The Business Case for DSME


Medicare and private insurers are moving away from a pure fee-for-service payment structure toward payment based on performance. Prepare for the new pay-for-performance reports that will include diabetes outcome measures derived from Medicare claims.

Medicare’s pay-for-performance will be phased in during the next few years based on the number of eligible professionals (EPs) in a medical group. Payment adjustments are made two years after each performance time frame. Payment adjustments for groups of 100+ EPs are based on CY2013; 10+ EPs on CY2014; and 2+ EPs on CY2015.

Value-Based Payment Modifier/Quality Resource and Utilization Reports (QRURs): QRUR Reports will evaluate diabetes care including:

  • Cost per capita for patients with diabetes
  • Short-term complication admission rates (includes hospitalizations)
  • Long-term complication admission rates (includes amputations)

Refer All Patients with Diabetes for DSME: Qsource invites you to join us and our partners to ensure all patients with diabetes and pre-diabetes can take part in DSME. By making certain all people with diabetes are referred for DSME, you not only engage patients, but improve outcomes for patients with diabetes in your medical practice.