Here's
how the program works
First, you'll apply for
certification or recognition under the Diabetes Physician
Recognition Program (DPRP). This is a joint effort of
the American Diabetes Association and the National Committee
for Quality Assurance (www.ncqa.org),
the nations leading health care quality organization.
You will be able to choose
one of two reward tracks. The first is an annual certification
track that requires the submission of outcomes data;
the second is a three-year recognition track that requires
the submission of process
and outcome measures. Go
to DPRP measures, criteria and scoring.
Once you or your group
is approved, you will be featured as a physician or
group providing quality diabetes care to employees and
members of participating companies and health plans.
The Diabetes Care Link is sponsored by a coalition of
employers, including GE, Ford, UPS and Procter &
Gamble, as well as health plans like Humana, UnitedHealthcare,
Aetna and Blue Cross and Blue Shield. In their efforts
to direct employees to physicians who provide high quality
care, you or your group will be highlighted on a Web
site.
For each diabetic
patient cared for by you or participating physicians
in your group and covered by a participating employer,
you will receive a $100 annual cash bonus. Depending
on the number of diabetic patients you treat, these
bonus payments may amount to thousands of dollars per
year.
Help your patients help
themselves! By joining the program, you and your patients
can work as a team in making treatment decisions and
tracking care. Patients in this program can monitor
and organize their care data through an online tool.
And they can earn points toward valuable incentives
through the CareRewards program. The idea is to help
patients manage their conditions and reduce their risk
of complications
while helping you differentiate
your services and earn rewards for leadership and effectiveness.
Go directly to the DPRP
Web site to get application materials. Or call NCQA
Customer Support at 1-888-275-7585 for more information.
Get program details and
answers to Frequently
Asked Questions.
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Frequently Asked
Questions
Why are employers
and health plans launching this initiative?
Employers recognize that
physicians work hard every day to care for their patients.
They also recognize that better quality of care will
help keep their employees active and at work, or help
them get back to work faster and in better health. To
encourage high quality, evidence-based care, they want
to reward physicians, using objective and validated
measures to compare performance.
How will I know how
many of my diabetics are covered under this program?
At the official launch
of DCL, each eligible physician will receive a count
of their diabetic patients employed by participating
purchasers. Physicians and patient counts are identified
by the health plans participating with this program,
based on inpatient and ambulatory claim and encounter
data for a 12-month measurement period.
In year one of the program,
there will not be an appeal process. Creation of an
appeal process will be considered for future years,
based on experience with the first year of the program.
Questions on patient counts can be directed to MEDSTAT
at1-800-224-7161.
How much reward can
I earn?
You can earn $100 annually
per eligible diabetes patient. Your annual eligible
reward amount is based on the following:
- The number of eligible diabetes patients you treat.
Eligible diabetes patients are determined by Bridges
to Excellence based on inpatient and ambulatory claim
and encounter data supplied by the participating health
plans for the participating purchasers.
- Obtaining 1-year certification or 3-year recognition
through NCQA's Diabetes Physician Recognition Program
(DPRP). If you obtain certification or recognition,
you will earn $100 for each of your eligible diabetes
patients.
Who is eligible to
participate in the Diabetes Care Link (DCL) program?
The Diabetes Care Link
(DCL) program is targeting physicians who have primary
responsibility for managing the overall care of patients
with diabetes. Physicians are eligible to participate
in the DCL program if they:
- provide primary care for 10 or more eligible diabetes
patients identified by Bridges to Excellence based
on inpatient and ambulatory claim and encounter data
supplied by the participating health plans for the
participating employers.
- obtain 1-year certification or 3-year recognition
through NCQA's Diabetes Physician Recognition Program
(DPRP).
Physicians who treat diabetes patients due to their
particular specialty practice (e.g., ophthalmology,
podiatry) may qualify for the DCL program only if they
provide primary care and overall care management for
diabetes patients.
Group practices also may be eligible for rewards when
eligible diabetes patients cannot be attributed to individual
physicians (e.g., when all physicians at the group submit
claims only under the group name). To be eligible for
rewards, groups must provide primary care for at least
20 eligible diabetes patients. To qualify for these
rewards, the group must have at least 2 group physicians
apply to NCQA and a minimum average of 10 eligible diabetes
patients per applying group physician. Each applying
physician is eligible for an equal proportion of the
practice's total possible reward.
For example, if Smith Family Practice is identified
as eligible for rewards with 39 eligible diabetes patients
($3900 possible reward), the group would qualify for
the rewards if the practice applies to NCQA with either
2 or 3 physicians. If the practice applies with 3 physicians,
each applying physician is eligible to receive $1300
rewards (13 patients x $100). In order to receive the
rewards, the group practice must obtain 1-year certification
or 3-year recognition through NCQA's DPRP.
Since outcomes will
be measured, will an allowance be made for physicians
who treat sicker patients?
Physicians who believe
they treat sicker patients may request to have their
patients clinical data risk-adjusted. Risk-adjustment
is available for the annual certification, but is not
available for the three-year ADA/NCQA recognition. The
existing three year DPRP initiative does not include
a mechanism for risk adjustment.
