title: Payment Reform Needed to Address Health Disparities of Undiagnosed Diabetic Retinopathy in the City of Chicago.
abstract: BACKGROUND
  The Affordable Care Act (ACA) has expanded health coverage for thousands of Illinois residents. Expanded coverage, however, does not guarantee appropriate health care. Diabetes and its ocular complications serve as an example of how providers in underserved urban areas may not be able to keep up with new demand for labor- and technology-intensive health care unless changes in reimbursement policies are instituted.
  
  
  METHODS
  A retrospective cohort study was conducted using medical encounter information from the Chicago HealthLNK Data Repository (HDR), an assembly of non-duplicated and de-identified patient medical records. We used a method of estimating the geographic distribution of undiagnosed diabetic retinopathy in the city of Chicago to illustrate the magnitude of potentially preventable eye disease. All rates were calculated for all ZIP Codes within Chicago (Cook County), and statistical differences between observed and geographically adjusted expected rates (p < 0.10, p < 0.05, p < 0.01) were highlighted as underserved areas.
  
  
  RESULTS
  This analysis included 150,661 patients with diabetes identified from a total of nearly two million patients in Chicago. High rates of undetected diabetic retinopathy were found in low-income and minority areas. Within these areas, 37% of the identified diabetics were uninsured, with rates ranging widely from 20% to 68.6%. Among those with insurance, 32.8% were covered by Medicare and only 10% by Medicaid. Most patients with untreated diabetic retinopathy were found to reside in areas where primary health care is provided through Federally Qualified Health Centers.
  
  
  CONCLUSIONS
  With 150,661 diabetics identified in the city of Chicago, and this number continuing to rise each year, a manpower approach with ophthalmologist screening for diabetic retinopathy is not realistic. The ability to identify the growing number of diabetic patients with retinopathy in low-income areas will likely require the adoption of cost-effective screening technologies that are currently not funded by Medicare and Medicaid.
authors.affiliation: Department of Ophthalmology, Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Dustin.French@northwestern.edu.|Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA. Dustin.French@northwestern.edu.
authors.forename: Dustin D
authors.initials: DD
authors.lastname: French
authors.affiliation: Department of Medicine, and Center for Health Information Partnerships, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Jess J
authors.initials: JJ
authors.lastname: Behrens
authors.affiliation: Department of Medicine, and Center for Health Information Partnerships, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Jackson
authors.affiliation: Department of Medicine, and Center for Health Information Partnerships, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Abel N
authors.initials: AN
authors.lastname: Kho
authors.affiliation: Department of Medicine, and Center for Health Information Partnerships, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Theresa L
authors.initials: TL
authors.lastname: Walunas
authors.affiliation: Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA.|Department of Preventive Medicine, Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Charlesnika T
authors.initials: CT
authors.lastname: Evans
authors.affiliation: Department of Ophthalmology, Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Mbagwu
authors.affiliation: Department of Ophthalmology Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Curtis E
authors.initials: CE
authors.lastname: Margo
authors.affiliation: Department of Ophthalmology, Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Bryar
keywords: Diabetes; Disparities; Ophthalmology; Physician payment; Policy; Retinopathy; Telehealth