The terms ‘one or more’ and ‘at least once’ are intended to describe the minimum expected frequency of the numerator action – eg, dilated macular or fundus exam with documentation of level of severity of retinopathy AND presence or absence of macular edema, documentation of the findings of the dilated macular or fundus exam via communication to the physician managing the patient’s diabetic care. These terms mean that it should be done once for the purposes of this measure, but don’t want to send the message that the numerator action should only be done once. For the patient to be included in the population of interest – the initial patient population – the eMeasure requires that a patient have a ‘Count >= 2’ of any combination of encounters listed in the respective value sets during the measurement period AND that they had an active diagnosis of Diabetic Retinopathy at the time of a visit during the measurement period (the active diagnosis can start any time before a visit in the measurement period). The requirement of a patient having two visits during a measurement period is a way to demonstrate that the physician and the patient have a standing relationship and the physician should be held accountable for the quality of care the patient receives.  

Several of the ophthalmology related measures (088, 089) use terminology to define the denominator as having one or more visits or at least one visit. Our EHR vendor is defining that to mean at least 2 visits so we have a very low to zero denominator on most measures as the standard of care is to see these patients just the one time. This results in lower denominator value than likely intent. For example, diabetic retinopathy patients who are dilated and have the severity of the retinopathy recorded as well as the presence or absence of edema should meet the denominator and numerator. They do NOT unless they come in another time in the 12 month period. The ONLY time that occurs is if they come in for some unrelated reason. That clearly does not seem to be the intent of this measure (as well as measure 089) yet this is how it is being interpreted. We need clarification.