In addition to the data
required to apply for certification, risk adjustment
will require the following information:
- Patient age, gender, height, and weight
- HemoglobinA1C, blood pressure, lipid profile, creatinine
or BUN, hemoglobin or hematocrit values for dates
of service PRIOR to the dates submitted in the patient
sample data for certification or recognition
- Types of treatment being received by patients in
the sample (i.e., insulin, oral hypoglycemics, antihypertensives,
lipid lowering agents, renal dialysis)
- ICD-9-CM diagnosis codes.
Physicians may request
risk adjustment for the annual certification, based
on the required sample of 35 patients. For a more complete
assessment of risk, physicians may also submit data
for additional patients. Physicians who wish to have
their patient data risk-adjusted may contact Joan DeSeno
at Michael Pine and Associates, Inc., for forms, software
and assistance in accessing their data in the most efficient
manner possible. Ms. DeSeno can be reached by phone
at 773-643-1700, by fax at 773-643-6601, or by e-mail
at [email protected].
Go to Rationale
and Methods for Risk-Adjusting Diabetic Outcomes.
Benefits of Participation
Will this Program
improve the quality of diabetes care?
Yes, as seen in DPRP
historical results, we believe that if physicians 1)
know what processes and outcomes are essential, and
2) collect data on what they do and are able to review
aggregate data from their patient population, care will
improve.
For DPRP applicants from
1997 to 2002:
- The average rate of diabetes patients who had Hemoglobin
A1c (HbA1c) levels of less than 7 percent increased
from 25 percent to 45 percent, an indication that
more adults with diabetes are maintaining proper HbA1c
control. HbA1c is a measure of average blood sugar
over the previous three months.
- The rate of diabetes patients who had controlled
low-density lipoprotein (LDL) cholesterol below 100
mg/dl rose from 17 percent to 45 percent.
- The rate of diabetes patients monitored for kidney
disease rose from 60 percent to 83 percent.
Data source: NCQA
Why should I apply?
In todays competitive
health care marketplace, benchmark data for physicians,
groups, and health plans is becoming very important
to payers, purchasers, and consumers. By participating
in the DCL and seeking certification or recognition,
you will be able to review practice patterns for diabetes
care and determine if improvements are needed.
How will the public
know which physicians are certified or recognized?
All physicians achieving
certification or recognition will be promoted through
a website for patients with diabetes. In addition, physicians
achieving three-year recognition will be promoted through
the NCQA and ADA Web sites. Physicians who submit an
application but do not achieve certification
or recognition will not be publicly identified.
Is there a deadline
or required date for submitting patient data for certification
or recognition?
You may submit your data
at any time during the year, and rewards will be paid
on a quarterly basis after certification or recognition
is achieved.
How does this program
help my patients?
By joining the program,
you and your patients can work as a team in making treatment
decisions and tracking care. Patients in this program
can monitor and organize their care data through an
online tool. And they can earn points through the CareRewards
program to stay motivated. The idea is to help patients
manage their conditions and reduce their risk of complications
while helping you differentiate your services
and earn rewards for leadership and effectiveness.
Application Information
What measures will
be used to determine eligibility for recognition and
rewards?
You may choose one of
two scoring and reward tracks. The first is an annual
certification track that requires the submission of
outcomes data; the second is a three-year track that
requires the submission of process and outcomes measures.
The measures, criteria and scoring are below. To achieve
three-year recognition and rewards, physicians must
submit data for all of the measures. To receive a reward
for one year, physicians must submit data on HbA1c,
blood pressure and lipid testing.

 |
Measures For Both 3-Year Recognition
and Rewards and Annual Rewards
|
HbA1c* (most
recent result) |
93% |
NA |
Once per year |
Proportion w/
HbA1c <8% |
55% |
5.0 |
|
Proportion w/
HbA1c >9.5%* |
<21% |
10.0 |
|
Blood pressure
frequency (most recent result) |
97% |
10.0 |
Once per year |
Proportion w/
BP <140/90 mm Hg |
65% |
5.0 |
|
Lipid profile*
|
85% |
5.0 |
Annual** |
Proportion with
LDL <130 mg/dl* |
63% |
5.0 |
|
Additional Required Measures
For 3-Year Recognition
|
Eye exam* |
61% |
10.0 |
Annual** |
Foot exam |
80% |
10.0 |
Annual |
Nephropathy
assessment* |
73% |
10.0 |
Annual** |
70.0 |
|
52.0 |
|
30.0 |
|
 |
Measures For Both 3-Year Recognition
and Rewards and Annual Rewards
|
HbA1c* (most
recent result) |
93% |
10.0 |
Once per year |
Proportion w/
HbA1c <8% |
34% |
5.0 |
|
Proportion w/
HbA1c >9.5%* |
84% |
10.0 |
|
Blood pressure
frequency (most recent result) |
97% |
10.0 |
Once per year |
Proportion diastolic
pressure <90 mm Hg |
96% |
NA |
|
Additional Required Measures
For 3-Year Recognition
|
Eye exam *^ |
40% |
10.0 |
Annual |
35.0 |
|
26.0 |
|
18.0 |
|
Special
Pediatric Age Requirement: Pediatric age range
defined as 0-17 years. Pediatric patients must be
5 years of age or older, before data can be submitted
as part of an application for recognition and the
rewards from the DQP employer coalition. |
Notes:
* Consistent with Diabetes Quality Improvement
Project and HEDIS measures
** Measure may be performed in the past two years,
based on patient-specific criteria
^ For calculation of results for this measure, the
denominator will be those patients from the applicants
sample who have had diabetes for > 5 years |
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How are patients identified
for inclusion in the sample?
