October is Breast Cancer Awareness Month D ilated Eye Exam Initiative The Health Care Financing Administration (HCFA), the American Academy of Ophthalmology (AAO), and the American Optometric Association (AOA) have launched a cooperative initiative to increase the dilated eye exam rate among Medicare beneficiaries with diabetes. The AAO and AOA will match patients with diabetes with an eye professional in their area who has agreed to perform a dilated eye exam and to provide or arrange subsequent care, at no cost to the beneficiary. Approximately 10,000 Alabama Medicare beneficiaries with diabetes have not had a dilated eye exam in at least 3 years. The initiative will include: 1) 2) 3) In Alabama, 23.2 per 100,000 women died from breast cancer during 1992-1996. Approximately 50% of the female Medicare beneficiaries over the age of 50 in the state of Alabama did not have a mammogram in 1997 and 1998 even though Medicare Part B pays for 80% of the cost of a screening mammogram. Medicare pays this even if the beneficiary has not reached the annual deductible. Excluding cancers of the skin, breast cancer is the most common cancer among women, accounting for nearly one of every three cancers diagnosed in United States women. In 1999, approximately 175,000 new cases of invasive breast cancer will be diagnosed among women, as will nearly 40,000 additional cases of in situ breast cancer 1. In 1999, 43,300 women are expected to die from this disease. Only lung cancer accounts for more cancer deaths in women. Continue annual mammograms in all your elderly female patients! Breast cancer incidence and mortality increase as the population ages. Seventy-seven percent of new cases and 84% of breast cancer deaths occur in women aged 50 and older. For all races combined, women aged 20-24 have an age-specific incidence rate* of only 1.3 cases per 100,000; women aged 75-79 have the highest incidence rate, 483.3 cases per 100,000. A thirty second (: 30) television public service announcement featuring Bill Cosby which has been mailed to 24 stations in the state. Mr. Cosby urges seniors with diabetes to get an annual dilated eye exam, then directs viewers to call the AAO or AOA national help-line at 1-800-222-3937, or 1-800-262-3947. Medicare beneficiaries with diabetes will receive a brochure the end of October 2000, and a second mailing of the same brochure, 3 weeks later. The brochure states, “If you have diabetes you are at risk for eye problems, including blindness, and may need treatment even if your vision is normal”. The AAO and AOA eye exam programs are explained and the beneficiary is told to contact one of the toll-free numbers and to get a dilated eye exam. The AAO and AOA toll-free numbers are printed on the brochure. Press Releases which have been mailed to 156 media outlets throughout the state. The article briefly explains the eye initiative and lists the AAO and AOA toll-free numbers. Radio public service announcements featuring Alabama native, Nell Carter. Ms. Carter speaks as a patient with diabetes and the importance of management and prevention. The radio announcements will be distributed to radio stations throughout the state in November. Please help us make this initiative a success. As your patients with diabetes come into your offices, ask them the date of their last dilated eye exam. If your patients do not remember, please schedule their appointments with an eye professional before the patients leave your office. The Diabetes Eye Assessment Form can be found at www.aqaf.com (please go to Medicare-HCQIP Projects-Diabetes to print the PDF file). It will also be mailed to you in the near future with instructions for its use. Feel free to make copies of the form. The eye professional is to send your office a copy of the results of the eye exam for you to place in the patient’s medical record. On the Road... Don’t forget your African-American patients! For all ages combined, Caucasian women are more likely to develop breast cancer than African-American women. However, African-American women under the age of 50 have higher incidence rates than Caucasian women. In Alabama, there is an 11% disparity rate in the mammography utilization rates between African-American and Caucasian Medicare beneficiaries. 1 www.cancer.org/statistics/99bcff/who.html YOU CAN HELP! 1. Perform an annual clinical breast exam on all of your female patients over 40. 2. Discuss the advantages of early detection by mammography. 