Diabetic Retinal Eye Exam Reminders

National guidelines and the National Committee of Quality Assurance (NCQA) recognize the importance of screening people with diabetes annually for diabetic retinopathy through its inclusion in one of the Comprehensive Diabetes Care (CDC) measures. Similarly, Anthem has included retinal eye exams (either by dilation or photograph) for people with diabetes as one of the measures on the Enhanced Personal Health Care scorecard. For more information contact Jennifer Castore at 614-546-4257 or Jennifer.Castore@mchs.com

What can you do to improve compliance rates?

• Talk to your patients with diabetes about the importance of getting an annual comprehensive eye exam including dilation. Since the retinal eye exam (DRE) is recommended by evidenced-based clinical guidelines as a medically necessary part of a diabetic care plan, a member’s medical benefits will cover the exam, subject to his or her share of the cost, including copays and deductibles. A diabetic eye exam does NOT require vision benefits, as it is part of the medical benefit package. Patients should call Member Services on the back of their identification card for clarification around benefits.
• If you are a primary care doctor or endocrinologist, refer your patients with diabetes to an in-network ophthalmologist or optometrist, if they aren’t already connected with an eye doctor. Follow-up with their eye doctor, as you would any other specialist.
• If you are an eye doctor, follow-up and provide the patient’s test results to their primary care doctor and/or endocrinologist. Keep clear documentation in the patient’s medical record. Clearly document referrals, eye exam and lab results. Record the date of the most recent diabetic eye exam with results and name of vision provider. Obtain and include a copy of diabetic eye exams performed by an optometrist or ophthalmologist.