Your Valuable Input Is Requested

We are looking to align our future no-cost QPP resources with the goals of CMS (The Centers for Medicare & Medicaid Services). By 2024, CMS is seeking to improve the prevention and management of chronic diseases, including Diabetes. This focus helps in all areas of MIPS - especially the quality and cost categories.

Please complete this brief diabetes questionnaire to help us learn more about how we can prioritize and create relevant no-cost resources to practices throughout New England.

Question Title

* 1. Contact Information

Question Title

* 2. Please indicate the number of Medicare* (or total) patients in your practice for each of the following categories:

  Baseline Period
(11/1/18-10/31/19 OR Jan-Dec 2019) 		Q1
(Jan-Mar 2020) 		Q2
(Apr - June 2020) 		Q3
(July - Sept 2020) 		Q4
(Oct - Dec 2020) 		Type of Data Provided
Patients in your panel
Pre-diabetic patients (HbA1c between 5.7% - 6.4%)
Pre-diabetic patients referred to a MDPP or DPP** Program
Pre-diabetic patients referred to a life style change program** other than MDPP or DPP
Diabetic patients
Diabetic patients whose most recent HbA1c level is > 9.0
Diabetic patients whose most recent HbA1c level is > 9.0  that have been referred to a Diabetes or Chronic Disease Self-Management Education/Training program
* Medicare Patients include Fee for Service, Medicare Advantage, and those Dually Eligible for both Medicare and Medicaid. If you are not able to separate your Medicare patients,  please use Total Patients.

** MDPP is the Medicare Diabetes Program, DPP is the Diabetes Prevention Program

** Style Change Program examples include health education, weight reduction, exercise or physical activity, nutrition or other lifestyle change program, including but not limited to a Diabetes or Chronic Disease Self-Management Education/Training program. Include programs internal to your practice as well as external programs.

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