URSA-QUALITY-EED: Eye Exam for Patients With Diabetes (EED)

Measure Description

The percentage of members 18–75 years of age with diabetes (types 1 and 2) who had a retinal eye exam in the last 12 months.

Metadata

• Measure Type: Rate Measure
• Temporal Structure: Entity
• Component Class: Long-Form
• Denominator Case Field: Patient ID, Output NCQA Payer Type Code
• Target Direction: Up

Denominator Description

Patients aged 18 to 75 with diabetes as of the snapshot date.

Numerator Description

Qualifying denominator patients with a qualifying eye exam in the last 12 months.

Published Fields

• Data Model Keys

  • Patient ID
  • Primary Payor ID
  • Primary Plan ID

• Patient Fields

  • Patient Operational ID
  • Patient Date of Birth
  • Patient Age Integer
  • Is Patient Sex Female
  • Is Patient Sex Male
  • Patient State Abbreviation
  • Patient ZIP Code 5-Digit

• Date Fields

  • Current Continuous Primary Payor Membership Episode Start Date
  • Current Continuous Primary Payor Membership Episode End Date
  • Segment Start Date -- The start date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
  • Segment End Date -- The end date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
  • Snapshot Date -- The date, evaluated at 00:00:00 AM, giving the moment the state of the world will be set to for the purposes of an analysis. The snapshot date does not represent the freshness of the data, or the date in real time at which an analysis was executed.

• Provider Fields

  • Primary Plan Attributee Provider ID
  • Primary Plan Attributee Provider Description
  • Primary Plan Attributee Primary NUCC Provider Taxonomy Description

• Insurance Fields

  • Primary Payor Description
  • Primary Plan Description
  • Primary Plan Financial Class Description

• Denominator Fields

  • Is Denominator Event Criterion Met
  • Is Continuous Membership Criterion Met
  • Is Eligible Population
  • Is Any Required Exclusion
  • Is Required Exclusion for Medicare 66+ Institutionalized Status
  • Is Required Exclusion for Hospice
  • Is Required Exclusion for Patient Death
  • Is Required Exclusion for Palliative Care
  • Is Required Exclusion for Bilateral Absence of Eyes
  • Is Required Exclusion for Unilateral Eye Enucleation with a Bilateral Modifier
  • Is Required Exclusion for Bilateral Eye Enucleations
  • Denominator Excluded Reasons Description
  • Is Required Exclusion for Age 66+ with Frailty and Advanced Illness

• Numerator Fields

  • Right Eye Exam Numerator Document Effective Date
  • Left Eye Exam Numerator Document Effective Date
  • Right Eye Enucleation Numerator Document Effective Date
  • Left Eye Enucleation Numerator Document Effective Date
  • Eye Exam Numerator Document Effective Date
  • Is Numerator Qualifying Using Standard End-of-Year Timing
  • Numerator Component Contribution Using Standard End-of-Year Timing
  • Document ID
  • Document Effective Date

• Metadata Fields

  • Table Last Updated Datetime
  • Is Parameter Set to Override Continuous Enrollment Criteria
  • Is Parameter Set to Override Payor Criteria

• Measure Fields

  • Denominator
  • Numerator

• Numerator

  • Numerator Contribution

• NCQA Cert Fields

  • Is NCQA Numerator Criteria Met
  • Prior Year Negative Eye Exam Numerator Document Effective Date
  • Output NCQA Payer Type Code
  • NCQA Race Code
  • NCQA Ethnicity Code
  • NCQA Gender Code
  • Patient Age Integer Unbounded by Death

• [No Field Group]

  • Measure ID
  • Measure Name
  • Ursa Serial ID