Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Last updated: October 25, 2017

CMS Measure ID: CMS138v6
Version: 6
NQF Number: 0028
Measure 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 intervention if identified as a tobacco user

Three rates are reported:

a. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months

b. Percentage of patients aged 18 years and older who were screened for tobacco use and identified as a tobacco user who received tobacco cessation intervention

c. 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 intervention if identified as a tobacco user

Initial Patient Population:

All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period

Denominator Statement:

Population 1:

Equals Initial Population

Population 2:

Equals Initial Population who were screened for tobacco use and identified as a tobacco user

Population 3:

Equals Initial Population

Denominator Exclusions:

None

Numerator Statement:

Population 1:

Patients who were screened for tobacco use at least once within 24 months

Population 2:

Patients who received tobacco cessation intervention

Population 3:

Patients who were screened for tobacco use at least once within 24 months AND who received tobacco cessation intervention if identified as a tobacco user

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Population 1:

Documentation of medical reason(s) for not screening for tobacco use (eg, limited life expectancy, other medical reason)

Population 2:

Documentation of medical reason(s) for not providing tobacco cessation intervention (eg, limited life expectancy, other medical reason)

Population 3:

Documentation of medical reason(s) for not screening for tobacco use OR for not providing tobacco cessation intervention for patients identified as tobacco users (eg, limited life expectancy, other medical reason)

Measure Steward: PCPI(R) Foundation (PCPI[R])
Domain: Community/Population Health
Previous Version: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Improvement Notation:

Higher score indicates better quality

Guidance:

If a patient uses any type of tobacco (ie, smokes or uses smokeless tobacco), the expectation is that they should receive tobacco cessation intervention: either counseling and/or pharmacotherapy.

If a patient has multiple tobacco use screenings during the 24 month period, only the most recent screening, which has a documented status of tobacco user or tobacco non-user, will be used to satisfy the measure requirements.

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.

The medical reason exception may be applied to either the screening data element OR to any of the applicable tobacco cessation intervention data elements (counseling and/or pharmacotherapy) included in the measure.

If a patient has a diagnosis of limited life expectancy, that patient has a valid denominator exception for not being screened for tobacco use or for not receiving tobacco use cessation intervention (counseling and/or pharmacotherapy) if identified as a tobacco user.

As noted above in a recommendation statement from the USPSTF, the current evidence is insufficient to recommend electronic nicotine delivery systems (ENDS) including electronic cigarettes for tobacco cessation. Additionally, ENDS are not currently classified as tobacco in the recent evidence review to support the update of the USPSTF recommendation given that the devices do not burn or use tobacco leaves. In light of the current lack of evidence, the measure does not currently capture e-cigarette usage as either tobacco use or a cessation aid.

The requirement of Count >=2 Encounter, Performed is to establish that the eligible professional or eligible clinician has an existing relationship with the patient for certain types of encounters.

This measure contains three reporting rates which aim to identify patients who were screened for tobacco use (rate/population 1), patients who were identified as tobacco users and who received tobacco cessation intervention (rate/population 2), and a comprehensive look at the overall performance on tobacco screening and cessation intervention (rate/population 3). By separating this measure into various reporting rates, the eligible professional or eligible clinician will be able to better ascertain where gaps in performance exist, and identify opportunities for improvement. The overall rate (rate/population 3) can be utilized to compare performance to prior published versions of this measure.

Addendum Notes: Value Set content updated Sept 2017

Specifications

Release Notes

Header and Logic

  • Based on feedback received from clinical experts, federal agencies, and the updated standards, the measure developer has revised the measure in a way to better highlight performance and areas for improvement. This measure has undergone a number of changes which will enable eligible professionals or eligible clinicians to more clearly understand their performance on the individual clinical actions included in the measure. Additionally, the changes have resulted in new relationships and timings among data elements in order to more accurately capture the clinical actions indicated by this measure.

    Measure Section: Multiple sections

    Source of Change: Measure Lead, Expert Work Group

Header

  • ​Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Added instructions surrounding the three performance rates based on the measure restructure.