3. Make the mammogram appointment for your female patients. Together, we can make a difference! Roberta Ford will do what she can to make sure she is around to enjoy her grandson Tevyn by getting her annual mammogram screening. Medicare covers an annual screening once every 12 months. Cover Photo: Roberta Ford with her three grandsons, Mychal, Trynton and Tevyn Richardson at Murphree’s Fruits and Vegetables. This material was prepared by Alabama Quality Assurance Foundation under a contract with the Health Care Financing Administration. Contents do not necessarily represent Health Care Financing Administration policy. 6SOW-AL-OUPT-00-09 / qp1000.pm6 Many of you know that Medicare, through the Health Care Financing Administration (HCFA), is covering more preventive care services than in the past. We want to help you educate your patients on what preventive services they need and what Medicare covers. In our continuing effort to meet as many of Alabama’s physician office staff as possible, AQAF is partnering with Blue Cross/Blue Shield of Alabama Physician Network Representatives. An AQAF project manager will be making a brief presentation on AQAF, what services we offer, and available patient education materials. The BC/BS network representative in your area will be contacting you with dates and times of the meetings. We look forward to talking with each of you this fall. Ideas You Can Use to Improve Care We would like to thank our new outpatient project study group. These enthusiastic physicians, nurses and pharmacists met on August 22, 2000 to address the challenge of improving outpatient medical care for breast cancer, diabetes and immunizations in the state of Alabama. Alabama Quality Assurance Foundation / One Perimeter Park South, Suite 200 North / Birmingham, Alabama 35243-2354 Ideas generated from the diabetes group: • • • • October 2000 Outpatient Provide standing orders and protocols for the patient with diabetes regarding HbA1c and lipids. Share the diabetes eye initiative. Share the Diabetes Eye Assessment Form. Use the eye intervention poster. Ideas generated from the breast cancer/disparity group: Continued from previous page • We continue to invite all health care providers to become involved in these important projects and appreciate any comments or advice which may facilitate overall improvement of the quality of care for Medicare beneficiaries in the state of Alabama. • • • Advertise and support the use of mobile units in areas where mammography services are not available. Use “tool boxes” that would include information on recommended screenings, billing/coverage information and liability information. Inform beneficiaries on Medicare coverage of screening vs. diagnostic mammograms as well as other services covered by Medicare. Use reminder stickers on the medical record. *AQAF has the following items available upon request: Ideas generated from the immunization group: • • • Give influenza and pneumococcal vaccines. Wear “Have you been vaccinated?” reminder stickers. Offer CEUs/CMEs for educational inservices. AQAF Inpatient Indicator Poster (1.00 each after first 25) continued on back page AQAF Outpatient Indicator Poster (1.00 each after first 25) AQAF Diabetes Poster ($1.00 each after first 25) AQAF Care for the Patient with Diabetes Brochures • Introduction to Diabetes: What Medicare Pays ($.25 each after first 25) • Blood Pressure Medication/Immunizations ($.25 each after first 25) *Please fax or e-mail your request for an order form to 9701624 or [email protected] with your name and address. The order form can also be found at aqaf.com under HCQIP Projects. • Fasting Blood Sugar/ Serum Creatinine/Lipids ($.25 each after first 25) • Hemoglobin A1c ($.25 each after first 25) • Foot Care/Exercise/Diet ($.25 each after first 25) Breast Cancer Awareness Month Diabetes Eye Assessment Form Now Available Compliments to this Dynamic Outpatient Committee David S. Bell, MD Michael Collins, MD Harold Cox, MD Greer Geiger, MD Ghayas Habach, MD Jack Hataway, MD Saunders Hupp, MD William Peinhardt, MD Robert Sherrill, MD Thomas Stokes, MD Sarah Franklin, CRNP Danny Johnson RPh Jon Tanja, RPh Patsy Kanter, RN Lisa Miller, RN NCI Mammogram Bookmark (S&H only after first 25) NCI Mammogram Booklet (S&H only after first 25) • Diabetic Eye Disease ($.25 each after first 25) NCI Pap Test Booklet (S&H only after first 25) AQAF Pneumonia Shot Brochure (S&H only after first 25) NCI Mammogram Poster (S&H only after first 25) HCFA Mammogram Bookmark (S&H only after first 25) HCFA Mammogram Reminder Postcard (S&H only after first 25) Diabetes Standards of Care (Hard copy, No Charge, you make copies) AQAF Mammogram Brochure ($.25 each after first 25) Tear off pad of Diabetes Continuing Care Standards ($1.00 ea or you may copy) Coming Soon: Watch your mailbox for the new Diabetes Eye Assessment Form with instructions from Alabama Quality Assurance Foundation, Alabama Academy of Ophthalmology and Alabama Association of Optometry. Alabama Quality Assurance Foundation