Applicants will select
a start date and then consecutively identify eligible
patients each day until the required sample size is
reached. Eligible patients are those who have had diabetes
for at least 12 months and who have been under the care
of the applicant physician(s) for at least 12 months.
How do I receive application
materials?
Visit the DPRP Web site
(www.ncqa.org/dprp)
or call NCQAs Customer Support at 1-888-275-7585
to purchase application materials. Materials cost $80
and may be downloaded immediately. For the first 6 months
of the Diabetes Care Link program, the employers participating
in the initiative will cover the application fee for
those physicians or groups that are eligible for rewards
under the DCL program.
What does it cost
to apply for certification or recognition?
Physicians must include
the following fee with their completed application to
NCQA:
Individual
|
$375 |
$200 |
|
Group A Physicians
|
2-6 MDs |
$375 per physician |
$200 per physician |
7 or more MDs |
$2500 total |
$1400 total |
|
Group B Physicians
|
2-6 MDs |
$375 per physician |
$200 per physician
per site |
7 or more MDs |
$2500 per site |
$1400 per site |
For the first 6 months of the Diabetes Care Link program,
the employers participating in the initiative will cover
the application fee for physicians or groups that are
eligible for rewards under the DCL program, regardless
of whether they meet the performance measures. After
the initial six months of this program, DCL may elect
to discontinue this subsidy for physicians and groups
that fail to receive certification or recognition.
Eligible physicians who apply as part of a group that
is not eligible for rewards will receive reimbursement
for the materials fee and their per physician portion
of the application fee only. Eligible physicians who
become certified or recognized as part of a group will
receive their full individual reward amount.
How long will it take
to prepare an application?
On average it will take
approximately:
- 60 minutes to complete the basic application form
- 15 minutes to abstract the medical record for each
patient in the sample
For example, preparation
of an application package for one physician applicant
with a data sample of 35 patients is approximately 10
hours (application: 1 hour; medical record abstraction:
15 minutes x 35 patients = 8.75 hours). Preparation
time, however, will vary based on the administrative
data systems that are available to the applicant.
Who should transcribe
the data required in the application?
While the physician(s)
applying may elect to do all the work, the application
package (application form, medical record abstraction)
can be effectively completed by other health care professionals
within the practice, such as a nurse, dietitian, medical
record technician, or trained clerical support staff.
How long can a physician
or group of physicians maintain certification or recognition?
The annual certification
and reward is valid for one year. Recognition and associated
rewards are valid for three years. At the end of the
annual or three-year period, a new application is required.
Processing of Applications
How long will it take
for an application to be processed?
NCQA will make a decision
on an application and notify the applicant within four
weeks of receipt of a completed application. Incomplete
applications will be returned to the applicant for completion
and resubmission.
Is the data submitted
confidential?
All data is confidential
for both physicians and their patients. All physicians
achieving certification or recognition will be promoted
through DCL's Web site. In addition, recognized physicians
will be promoted through the ADA and NCQA Web sites.
Physicians who do not achieve certification or recognition
will not be identified. Patient data is confidential
and does not include patient name, address, phone
number, or social security number. Instead, during data
collection, physicians assign an identification number
to each patient, before submitting data to NCQA.
How will NCQA/ADA
know if real or accurate data has been submitted?
Random audits of applications
will occur to ensure the validity of the data submitted.
Note: The DCL
recognizes physicians who meet the standards of diabetes
care established by the Program. Designation does not
constitute an endorsement of the individual physician
or a guarantee that the physician will provide quality
treatment in any particular case. The DCL performance
indicators and outcomes measures represent consensus
standards for appropriate treatment of diabetes patients.
However, they are not intended to substitute for the
physician's independent judgment in treating each patient
based on the individual's condition and medical history.
Certification or recognition
in the one or three year program is not a guarantee
of payment. The DCL may choose to add to, change or
discontinue the program and/or reward payments and/or
reimbursement for certification fees at any time. Neither
payment of rewards nor reimbursement of fees creates
an employment relationship between DCL and physicians.
Contact Us:
For information on
the Diabetes Care Link visit:
http://www.bridgestoexcellence.org
For information on
annual certification or triennial recognition contact
NCQA at:
http://www.ncqa.org/dprp/
Customer Support @ 1-888-275-7585
For Information on
Risk Adjustments contact Michael Pine & Associates
at::
773-643-1700 - Joan DeSeno
[email protected]
For information on
Rewards contact The MEDSTAT Group at:
1-800-224-7161 or [email protected]
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