HEDIS^® Tip Sheet

Notes

• This measure applies to members ages 18-75 years as of December 31st of the measurement year.
• Includes members identified as having diabetes in the measurement year or the year prior to the measurement year.
• Blindness is not an exclusion for a diabetic eye exam. 

Measure Compliance (numerator):

• A retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist)
  • Negative retinal or dilated eye exam during the measurement year or the year before.
  • Positive retinal or dilated eye exam during the measurement year (must be done annually).

Best Practices

• Encourage patients to engage in Primary Care. Review diabetic services needed at each office visit.
• Patients with retinopathy need an annual retinal eye exam, while patients without signs of retinopathy need a retinal eye exam every two years. These exams must be performed by an eye care professional.
• Required documentation includes the date of service, eye exam results, and the eye care professional’s name and credentials.
• Educate patients and their families or caregivers about the importance of routine screenings and medication compliance.
• Utilize reminders in the patient’s EMR to alert staff of when patients’ screenings are due.
• Promote utilization of patient portal if your facility provides it (i.e., MyChart).
• Remind patients of upcoming appointments by making phone calls, sending text messages or utilizing patient portal messaging.
• Review and follow up on lab test results, eye exam results, and any specialist referral.
• Refer patients to an optometrist or ophthalmologist for a dilated or retinal eye exam and explain why this is different from a routine eye exam. 

Exclusions

• Bilateral absence of eyes at any time in the member’s history.
• Bilateral eye enucleation at any time in the member's history.
• Members who used palliative care or had a palliative care encounter during the measurement year.
• Members in hospice during the measurement year.
• Member who died during the measurement year.
• Members ages 66+ as of December 31 of the measurement year with frailty and advanced illness. Must meet both criteria:
  • Frailty: at least two frailty indicators from different dates during the measurement year.
  • Advanced Illness: either two advanced illness diagnoses on different dates (current or prior year) -or- dispensed dementia medication.