Referral Management Will Prevent More Than 20,000 Cases of Blindness Each Year

Posted by Jeremy Guttman on 6/2/16 6:13 PM


The leading cause of blindness worldwide is diabetes. However, referral management makes a significant impact on saving the eyesight of diabetic patients. Most people who have diabetes for more than 20 years develop diabetic retinopathy1, a condition where elevated blood sugar damages the blood vessels inside the retina. Over 7.7 million American adults have diabetic retinopathy today and that number is expected to double by 2050. The condition affects almost 30% of the US diabetic population over the age of 402 and causes up to 24,000 new cases of blindness in the US each year.


To view the full version of this NIH infographic, click here

Referrals are absolutely crucial for early detection

In order to detect and treat diabetic retinopathy early, referrals are crucial. PCPs need to regularly refer diabetic patients to eye doctors, predominantly Ophthalmologists, for diabetic eye exams. Early detection and treatment of diabetic retinopathy can have a monumental impact on the chances of blindness - reducing the risk by 95%!3

High-performance referral management enhances communication in the Ophthalmology referral process to reduce the risk of patients going blind from diabetes.

Each year 24,000 new cases of blindness are caused by diabetic retinopathy in the US. Because early detection and treatment can reduce the risk of blindness by 95%, referral management can come to the rescue for 22,800 people each year who would have otherwise gone completely blind.

Without referral management, half of diabetics fail to follow recommendations and risk blindness

According to the American Diabetes Association, the range of examinations is directly associated with the severity of the condition. For those with no evidence of retinopathy for one or more exams, dilated fundus examinations (DFEs) are recommended every 2 years. If retinopathy is detected, annual exams are recommended. Examinations are suggested even more frequently for progressing retinopathy in order to reduce the risk of severe vision loss and blindness.4

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The bad news is that up to 48% of adults with diabetes do not follow this annual eye exam recommendation, according to the National Committee for Quality Assurance (NCQA). This rate has stayed consistent despite initiatives to improve patient adherence. Healthy People 2010, a program launched in 2000 by the U.S. Department of Health and Human Services (HHS), set a visionary goal (pun intended!) to bring the rate of annual dilated eye exams in adults with diabetes to 75%. But the figure did not budge. It stayed in the low 50% range.5


Image courtesy of National Eye Institute, National Institutes of Health

One might expect a country with universal health insurance to have a higher adherence rate for recommended diabetic eye exams because the exams are more subsidized. However, down under in Australia, where there is universal health coverage, nearly half of adults with diabetes did not receive adequate screening or follow up for diabetic retinopathy.6 Thus, the adherence rate in Australia is similar to the adherence rate in the United States.

No referral = no appointment

According to the journal Ophthalmic Epidemiology, almost half of diabetics don’t get eye exams because referrals for comprehensive eye exams by primary care providers are “far from universal or automatic.”6 Patients aren’t going to go to an ophthalmology appointment unless they are referred by their doctor.7

Google and other technology companies have been experimenting with machine learning and artificial intelligence to conduct diabetic eye exams. One day, a computer could help in the diagnostic process. But for the foreseeable future, diabetics will continue to need the skills and experience of a specialized eye doctor to recognize diabetic retinopathy in scans.8

PCP-Ophthalmologist communication increases patient adherence

It’s crystal clear that improved care coordination is critical for Ophthalmology referrals. According to a recent study published in the journal Retina in January 2016, communication between primary care and specialist providers is a “clear area for potential improvement” because it does not occur often enough.

The results showed that communication from Ophthalmologists to PCPs increased adherence by almost 10% and communication from PCPs to Ophthalmologists increased adherence by more than 16%.2


Additionally, the study expands on the communication benefits between providers:

Benefits of PCP to Ophthalmologist communication

  • 16% increase in appointment adherence
  • Communication informs Opthalmologist of a patient’s
    • systemic diabetes complications
    • hemoglobin A1C levels
    • current treatment regimen
    • adherence to systemic therapy

Benefits of Ophthalmologists to PCP communication

  • 10% increase in appointment adherence
  • Communication informs PCP of a patient’s
    • severity and progression of their diabetic retinopathy
    • adherence to recommended ocular care
    • need for follow-up visits
    • treatment plans

The Retina study concludes with a final recommendation for electronic system interventions, such as referral management software, to boost doctor-to-doctor dialogue.2

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Improve PCP-Ophthalmologist collaboration with high-performance referral management

High performance referral management gives leading primary care practices the right kind of insight into Ophthalmologist referral performance metrics. Those metrics reveal actionable diabetic eye exam referral patterns. Primary care practice coordinators can review referrals by physician to identify and address the patients that are not meeting annual guidelines.

In addition, high-performance referral management gives primary care practices optics into specialist performance metrics (time-to-treatment, consult report compliance, patient satisfaction) for their Ophthalmologist referral partners. This allows PCP practices to address any pivotal deficiencies in the referral loop process. These types of referral behavior analytics are not available from EHR systems or claims data.

Increased patient adherence for diabetic eye exams will significantly help with patient care as well as with practice reimbursement requirements. Most primary care practices in the United States are beginning to get reimbursed based on quality metrics. One of the core quality metrics established by the Core Quality Measures Collaborative is the percentage of diabetic patients who had a comprehensive eye exam. The metric measures and scores the percentage of diabetic patients who had eye exams done in the past year or the percentage who had a negative eye exam result in the previous year.9

It’s vital for primary care practices to choose the best solutions to enhance PCP-specialist communication, such as high-performance referral management, which increases patient adherence for diabetic eye exams.

Referral management allows practices to offer the best preventative care for their diabetic patients. As a result, everyone wins. Patients get the recommended diabetes care they need and 95% fewer patients with diabetic retinopathy go blind.

In the past, nurses or secretaries made referrals that were never tracked. Now, with referral management software, doctors can see if their referrals are being initiated and completed.

- Dr. Charles Kent, MD | Ophthalmologist, Oculoplastic and Cataract Surgeon



1 Diabetes Care |

2 Retina |

3National Eye Institute |

4 Diabetes Care |

5 Vision & Eye Health Council |

6 Ophthalmic Epidemilology |

7 National Eye Inistitute |

8 Fast Company |

9 CMS Consensus Core Set: ACO and PCMH / Primary Care Measures |


Topics: Coordinated Care, Healthcare Analytics, Referral Management, Closed-Loop Referral Management, Patient Adherence, Diabetic Eye Exam