Between February and May, you may receive requests from us for patient medical records on behalf of our health plan partners. Health plans review these medical records for specific information to determine if the record satisfies the Eye Exam for Patients with Diabetes (EED) measure criteria for HEDIS® submission.
HEDIS® stands for the Healthcare Effectiveness and Data Information Set (HEDIS®), created by the National Committee of Quality Assurance (NCQA®). It is one of healthcare’s most widely used performance improvement tools and consists of more than ninety measures across six domains of care. These measures are designed to ensure that purchasers and consumers have the information they need to reliably compare health care quality between health plans.1
Why It Matters
The EED measure is defined as the percentage of diabetic members who had a retinal eye exam. The 2024 Standards of Care in Diabetes2 recommends “screening every 1-2 years” for diabetic patients with no evidence of retinopathy and “at least annually if any level of diabetic retinopathy is present.” These recommendations help ensure early detection and timely intervention that could prevent vision loss for your patients.
How You Can Help
As an eye care professional, you are an integral part of a health plan’s annual HEDIS® rate submission for the EED measure. To ensure your patient records have the necessary information to meet the EED measure criteria, here are some helpful tips:
- Medical Records MUST include the following:
- Patient’s Name
- Patient’s Date of Birth
- Exam Date/Date of Service
- Eye Exam Results (Positive or Negative for Retinopathy)
- Provider Signature and Credentials
- Routine eye exams for glasses, glaucoma, or cataracts do not count. Must be a dilated/retinal exam
- Hypertensive retinopathy is not handled differently from diabetic retinopathy when reporting this measure
- Eye exam results documented as unknown do not meet criteria
Your office will receive requests for medical records by fax, email, and telephone. Requests are time sensitive. Please return clear and complete medical records by the due date on each request. Your office may be contacted for additional information if the record does not contain the required information.
Thank you for your assistance with this important quality initiative and for working to protect your patients’ vision.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
- https://www.ncqa.org/
- American Diabetes Association Professional Practice Committee (2024). Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2024. Diabetes Care 2024; 47(Supplement_1): S231–S243. https://doi.org/10.2337/dc24-S012