Oakland Southfield Physicians, PC Administrative Network, Inc.

1. Diabetes Physician Recognition Programa part of the comprehensive Patient-Centered Medical Home Initiative Oakland Southfield Physicians, PC Administrative Network, Inc. PC-MH Initiative

2. What measures include:Structure, process and outcomes of excellent care management Where they come from:Partnership with leading national health organizations and professionals Who rewards recognized physicians:Many health plans (BCBSM, BCN) as well as Bridges to Excellence employers, including local employers General Motors, Ford, and GTE Energy What’s new:Physician Practice Connections - Patient-Centered Medical Home Recognition Program NCQA Physician Recognition Programs Recognition is for 3 years PPC-PCMH Over 9000 Physicians Recognized Nationally PC-MH Initiative

3. OSP DPRP Support • Utilizing DPRP – Diabetes Physician Recognition Program – criteria, OSP will: • Work with your office to identify eligible patients • Help you pull charts for ease of data extraction • Collect data from charts according to DPRP criteria • Provide you with your results following the chart pull • Submit data to NCQA on your behalf for recognition PC-MH Initiative

4. OSP Data Collection Rules • Utilizing DPRP Workbook • One workbook per physician per practice • Patient Sample Size requirements PC-MH Initiative

5. Criteria for Patient Eligibility PC-MH Initiative

6. Abstract Medical Record Data When abstracting medical record data OSP will: • Abstract data for care already completed for each patient in the sample for a 12-month period going back from the last visit date for each patient prior to the start date. (Doesn’t have to be a diabetes visit for a diabetic patient) • If start date June 2, 2008 will go back as far as June 2, 2007. • Use medical record documentation (electronic or paper), administrative data systems or registries to identify required data elements. PC-MH Initiative

7. Diabetes - DPRP Measures(ADA Clinical Practice Recommendations 2008) • HbA1c • Blood Pressure • LDL Control • Eye Examination • Foot Examination • Nephropathy Assessment • Smoking Status and Cessation Advice or Treatment PC-MH Initiative

8. Data elements Date (mm/dd/yyyy) and value of most recent HbA1c performed within the 12-month abstraction period or the 2 months prior to the abstraction period Tips May use date drawn or date received, do NOT use date ordered Use HbA1c value in the form n.n (e.g. 7.2, 10.6) If HbA1c was not completed, leave cell blank in workbook Data Abstraction Rules HbA1c Testing and Control Proportion w/ HbA1c > 9.0%* Proportion w/ HbA1c  7.0% * A measure of poor control PC-MH Initiative

9. Data elements Record date (mm/dd/yyyy) and value of most recent blood pressure measurement performed within the 12-month abstraction period If blood pressure was not taken in the last 12 months, leave cell blank in workbook Patient self report or home blood pressure monitoring is not acceptable Data Abstraction Rules Blood Pressure Measurement Proportion >/= 140/90 mm Hg* Proportion < 130/80 mm Hg * A measure of poor control PC-MH Initiative

10. Data elements Record date (mm/dd/yyyy) of most recent dilated retinal exam or retinal photograph performed within the 12-month abstraction period May use date within the past two years if patient showed no evidence of retinopathy in the 12 months prior to the abstraction period (next slide) Tips Patient self-report is not acceptable Use notes, reports, letters or photographs from eye care professionals If exam performed by a non eye care professional documentation must state dilated exam If an eye exam was not completed either during the 12-month abstraction period or in the 12 months prior to the abstraction period, leave the cell blank for that patient Data Abstraction Rules Eye Exam or Retinal Photographs PC-MH Initiative

11. Data Abstraction Rules Eye Exam or Retinal Photographs If an eye exam was not performed during the abstraction period, an exam performed in the 12 months prior to the abstraction period is acceptable if the patient meets the following criteria (indicated by a "Yes" response): • Did an exam of the patient by an eye care professional show no evidence of retinopathy during the 12 months prior to the abstraction period? • Enter or choose "Yes" or "No" to respond to this question. If there is no documentation in the patient's records enter or choose "Not Known." PC-MH Initiative

12. Data Element Document smokingstatus Tips If there is documentation that the patient is a non-smoker, no further documentation is required Smokers: Record date that documents smoking cessation counseling or treatment within the abstraction period If there is no documentation in this patient’s records to indicate whether or not this is a smoker, select “Not Known” Data Abstraction Rules Smoking Status PC-MH Initiative

13. Data Abstraction Rules Lipid Control Proportion w/LDL >/=130mg/dl* Proportion w/LDL <100mg/dl • Data element • Record date (mm/dd/yyyy) and value of most recent LDL within the 12-month abstraction period or the 2 months prior to the abstraction period • If a LDL test was not taken in the last 12 months or the 2 months prior to the abstraction period, leave cell blank in workbook * A measure of poor control PC-MH Initiative

14. Data Element Record date (mm/dd/yyyy) of most recent test for microalbuminuria or positive urine analysis within the 12-month abstraction period or the 2 months prior to the abstraction period Tips Documentation must include one of the following: 1st Microalbuminuria test 2nd Positive urinalysis for protein 3rd Medical attention for nephropathy 4th Evidence of ACE/ARB therapy If no documentation is found of an assessment of nephropathy during the 12-month abstraction period or in 2 months prior to the abstraction period, leave the cell blank for that patient Data Abstraction Rules Nephropathy Assessment PC-MH Initiative

15. Data Abstraction Rules Nephropathy Assessment PC-MH Initiative

16. Data element Record date (mm/dd/yyyy) of most recent foot exam within the 12-month abstraction period or 2 months prior to the abstraction period Tips May use notes, reports, letters or assessments from podiatrists, or PCP’s examination Documentation must support that feet were examined with shoes and socks off Data Abstraction Rules Foot Examination PC-MH Initiative

17. Data Abstraction Rules Foot Examination PC-MH Initiative

18. Data Collection: Utilizing the DPRP Workbook PC-MH Initiative

19. Questions and Answers If you have any questions please do not hesitate to call or email at: 248.357.4048 Pam Heffernan pam@aniosp.com Angie Martin angie@aniosp.com PC-MH Initiative