001. Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

Document the diabetic patient’s A1c levels:

1. Open the Ocular Exam.
2. Select a diabetes Diagnosis.
3. Select a counseling Plan.
4. Select the appropriate condition from the Quality 1 drop-down.

Alternatively, code quality with a special plan:

1. Open the Ocular Exam.
2. Select a Diagnosis and Plan.
3. Tap Special Plans and select MIPS.
4. From Popular Plans, select MIPS Quality.
5. Tap the Diabetes tab.
6. Select the appropriate condition from the Quality 1 drop-down.
7. Tap Done.

• Claims
• Registry

This topic describes how points are calculated for this measure. To learn more about scoring, go to Scoring.

Benchmarks are displayed here as both a chart and a table. The chart gives you a visual representation and helps you quickly compare benchmarks across different reporting methods. The table lists the specific benchmark criteria for each available reporting method.

This is an inverse measure. A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Reporting that numerator option will produce a performance rate that trends closer to 0%, as quality increases.

 

Submission Method	3rd Decile	4th Decile	5th Decile	6th Decile	7th Decile	8th Decile	9th Decile	10th Decile
Claims*	80.00– 70.01	70.00– 60.01	60.00– 50.01	50.00– 40.01	40.00– 30.01	30.00– 20.01	20.00– 10.01	≤ 10.00
Registry	80.00– 70.01	70.00– 60.01	60.00– 50.01	50.00– 40.01	40.00– 30.01	30.00– 20.01	20.00– 10.01	≤ 10.00

Patients aged 18 to 75 years on the date of the encounter;

AND who had a diagnosis of diabetes:

AND who had a visit during the measurement period:

Denominator Exclusions

Hospice services given to patient any time during the measurement period:

Patients age 66 and older in Institutional Special Needs Plans (SNP) or residing in long-term care with a POS code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period:

Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND a dispensed medication for dementia during the measurement period or the year prior to the measurement period :

Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ED or non-acute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period:

Patients who are included in the denominator

AND whose most recent HbA1c level (performed during the measurement period) is > 9.0% or is missing, or was not performed during the measurement period

Performance Met

Most recent hemoglobin A1c level is greater than 9.0%:

OR hemoglobin A1c level was not performed during the measurement period (12 months):

Performance Not Met

Most recent hemoglobin A1c (HbA1c) level is less than 7.0%:

OR most recent hemoglobin A1c (HbA1c) level is 7.0 to >8.0%:

OR most recent hemoglobin A1c (HbA1c) level is 8.0 to >9.0%: