Recently, our practice has seen an uptick in referrals from primary care physicians (PCPs) who are advising their senior patients to be screened for glaucoma and their patients with diabetes to undergo a retinal exam. This is undoubtedly in response to the provision of the Affordable Care Act (ACA) that enables CMS to increase or decrease payments to Medicare Advantage Plans based on their Medicare Health Plan Quality and Performance Ratings, i.e. their Star Ratings. The plans in turn must ensure their participating providers are mindful of the Star Ratings components, two of which are eyecare-related HEDIS measures. The Glaucoma Screening in Older Adults (GSO) measure tracks the percentage of plan members age 65 and older who receive an eye exam for early identification of glaucomatous conditions. The Comprehensive Diabetes Care (CDC) measure tracks the percentage of plan members age 18-75 who have diabetes who undergo a list of tests, including a retinal exam.
As additional aspects of the ACA click into place, we can expect this type of referral to increse even more. Health insurance exchanges, for example, will encompass different types of managed care plans aimed at the general populations that are government-funded or subsidized and likely subject to Star Ratings or similar quality measures. These dynamics offer ophthalmology and optometry practices the opportunity to develop referral patterns with the primary care physician in our communities. Whether or not patients have been referred to our offices by their primary care doctors, we can identify those to whom the quality measures pertain, provide the relevent services and inform the doctors of the tests and results. We gain a marketing tool, while our patients benefit from the preventative care.