by HbA1c) to as near to normal as is safely possible (Lim et al., 2025). |
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| Improvement Notation | Higher score indicates better quality | |||
| Definition | Communication – May include documentation in the medical record indicating that the findings of the dilated macular or fundus exam were communicated (e.g., verbally, by letter) with the clinician managing the patient’s diabetic care OR a copy of a letter in the medical record to the clinician managing the patient’s diabetic care outlining the findings of the dilated macular or fundus exam.
Findings – Includes level of severity of retinopathy (e.g., mild nonproliferative, moderate nonproliferative, severe nonproliferative, very severe nonproliferative, proliferative) AND the presence or absence of macular edema. |
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| Guidance |
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| Initial Population | All patients aged 18 years and older with a diagnosis of diabetic retinopathy during the measurement period | |||
| Denominator | Equals Initial Population who had a dilated macular or fundus exam performed during the measurement period | |||
| Denominator Exclusions | None | |||
| Numerator | Patients with documentation, at least once within the measurement period, of the findings of the dilated macular or fundus exam via communication to the physician who manages the patient’s diabetic care | |||
| Numerator Exclusions | None | |||
| Denominator Exceptions | Documentation of medical reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes
Documentation of patient reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes |
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| Telehealth Eligible | Yes | |||
| Next Version | No Version Available | |||
| Previous Version | CMS142v13 | |||
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