Preventive Care and Screening: Influenza Immunization

Last updated: March 22, 2017

CMS Measure ID: CMS147v5
Version: 5
NQF Number: 0041
Measure Description:

Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization

Initial Patient Population:

All patients aged 6 months and older seen for at least two visits or at least one preventive visit during the measurement period

Denominator Statement:

Equals Initial Population and seen for a visit between October 1 and March 31

Denominator Exclusions:

None

Numerator Statement:

Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization

Numerator Exclusions:

Not Applicable

Denominator Exceptions:
  • Documentation of medical reason(s) for not receiving influenza immunization (eg, patient allergy, other medical reasons)
  • Documentation of patient reason(s) for not receiving influenza immunization (eg, patient declined, other patient reasons)
  • Documentation of system reason(s) for not receiving influenza immunization (eg, vaccine not available, other system reasons)
Measure Steward: American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
Domain: Community/Population Health
Next Version: Preventive Care and Screening: Influenza Immunization
Previous Version: Preventive Care and Screening: Influenza Immunization
Measure Score: Proportion
Improvement Notation:

Higher score indicates better quality

Guidance:

The timeframe for the visit during the Encounter, Performed: Encounter-Influenza or Procedure, Performed: Peritoneal Dialysis or Procedure, Performed: Hemodialysis in the Population Criteria-Denominator, refers to the influenza season defined by the measure: October through March (October 1 for the year prior to the start of the reporting period through March 31 during the reporting period). The Encounter-Influenza Grouping OID detailed in the data criteria section below is comprised of several individual OIDs of different encounter types. The individual OIDs are included in the value set and should be reviewed to determine that an applicable visit occurred during the timeframe for Encounter, Performed: Encounter-Influenza as specified in the denominator.

To enable reporting of this measure at the close of the reporting period, this measure will only assess the influenza season that ends in March of the reporting period. The subsequent influenza season (ending March of the following year) will be measured and reported in the following year.

To account for the majority of reporting years' appropriate flu season duration, the measure logic will look at the first 89 days of the measurement period for the appropriate criteria and actions to be present/performed (January 1 through March 31). The measure developer believes it is best to keep the logic as static as possible from one reporting year to the next. Therefore, during leap years, only encounters that occur through March 30 will be counted in the denominator.

Specifications

Release Notes

Header

  • Clinical Recommendation Statement updated.
  • Copyright updated.
  • Disclaimer updated.
  • eMeasure version number incremented.
  • Guidance updated.
  • Reference updated.

Logic

  • Added logical operator 'AND NOT' with timing relationship > 89 day(s) starts after start of 'Measurement Period' to Diagnosis, Active: Allergy to Eggs, Allergy to Influenza Vaccine, and Intolerance to Influenza Vaccine, and to Procedure, Intolerance: Influenza Vaccination, Medication, Intolerance: Influenza Vaccine, Medication, Allergy: Influenza Vaccine to ensure allergies detected after the flu season are not considered for the denominator exception.
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
  • Replaced 'starts before or during' (SBOD) with 'starts before end of' (SBE).
  • Replaced timing relationship 'starts after start of' with 'starts after or concurrent with start of' in the Denominator, Numerator and Denominator Exceptions to ensure the inclusion of the start point of the measurement period.
  • Replaced timing relationship 'starts before start of' with 'starts before or concurrent with start of' in the Denominator, Numerator and Denominator Exceptions to ensure the inclusion of the start point of the measurement period.
  • The top level logical operator for the Numerator Exclusions, Denominator Exclusions, Denominator Exceptions, and Measure Population Exclusions defaults to 'OR'.

Value Sets

  • Value set Influenza Vaccination (OID 2.16.840.1.113883.3.526.3.402): Added 2 CPT codes (90630, 90673).
  • Value set Influenza Vaccine (OID 2.16.840.1.113883.3.526.3.1254): Deleted 1 CVX code (111); Added 6 CVX codes (153, 155, 158, 161, 166, 88).
  • Value set Patient Reason (OID 2.16.840.1.113883.3.526.3.1008): Deleted 1 SNOMED code (30164005).

External Resources