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HIV Screening

Compare Versions of: "HIV Screening"

The Compare function compares two years of the measure specifications found in the header of the measure's HTML. It does not include a comparison of any information in the body of the HTML, e.g., population criteria, Clinical Quality Language, or value sets.

Strikethrough text highlighted in red indicates information changed from the previous version. Text highlighted in green indicates information updated in the new eCQM version.

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Measure Information 2022 Performance Period 2023 Performance Period 2024 Performance Period
Title HIV Screening HIV Screening HIV Screening
CMS eCQM ID CMS349v4 CMS349v5 CMS349v6
CBE ID Not Applicable Not Applicable Not Applicable
MIPS Quality ID 475 475 475
Description

Percentage of patients aged 15-65 at the start of the measurement period who were between 15-65 years old when tested for HIV

Percentage of patients aged 15-65 at the start of the measurement period who were between 15-65 years old when tested for Human immunodeficiency virus (HIV)

Percentage of patients aged 15-65 at the start of the measurement period who were between 15-65 years old when tested for Human immunodeficiency virus (HIV)

Definition *See CMS349v4.html *See CMS349v5.html

None

Initial Population

Patients 15 to 65 years of age at the start of the measurement period AND who had at least one outpatient visit during the measurement period

Patients 15 to 65 years of age at the start of the measurement period AND who had at least one outpatient visit during the measurement period

Patients 15 to 65 years of age at the start of the measurement period AND who had at least one outpatient visit during the measurement period

Numerator

Patients with documentation of an HIV test performed on or after their 15th birthday and before their 66th birthday

Patients with documentation of an HIV test performed on or after their 15th birthday and before their 66th birthday

Patients with documentation of an HIV test performed on or after their 15th birthday and before their 66th birthday

Numerator Exclusions

Not Applicable

Not Applicable

Not Applicable

Denominator

Equals Initial Population

Equals Initial Population

Equals Initial Population

Denominator Exclusions

Patients diagnosed with HIV prior to the start of the measurement period

Patients diagnosed with HIV prior to the start of the measurement period

Patients diagnosed with HIV prior to the start of the measurement period

Denominator Exceptions

None

None

Patients who die on or before the end of the measurement period

Measure Steward Centers for Disease Control and Prevention (CDC) Centers for Disease Control and Prevention (CDC) Centers for Disease Control and Prevention (CDC)
Measure Scoring Proportion measure Proportion measure Proportion measure
Measure Type Process measure Process measure Process measure
Improvement Notation

Higher score indicates better quality

Higher score indicates better quality

Higher score indicates better quality

Guidance

This measure evaluates the proportion of patients aged 15 to 65 at the start of the measurement period who have documentation of having received an HIV test at least once on or after their 15th birthday and before their 66th birthday. In order to satisfy the measure, the reporting provider must have documentation of the administration of the laboratory test present in the patient's medical record. In cases where the HIV test was performed elsewhere, providers cannot rely on patient attestation or self-report to meet the measure requirements, as previous research has shown that patient self-report is an unreliable indicator of previous HIV testing history. Rather, providers must request documentation of those test results. If such documentation is not available, the patient should be considered still eligible for HIV screening. If such documentation is available, but cannot be provided in a standardized, structured format (such that the lab test and results can be readily incorporated as structured data within the EHR), providers should enter the information into their EHR as a laboratory test in a manner consistent with the EHR in use. If the specific Human Immunodeficiency Virus (HIV) Laboratory Test LOINC code of the test is not known, the entry should use the more generic code LOINC panel code [75622-1].

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

This measure evaluates the proportion of patients aged 15 to 65 at the start of the measurement period who have documentation of having received an HIV test at least once on or after their 15th birthday and before their 66th birthday. In order to satisfy the measure, the reporting provider must have documentation of the administration of the laboratory test present in the patient's medical record. In cases where the HIV test was performed elsewhere, providers cannot rely on patient attestation or self-report to meet the measure requirements, as previous research has shown that patient self-report is an unreliable indicator of previous HIV testing history. Rather, providers must request documentation of those test results. If such documentation is not available, the patient should be considered still eligible for HIV screening. If such documentation is available, but cannot be provided in a standardized, structured format (such that the lab test and results can be readily incorporated as structured data within the EHR), providers should enter the information into their EHR as a laboratory test in a manner consistent with the EHR in use. If the specific Human Immunodeficiency Virus (HIV) Laboratory Test LOINC code of the test is not known, the entry should use the more generic code LOINC panel code [75622-1].

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

This measure evaluates the proportion of patients aged 15 to 65 at the start of the measurement period who have documentation of having received an HIV test at least once on or after their 15th birthday and before their 66th birthday. In order to satisfy the measure, the reporting provider must have documentation of the administration of the laboratory test present in the patient's medical record. In cases where the HIV test was performed elsewhere, providers cannot rely on patient attestation or self-report to meet the measure requirements, as previous research has shown that patient self-report is an unreliable indicator of previous HIV testing history. Rather, providers must request documentation of those test results. If such documentation is not available, the patient should be considered still eligible for HIV screening. If such documentation is available, but cannot be provided in a standardized, structured format (such that the lab test and results can be readily incorporated as structured data within the EHR), providers should enter the information into their EHR as a laboratory test in a manner consistent with the EHR in use. If the specific Human Immunodeficiency Virus (HIV) Laboratory Test LOINC code of the test is not known, the entry should use the more generic code LOINC panel code [75622-1].

