Tobacco Use: Screening & Cessation Intervention

Transcription

1 Tobacco Use: Screening and Cessation Intervention MSSP ACO Measure Tobacco Use: Screening & Cessation Intervention Domain: Preventive Care and Screening ACO 17 PREV- 10 PQRS NQF 0028 Measure Steward: AMA/PCPI ACO submits data to CMS CPT II coding required: YES Click here to go to Table of Contents MSSP 2015 Measures Page 64 of 234 Dated: 5/27/2015

2 2015 MSSP ACO Measures Reporting Tracking Performance for Quality Improvement Tobacco Use: Screening and Cessation Intervention This measure looks at the percentage of patients aged 12 years* and older who were screened for tobacco use one or more times within 24 months** AND who received cessation counseling intervention if identified as a tobacco user. *MSSP age range = 18 years and older Key: Performance Met Performance Not Met Excluded from Performance Measurement A higher score indicates better quality. RATIONALE: This measure is intended to promote adult tobacco screening and tobacco cessation interventions for those who use tobacco products. There is good evidence that tobacco screening and brief cessation intervention (including counseling and/or pharmacotherapy) is successful in helping tobacco users quit. Tobacco users who are able to stop smoking lower their risk for heart disease, lung disease, and stroke. CLINICAL RECOMMENDATION STATEMENTS: All patients should be asked if they use tobacco and should have their tobacco use status documented on a regular basis. Evidence has shown that clinic screening systems, such as expanding the vital signs to include tobacco use status or the use of other reminder systems such as chart stickers or computer prompts, significantly increase rates of clinician intervention. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008) All physicians should strongly advise every patient who smokes to quit because evidence shows that physician advice to quit smoking increases abstinence rates. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008). Target Population Procedure Codes & Code Descriptors ELIGILBLE POPULATION All patients aged 12 years and older + seen for at least two visits or at least one preventive visit during the measurement period NUMERATOR: Patients who were screened for tobacco use at least once within 24 months AND who received tobacco cessation counseling intervention if identified as a tobacco user DENOMINATOR EXCEPTIONS: Documentation of MEDICAL REASON(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason) Definitions: ** Within 24 months is defined as: The 24-month look-back from the measurement period end date Dec 31 st. Tobacco Use Includes any type of tobacco. Cessation Counseling Intervention Includes counseling, including brief counseling (3 minutes or less) and/or pharmacotherapy Choose one of the codes below: Patient Screened for Tobacco Use CPT II code 1036F: Current tobacco non-user CPT II code 4004F: Screened AND received cessation intervention (counseling or pharmacotherapy, or both) if tobacco user Patient NOT Screened /Reason Is Documented CPT II code 4004F - 1P: Screening not performed AND medical reason is documented (e.g. limited life expectancy) Performance Not Met CPT II code 4004F - 8P: Tobacco screening OR tobacco cessation intervention not performed and reason is not otherwise specified MSSP 2015 Measures Page 65 of 234 Dated: 5/27/2015

3 To Determine the Denominator CPT codes or HCPCS codes, and patient demographics are used to identify patients who are included in the measure s denominator. Step 1: Identify all members: aged 12 years and older and Patient encounter during the reporting period (CPT and HCPCS): Tobacco Use: Screening and Cessation Intervention: Eligible Cases Patient encounter during the reporting period (CPT or HCPCS) Patients aged 12 years + Encounter occurring during the measurement period Exclusions MEDICAL REASONS for Not Screening for Tobacco Use: Limited life expectancy, other medical reasons AND CPT 90791, 90792, 90832, 90834, 90837, 90839, 90845, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 97003, 97004, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99406, G0438, G0439 or HCPCS To Determine the Numerator Patients who were screened for tobacco use at least once within 24 months AND who received tobacco cessation counseling intervention if identified as a tobacco user Quality-data CPT II codes are used to report the numerator of the measure.. To Determine if patient is not eligible Documentation of Medical Exclusions listed above MSSP 2015 Measures Page 66 of 234 Dated: 5/27/2015

