1. Azara Proprietary & Confidential Overview June 2014 Improving Patient Outcomes through Data

2. 2 2 0059 Diabetes: A1C >9 (Poor Control) CMS122 Measure Update Measure Title & Steward # Measure Description Measure Comparison MU 2011 vs MU 2014 What did the old measure include What changes are applied to the new measure What are current considerations due to measure update Azara CQM’s

3. 3 3 0059 Diabetes: A1C >9 (Poor Control) CMS122 LOINC LOINC codes were updated. Recommended that practices review commonly used lab orders to reconcile appropriate LOINC codes for ordered testing. LOINC LOINC codes were updated. Recommended that practices review commonly used lab orders to reconcile appropriate LOINC codes for ordered testing. Codes were added (e.g., Diabetes, HbA1c test, Polycystic ovaries and Steroid induced diabetes) and removed (e.g., Diabetes and Face-to-Face Interaction) to align with the updates for the 2014 specifications Codes were added (e.g., Diabetes, HbA1c test, Polycystic ovaries and Steroid induced diabetes) and removed (e.g., Diabetes and Face-to-Face Interaction) to align with the updates for the 2014 specifications ICD 9 and 10 Codes Diagnosis Updates to align with the 2014 ICD 9 and ICD 10 inclusion and exclusion codes were made (e.g., Polycystic Ovaries no longer meet the exclusion criteria for the numerator). ICD 9 and 10 Codes Diagnosis Updates to align with the 2014 ICD 9 and ICD 10 inclusion and exclusion codes were made (e.g., Polycystic Ovaries no longer meet the exclusion criteria for the numerator). Updates to align with the 2014 criteria removes several procedural service codes. Most of these codes no longer count for encounter types in conjunction with the DM Dx. ___________________ HCPCS Home health services procedures were added Updates to align with the 2014 criteria removes several procedural service codes. Most of these codes no longer count for encounter types in conjunction with the DM Dx. ___________________ HCPCS Home health services procedures were added Population Criteria Medications (dispensed, order or active) indicative of DM Dx will no longer count towards patients with DM. A Dx of DM with an encounter is required for 2014 Specifications. The 2014 Numerator exclusions no longer list polycystic ovaries, gestational DM and steroid induced DM as criteria. 2014 Denominator exclusions include gestational DM, but period for diagnosis is shortened to the Measurement Period. Population Criteria Medications (dispensed, order or active) indicative of DM Dx will no longer count towards patients with DM. A Dx of DM with an encounter is required for 2014 Specifications. The 2014 Numerator exclusions no longer list polycystic ovaries, gestational DM and steroid induced DM as criteria. 2014 Denominator exclusions include gestational DM, but period for diagnosis is shortened to the Measurement Period. MU 2014 Measure Update Change Summary What’s New with MU 2014 Diabetes A1c: >9 (Poor Control) CPT Codes & HCPCS SNOMED What’s New with MU 2014 Diabetes A1c: >9 (Poor Control) What’s New with MU 2014 Diabetes A1c: >9 (Poor Control)

4. 4 4 0059 Diabetes: A1C >9 (Poor Control) CMS122 Diabetes A1c: >9 (Poor Control) Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period Measure Description Patients whose most recent HbA1c level (performed during the measurement period) is >9.0% Numerator Patients 18-75 years of age with diabetes with a visit during the measurement period Denominator

5. 5 5 0059 Diabetes: A1C >9 (Poor Control) CMS122 Explanation and Impact of Changes Population Criteria Diabetes A1c: >9 (Poor Control) Population Criteria See Excel for detailed Population Criteria

6. 6 6 0059 Diabetes: A1C >9 (Poor Control) CMS122 Explanation and Impact of Changes (CPT Codes) CPT Codes Removed - Encounter acute inpatient - Encounter ED - Encounter non-acute inpatient - Encounter outpatient - Encounter outpatient - ophthalmological services - HbA1c test  Updates to align with the 2014 criteria remove several procedural service codes highlighted below, most of which no longer count for encounter types in conjunction with the DM Dx  Home health services procedures were added  Updates to align with the 2014 criteria remove several procedural service codes highlighted below, most of which no longer count for encounter types in conjunction with the DM Dx  Home health services procedures were added CPT Codes Added - Home Healthcare Services CPT Code Changes See Excel for detailed list of all CPT codes

7. 7 7 0059 Diabetes: A1C >9 (Poor Control) CMS122 Explanation and Impact of Changes Health Care Common Procedure Codes (HCPCS) HCPCS Codes Removed - NONE HCPCS Codes Added Annual Wellness Encounter G0438, G0439  HCPCS Home health service procedures were added  No HCPCS were removed  HCPCS Home health service procedures were added  No HCPCS were removed HCPCS Code Changes See excel for detailed HCPCS codes

8. 8 8 0059 Diabetes: A1C >9 (Poor Control) CMS122 Explanation and Impact of Changes ICD 10/ ICD 9 Codes ICD-10-CM Removed - Gestational diabetes - Polycystic ovaries - Steroid induced diabetes ICD-10-CM Added - Diabetes - Gestational Diabetes ICD-9-CM Removed - Diabetes codes - Gestational Diabetes - Polycystic Ovaries - Steroid induced diabetes ICD-9-CM Added None ICD 10/ ICD 9 Code Changes  Updates to align with the 2014 ICD 9 and 10 inclusion and exclusion codes were made (e.g. Polycystic Ovaries no longer meets the exclusion criteria for the numerator).  No new ICD 9 codes were added  See Excel for detailed ICD10/ICD9 codes  Updates to align with the 2014 ICD 9 and 10 inclusion and exclusion codes were made (e.g. Polycystic Ovaries no longer meets the exclusion criteria for the numerator).  No new ICD 9 codes were added  See Excel for detailed ICD10/ICD9 codes

9. 9 9 0059 Diabetes: A1C >9 (Poor Control) CMS122 Explanation and Impact of Changes SNOMED- CT Codes Removed ⁻Diabetes ⁻HbA1c test ⁻Polycystic ovaries ⁻Steroid induced diabetes SNOMED-CT Codes Added ⁻Diabetes ⁻Face-to-Face Interaction Systematized Nomenclature of Medicine Codes (SNOMED-CT)  Codes were added and removed to align with the updates for the 2014 specifications SNOMED-CT Code Changes See Excel for detailed SNOMED codes

10. 10 0059 Diabetes: A1C >9 (Poor Control) CMS122 Explanation and Impact of Changes LOINC CODES LOINC codes Removed ⁻HbA1c test 4549-2 LOINC codes Added - HbA1c Laboratory Test 17855-8, 4548-4  Updates to LOINC codes for Hba1C testing. Practices should review commonly used lab orders to reconcile appropriate LOINC codes for ordered testing. LOINC Code Changes