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Diabetes
Provider Recognition Process
Summary
of Process/Getting Started
FAQs
What are the goals of
recognition?
§
Improve care
given to people with diabetes.
§
Motivate other
physicians and groups to document and improve the delivery of care.
Who should apply for
recognition?
§
An individual
physician who provides direct, continuing care for at least 25 diabetic
patients in a 12-month period.
Why should I apply for
recognition?
§
Review practice
patterns and determine if improvement is needed.
§
Benchmark data
for purchasers and consumers.
How do I apply for
recognition?
1. Complete an application form with general
information.
2. Abstract 25 medical records for eligible patients
with diabetes per participating physician- review the patients care for the
previous 12 months,
3. Administer a patient survey to those patients whom
are eligible (optional).
What’s the size of the
patient sample?
§
Individual
physicians must submit a sample of 25 patients.
§
A group (6 or
more physicians) must submit a maximum of 210 patients.
What’s the process of
selecting a patient sample?
§
Choose a start
date: Either move forward OR backwards as a group from the start date; movement
is based on the scheduled appointment book or as patients present for care.
§
Identify
eligible patients who meet the following criteria: 1) any patient that is at
least 5 years of age, 2) has a Diabetes diagnosis as defined by HEDIS and 3)
has been under the care of the PCP for at least 12 months.
§
If a patient
does not meet the identified criteria (either moving forward OR backwards from
the start date), skip to the next patient.
How am I scored during
the recognition process?
§
Physicians are
scored based on the percentage of patients they have that meet the performance
rates for providing superior care (example= 40% of patients w/ HbA1c<7= 10
points, 80% of patients must have a foot exam = 5 points).
How often do I have to
renew my certification?
§
Every 3 years.
Can I use the same
patients during my renewal that I used in my original sample?
§
Patients used
in the initial process cannot be used (with the exception of a few patients).
How much does recognition
cost?
§
$60 for
application and materials; payment is required when beginning the process
§
Individual
recognition is $360 ($60 for application and $300 when submitting the
application).
§
A group
applicant with more than six physicians is $2700.
Is there any
reimbursement for recognition?
§
Beginning in
2007 groups will receive monetary reimbursement for Diabetes Recognition. Rewards will be paid out through
participating employers in the Bridges to Excellence Program. Those employers include AstraZenca, GE, EMC,
Verizon and Raytheon. Reward estimates
will be available in early 2007.
Who should I contact for
more information?
§
If you are
interested in participating and would like more information please contact
Lorraine Muttart, Program Implementation Specialist, PCHI, at 781-433-3041 or lmuttart@partners.org
§
Check out www.ncqa.org/dprp for more information and
lists of recognized providers.