4 STRATEGIES TO IMPROVE AND ENHANCE YOUR PERFORMANCE FREQUENCY: Perform Regularly (measure requires documentation of screening at least once within 24 months) All patients should be asked if they use tobacco and should have their tobacco use status documented on a regular basis. REPORTING FREQUENCY: This measure is to be reported once per reporting period for patients seen during the reporting period. Measure Reporting via Claims: CPT or HCPCS codes and patient demographics are used to identify patients who are included in the measure s denominator. Use correct diagnosis and procedure codes. Quality data coding is used to identify the patients who pass the measure. Use CPT Category II codes to report compliance with the measure. When reporting the measure via claims, submit the appropriate CPT or HCPCS codes, and the appropriate CPT Category II code OR the CPT Category II code with the modifier. The modifiers allowed for this measure are: 1P- medical reasons, 8P- reason not otherwise specified. All measure-specific coding should be reported on the claim(s) representing the eligible encounter. Submit claims and encounter data in a timely manner. Advise every patient who smokes to quit. Document it. The USPSTF recommends that clinicians ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products. Clinicians should encourage all patients attempting to quit to use effective medications for tobacco dependence treatment, except where contraindicated or for specific populations for which there is insufficient evidence of effectiveness (i.e., pregnant women, smokeless tobacco users, light smokers, and adolescents). If there is more than 1 patient query regarding tobacco use, use the most recent The measure requires that the patient was screened for tobacco use within a specified time period, therefore a screening date is required. If a patient uses any type of tobacco (i.e., smokes or uses smokeless tobacco), the expectation is that they should receive tobacco cessation: either counseling and/or pharmacotherapy. If tobacco use status of a patient is unknown, the patient does not meet the screening component required to be counted in the numerator and should be considered a measure failure. Instances where tobacco use status of unknown is recorded include: 1) the patient was not screened; or 2) the patient was screened and the patient (or caregiver) was unable to provide a definitive answer. If the patient does not meet the screening component of the numerator but has an allowable medical exception, then the patient should be removed from the denominator of the measure and reported as a valid exception. Exceptions only apply to the screening data element of the measure; once a patient has been screened, there are no allowable exceptions for not providing the intervention. MSSP 2015 Measures Page 67 of 234 Dated: 5/27/2015

5 PREV 10: Tobacco Use: Screening and Cessation Intervention Summary Description: Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation counseling if identified as a tobacco user. Denominator Exclusions: None Denominator Exceptions: Medical reasons What is the Quality Action? Screening for tobacco use at least once within 24 months. For any patient identified as a tobacco user, tobacco cessation counseling must also be provided. Tobacco use includes any type of tobacco. Where may the Quality Action take place? Must take place in a healthcare setting Who may perform the Quality Action? Any healthcare professional may screen for tobacco use. When must the Quality Action be performed? The screening for tobacco use must occur within the 24 months prior to the end of the measurement period. The same time frame also applies for cessation intervention for those patients identified as tobacco users. If there is more than one tobacco screening, use the most recent. What are the documentation requirements relative to the Quality Action? The patient s medical record must contain: The date and results of a query of the patient s use of tobacco; If identified as a tobacco user, documentation of a related cessation counseling intervention; or Documentation of the reason why the Quality Action is not performed due to an exception (see Data Guidance for specific medical reason exceptions). MSSP 2015 Measures Page 68 of 234 Dated: 5/27/2015

6 2015 MSSP Reporting Data Collection Form Tobacco Use: Screening and Cessation Intervention Target Population Age: Patients aged 12 years and older. Patient Name: DOB: (First) (M.I.) (Last) mm / dd / yyyy Gender: M F Medical Record Number: Date of Service : mm / dd / yyyy Step 1 Determine if the patient is eligible for this measure? Q1: Is the patient 12 years of age or older? Yes Continue to Q2 Q2: Was the patient was seen for a visit in the measurement year? Yes Continue to Q3 No Stop No Stop Step 2 Did you meet the measure? Q3: Determine if the patient was screened for tobacco use at least once within 24 months AND identified as a tobacco user Yes Not Screened or Tobacco Status Unknown Continue to Q5 If, go to Q4 Q4: Determine if there is documented medical reason(s) for not screening the patient for tobacco use (c) Medical Reasons: Select this option if the patient was not screened for tobacco use for medical reasons and the reason is documented (e.g., Limited life expectancy, other medical reasons) (b) No Reason Documented If (a) or (b) are checked, Stop. Do Not Answer Cessation Counseling Intervention Q5: Determine if tobacco cessation counseling intervention was received if the patient was identified as a tobacco user Cessation Counseling Intervention - Includes brief counseling (3 minutes or less), and/or pharmacotherapy Yes No Step 2 Reporting Options Check One: Screened for Tobacco use and identified as Current tobacco non-user CPT II 1036F Screened AND received cessation intervention (counseling or pharmacotherapy, or both) if CPT II 4004F tobacco user Screening not performed AND medical reason is documented (e.g. limited life expectancy) CPT II 4004F - 1P Tobacco screening OR tobacco cessation intervention not performed and reason is not otherwise specified CPT II 4004F - 8P For Practice Use: Form Completed by: Date: MSSP 2015 Measures Page 69 of 234 Dated: 5/27/2015