    Measure Section: Description

    Source of Change: Measure Lead

  • Revised 'cessation counseling intervention' to 'tobacco cessation intervention' in the Description to align with Numerator and data element names.

    Measure Section: Description

    Source of Change: Measure Lead

  • ​Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • ​Updated Disclaimer.

    Measure Section: Disclaimer

    Source of Change: Measure Lead

  • Replaced reference to smoking with reference to tobacco use to align with measure intent.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated the Definition for tobacco cessation intervention.

    Measure Section: Definition

    Source of Change: Measure Lead

  • Added Guidance regarding the encounter count requirement.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Added Guidance to highlight the most recent tobacco use screening is used to assess the logic requirements.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Added Guidance regarding the measure restructure to collect and report three different rates. This Guidance highlights the intent of each rate/population.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated Guidance related to Denominator Exception applicability; expanded applicability of the medical reason exception to the tobacco cessation intervention, per clinical experts' recommendations.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated to reflect the eligible populations for the three performance rates.

    Measure Section: Denominator

    Source of Change: Measure Lead

  • Updated to reflect the eligible populations for the three performance rates.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Revised Denominator Exception language to reflect that the medical reason exception is applicable to both not screening a patient for tobacco use and not providing tobacco cessation intervention for patients identified as tobacco users, per clinical experts' recommendations.

    Measure Section: Denominator Exceptions

    Source of Change: Measure Lead

  • Updated to reflect the eligible populations for the three performance rates.

    Measure Section: Denominator Exceptions

    Source of Change: Measure Lead

Logic

  • Moved 'Encounter, Performed: Face-to-Face Interaction' and 'Encounter, Performed: Speech and Hearing Evaluation' from the Count >= 1 requirement to the Count >= 2 requirement based on clinical experts' recommendations.

    Measure Section: Initial Population

    Source of Change: Expert Work Group Review

  • Restructured Denominator logic to reflect the population criteria for the three performance rates. Population Criteria 2 introduces a variable to capture the tobacco use screening during which a patient is identified as a tobacco user.

    Measure Section: Denominator

    Source of Change: Measure Lead

  • Replaced 'Risk Category Assessment' datatype with 'Assessment, Performed' datatype to conform with QDM 4.3 changes.

    Measure Section: Numerator

    Source of Change: QDM Standards

  • Restructured Numerator logic to reflect the population criteria for the three performance rates. Population Criteria 1 and 3 introduce variables to capture the tobacco use screening and tobacco use status. Population Criteria 2 and 3 introduce variables to capture the provision of tobacco cessation interventions.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Replaced 'Risk Category Assessment' datatype with 'Assessment, Performed' datatype to conform with QDM 4.3 changes.

    Measure Section: Denominator Exceptions

    Source of Change: QDM Standards

  • Expanded applicability of the medical reason exception to the tobacco cessation intervention, per clinical experts' recommendations.

    Measure Section: Denominator Exceptions

    Source of Change: Measure Lead

  • Restructured Denominator Exceptions logic to reflect the population criteria for the three performance rates. Population Criteria 2 and 3 introduce variables to capture a medical reason for not providing tobacco cessation intervention.

    Measure Section: Denominator Exceptions

    Source of Change: Measure Lead

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 Tobacco Use Cessation Pharmacotherapy (2.16.840.1.113883.3.526.3.1190): Added 5 RXNORM codes (1797886, 1801289, 199283, 993687, 993691) and deleted 2 RXNORM codes (896100, 966531).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Tobacco Use Cessation Counseling (2.16.840.1.113883.3.526.3.509): Added 8 SNOMEDCT codes (395700008, 449841000124108, 449851000124105, 449861000124107, 449871000124100, 702388001, 710081004, 711028002) and deleted 3 SNOMEDCT codes (185792005, 185793000, 185794006).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Occupational Therapy Evaluation (2.16.840.1.113883.3.526.3.1011): Added 4 CPT codes (97165, 97166, 97167, 97168) and deleted 2 CPT codes (97003, 97004).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Preventive Care Services - Other (2.16.840.1.113883.3.464.1003.101.12.1030): Deleted 1 CPT code (99420).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

External Resources