Diabetes Care – HbA1c Control (<8.0) (HBD)

What Is the Measure?

The measure assesses the percentage of members 18 to 75 years of age with a diagnosis of diabetes (type 1 and type 2) whose hemoglobin A1c (HbA1c) was below 8 during the measurement year.

Documentation

Evidence of an HbA1c test and the most recent HbA1C level performed during the measurement year. At a minimum, documentation in the medical record must include a note indicating the date when the HbA1c test was performed AND the result.

*This is an inverse measure; the goal is to be less than 8.0% (meets all measures).

Eligible Codes

Exclusions

Patients are excluded from the measure if they meet the following criteria:

• Hospice care

• Palliative care anytime during the measurement year

• Medicare patients 66 years of age and older as of December 31st of the measurement year who are either enrolled in an institutional special needs plan (I-SNP) or living long-term in an institution

• Patients 66 years of age and older as of December 31st of the measurement year who meet both frailty and advanced illness criteria

• Diagnosis of polycystic ovarian syndrome, gestational diabetes or steroid-induced diabetes during measurement year or the year prior to measurement year and do not have a diagnosis of diabetes during the measurement year or the year prior to the measurement year

How to Improve Score

• Frequency of visits should depend on level of A1c control; patients with elevated A1c levels need to be seen more frequently

• Monitor diabetic patients for changes and schedule follow-up testing

• For point-of-care HbA1c testing, document the date of the in-office test with the result; the office must submit the CPT code for the test performed in addition to CPTII codes to report A1C result value