AOA-backed legislation aims to boost eye exams among seniors with diabetes

March 2, 2016
Bill incentivizes referrals of Medicare patients with diabetes to eye doctors.

Proposed legislation would test incentivizing primary care provider referrals of diabetic Medicare patients to local eye doctors for comprehensive, dilated eye examinations.

Introduced by U.S. Representatives Chris Collins (R-New York) and Jerry McNerney (D-California), H.R. 4642—the Diabetic Eye Disease Prevention Act of 2016—which has been endorsed by the AOA, seeks to promote early detection and treatment of eye diseases associated with diabetes and reduce unnecessary Medicare spending by bolstering care coordination among the doctors already providing this critical care.

Originally considered as a would-be addition to the 21 st Century Cures initiative, the bill would create a five-year "national diabetic eye disease prevention and early treatment demonstration project" that would provide financial incentives to primary care practices for referring Medicare beneficiaries (at the time of their diabetes diagnosis, or if they have been diagnosed but haven't had an eye exam within 5 years) to an eye doctor for a comprehensive, dilated eye exam.

More specifically, the demonstration project would identify 100 participating Medicare primary care practices in states with high per-capita diabetes costs and provide them with a list of participating local eye doctors. Participating eye doctors would be required to report the eye exam back to the referring provider within 72 hours. The effort would be budget neutral and would test whether the arrangement improves detection and treatment of diabetes-related eye and vision conditions, saves money for Medicare in the long run, and improves overall patient satisfaction.

Steven A. Loomis, O.D., AOA president, says the bipartisan leadership of Reps. Collins and McNerney, and their determination to reduce unnecessary Medicare costs and improve seniors' lives through increased access to preventive eye health care, is necessary now more than ever.

"By encouraging better coordination and communication among key members of the diabetes care team—including America's doctors of optometry—and ensuring that a growing number of seniors with diabetes receive the comprehensive dilated eye exams that they need and deserve, together we can make even greater strides toward reducing seniors' potential for significant vision loss and blindness while saving Medicare from avoidable costs associated with delayed diagnosis and treatment of a range of diabetes-related eye and vision conditions," Dr. Loomis remarked on the bill.

While current quality measures exist to not only evaluate the eye care provided to such patients, but also document the care coordination among providers, it's clear more needs to be done to ensure that Americans with diabetes receive the diagnosis and care they need.

Current Physician Quality Reporting System (PQRS) measure 19 (NQF 0089) "Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care" captures this care coordination and communication aspect, while PQRS measure 117 (NQF 0055) "Diabetes: Eye Exam" captures a dilated or retinal exam. But while only about 36% of providers participate in PQRS, according to the Centers for Medicare & Medicaid Services, it is clear that the Medicare program is missing diagnosis and treatment opportunities for a large percentage of beneficiaries.

Read three reasons why comprehensive eye exams matter in diabetes care.

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