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 our 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 called MyDiabetesCoach. 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 are Rewards calculated?
The calculation used
to determine reward payment is $100 x patient count.
For example: $100 x 23 patients = $2300.00
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].
Who may apply for
the Annual Certification or Triennial Recognition?
An individual physician
(MD or DO) who provides direct, continuing care for
at least 35 diabetic patients in a 12-month period may
apply. In addition, a group of two or more physicians
who, by formal arrangement, share responsibility for
a common panel of patients from which a sample can be
drawn are eligible to apply as a group. Or, a group
of two or more physicians having comprehensive programs
or protocols directly related to the management and
treatment of diabetes, which are maintained across all
physicians are also eligible to apply as a group. A
group that operates more than one site may apply, as
long as data for patients from each site are submitted
in the groups application and other DPRP program
requirements are followed. A physician within a group
practice may also apply for rewards as an individual
physician.
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 2001:
- The average rate of diabetes patients who had Hemoglobin
A1c (HbA1c) levels of less than 8 percent increased
from 50 percent to 70 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 properly controlled
low-density lipoprotein (LDL) cholesterol gained 35
percentage points (37 percent to 72 percent).
- The rate of diabetes patients monitored for kidney
disease rose from 60 percent to 84 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
the MyDiabetesCoach
website for diabetics. 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 called MyDiabetesCoach.
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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What size patient
sample must be submitted?
An individual physician
must submit a patient sample of 35 of their patients
with diabetes who have been under care for at least
12 months. An applicant with two to six physicians would
provide data for 35 of their patients with diabetes
per physician. The maximum number of patients to be
sampled is 210 for eligible groups of seven or more
physicians.
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 with at least 10 eligible
employees. More information on the sponsored fees and
data assistance will be provided in a mailing to physicians
in February 2003.
What does it cost
to apply for certification or recognition?
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 with at least 10 employees.
More information on the sponsored fees and data assistance
will be provided in a mailing to physicians in February
2003.
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 physcian |
$200 per physician
per site |
7 or more MDs |
$2500 per site |
$1400 per site |
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 MyDiabetesCoach 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
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