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

Telehealth Eligible Yes Yes Yes
Rationale *See CMS349v4.html *See CMS349v5.html

HIV is a communicable infection that leads to a progressive disease with a long asymptomatic period. There were an estimated 34,800 new HIV infections in the United States in 2019 (Centers for Disease Control and Prevention, 2021). Without treatment, most persons develop acquired immunodeficiency syndrome (AIDS) within 10 years of HIV infection. Antiretroviral therapy (ART) delays this progression and increases the length of survival, but it is most effective when initiated during the asymptomatic phase. Persons living with HIV who use ART and achieve viral suppression can have a nearly normal life expectancy (Samji et al., 2013). The Department of Health and Human Services (DHHS) Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents recommends immediate antiretroviral therapy for all HIV-infected individuals, regardless of CD4 count at diagnosis, to reduce the risk of disease progression (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022).

 

CDC estimates that, at the end of 2016, approximately 14% of the 1.1 million adults and adolescents living with HIV infection in the United States were unaware of their infection (Centers for Disease Control and Prevention, 2019a). Among persons diagnosed with HIV in 2017, approximately 21% were diagnosed with Stage 3 HIV (AIDS) at the time of HIV diagnosis (Centers for Disease Control and Prevention, 2019c), which is when the median CD4 count at diagnosis is less than 200 cells/mm3 for persons aged greater than or equal to 6 years (Centers for Disease Control and Prevention, 2019b). HIV screening identifies infected persons who were previously unaware of their infection, which enables them to seek medical and social services that can improve their health and the quality and length of their lives. Additionally, using ART with high levels of medication adherence has been shown to substantially reduce risk for HIV transmission (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2022).

 

Based on the Behavioral Risk Factor Surveillance System (BRFSS), the percentage of ever tested for HIV increased from 42.9% in 2011 to 45.9% in 2017. Despite this increase, less than half of US adults have ever been tested for HIV over ten years after CDC’s recommendations (Patel et al., 2019).

Stratification *See CMS349v4.html *See CMS349v5.html

None

Risk Adjustment *See CMS349v4.html *See CMS349v5.html

None

Clinical Recommendation Statement *See CMS349v4.html *See CMS349v5.html

The US Preventive Services Task Force recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened (A Recommendation) (Owens et al., 2019).

Since 2006, the CDC has recommended routine opt-out HIV screening (i.e., patient is notified that testing will be performed unless the patient declines) in healthcare facilities of adolescents and adults 13-64 years of age and HIV diagnostic testing of adolescents and adults with clinical signs or symptoms consistent with HIV infection (Centers for Disease Control and Prevention, 2006).

Next Version No Version Available
Previous Version No Version Available

Header

  • Updated the eCQM version number.

    Measure Section: eCQM Version Number

    Source of Change: Annual Update

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • ​Updated rationale for consistency with updated evidence about use of antiretroviral agents.

    Measure Section: Rationale

    Source of Change: Annual Update

  • Updated references.

    Measure Section: Reference

    Source of Change: Annual Update

Logic

  • Updated Initial Population age logic to a closed interval for harmonization with other measures.

    Measure Section: Initial Population

    Source of Change: Annual Update

  • Updated numerator logic using 'has' instead of 'exists' for harmonization with other measures.

    Measure Section: Numerator

    Source of Change: Annual Update

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-6.2.000). Updated the 'Inpatient Encounter' definition to include a 'day of' timing clarification. Added the following timing functions: Normalize Interval, Has Start, Has End, Latest, Latest Of, Earliest, and Earliest Of. Please see individual measure details for application of specific timing functions.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Added new NormalizeInterval function to timing attributes to decrease implementation burden due to variable use of timing attributes for select QDM data types. The NormalizeInterval function was applied, where applicable, for the following data elements: Assessment, Performed; Device, Applied; Diagnostic Study, Performed; Intervention, Performed; Laboratory Test, Performed; Medication, Administered; Medication, Dispensed; Physical Exam, Performed; Procedure, Performed; Substance, Administered.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Value set Indicators of Human Immunodeficiency Virus (HIV) (2.16.840.1.113762.1.4.1056.54): Deleted 1 ICD-9-CM code (176.9) based on review by technical experts, SMEs, and/or public feedback. Added 11 SNOMED CT codes (838338001, 838377003, 840442003, 840498003, 860871003, 860872005, 860874006, 866044006, 870271009, 870328002, 870344006) based on terminology update. Renamed extensional value sets to match the grouping name, Indicators of Human Immunodeficiency Virus (HIV), based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Feb 13, 2024