Measure: CMS138

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

Measure Versions

eMeasure Code	Measure Year	Full Version Number	Title
CMS138v12	2024	12.0.000	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
CMS138v11	2023	11	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
CMS138v10	2022	10.0.000	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
CMS138v9	2021	9.2.000	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
CMS138v8	2020	8.1.000	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
CMS138v7	2019	7.1.000	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
CMS138v6	2018	6.1.000	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
CMS138v5	2017	5.0.000	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Description

Percentage of patients aged 12 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user. Three rates are reported: a. Percentage of patients aged 12 years and older who were screened for tobacco use one or more times during the measurement period b. Percentage of patients aged 12 years and older who were identified as a tobacco user during the measurement period who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period c. Percentage of patients aged 12 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user

Guidance

The requirement of two or more visits is to establish that the eligible clinician has an existing relationship with the patient for certain types of encounters. To satisfy the intent of this measure, a patient must have at least one tobacco use screening during the measurement period. If a patient has multiple tobacco use screenings during the measurement 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 a patient uses any type of tobacco (i.e., smokes or uses smokeless tobacco), the expectation is that they should receive tobacco cessation intervention: either counseling and/or pharmacotherapy. As noted above in the 2021 USPSTF recommendation statement, the current evidence is insufficient to recommend electronic cigarettes (e-cigarettes) for tobacco cessation. However, as noted above in the Definition section, the 2021 USPSTF recommendation also references the US Food and Drug Administration definition of tobacco, which includes e-cigarettes, hookah pens and other electronic nicotine delivery systems. Therefore, the measure does consider the use of e-cigarettes and other electronic nicotine delivery systems to be tobacco use. If a patient's tobacco use status is unknown, the patient does not meet the screening requirement and does not meet the numerator for populations 1 or 3. Instances where tobacco use status of "unknown" 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. In order to promote a team-based approach to patient care, the tobacco cessation intervention can be performed by another healthcare provider; therefore, the tobacco use screening and tobacco cessation intervention do not need to be performed by the same provider or clinician. 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 a 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 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 published versions of this measure prior to the 2018 performance year, when the measure had a single performance rate. For accountability reporting in the CMS MIPS program, the rate for population 2 is used for performance. The denominator of population criteria 2 is a subset of the resulting numerator for population criteria 1, as population criteria 2 is limited to assessing if patients identified as tobacco users received an appropriate tobacco cessation intervention. For all patients, population criteria 1 and 3 are applicable, but population criteria 2 will only be applicable for those patients who are identified as tobacco users. Therefore, data for every patient that meets the initial population criteria will only be submitted for population 1 and 3, whereas data submitted for population 2 will be for a subset of patients who meet the initial population criteria, as the denominator has been further limited to those who were identified as tobacco users. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Patient Group Definitions

Group	Description	Instructions Links
Initial Population	All patients aged 12 years and older seen for at least two visits or at least one preventive visit during the measurement period	Webchart Instructions
Denominator	Population 1: Equals Initial Population Population 2: Equals Initial Population who were screened for tobacco use during the measurement period and identified as a tobacco user Population 3: Equals Initial Population	Webchart Instructions
Denominator Exclusions	Exclude patients who are in hospice care for any part of the measurement period	Webchart Instructions
Numerator	Population 1: Patients who were screened for tobacco use at least once during the measurement period Population 2: Patients who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period Population 3: Patients who were screened for tobacco use at least once during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user	Webchart Instructions
Numerator Exclusions	Not Applicable	Webchart Instructions
Denominator Exceptions	None

Details

Full eMeasure Code	eMeasure Identifier	Measure Year	Version	NQF #	GUID
CMS138v12		2024	12.0.000	Not Applicable	e35791df-5b25-41bb-b260-673337bc44a8

Steward	Developer	Endorsed By
National Committee for Quality Assurance	National Committee for Quality Assurance

Scoring Method	Measure Type	Stratification	Risk Adjustment
Proportion	PROCESS	None	None

Rate Aggregation

None

Improvement Notation

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 using tobacco lower their risk for heart disease, lung disease, and stroke.

Clinical Recommendation Statement

The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and U.S. Food and Drug Administration (FDA)-approved pharmacotherapy for cessation to nonpregnant adults who use tobacco (Grade A Recommendation) (U.S. Preventive Services Task Force, 2021).

The USPSTF recommends that clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant persons who use tobacco (Grade A Recommendation) (U.S. Preventive Services Task Force, 2021).

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of pharmacotherapy interventions for tobacco cessation in pregnant women (Grade I Statement) (U.S. Preventive Services Task Force, 2021). 

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of electronic cigarettes (e-cigarettes) for tobacco cessation in adults, including pregnant persons. The USPSTF recommends that clinicians direct patients who use tobacco to other tobacco cessation interventions with proven effectiveness and established safety (Grade I Statement) (U.S. Preventive Services Task Force, 2021).

The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents (Grade B Statement) (U.S. Preventive Services Task Force, 2020).

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care--feasible interventions for the cessation of tobacco use among school-aged children and adolescents (Grade I Statement) (U.S. Preventive Services Task Force, 2020).

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).

Minimal interventions lasting less than 3 minutes increase overall tobacco abstinence rates. Every tobacco user should be offered at least a minimal intervention, whether or not he or she is referred to an intensive intervention. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008).

The combination of counseling and medication is more effective for smoking cessation than either medication or counseling alone. Therefore, whenever feasible and appropriate, both counseling and medication should be provided to patients trying to quit smoking. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008).

Definition

Tobacco Use - Use of any tobacco product The 2021 USPSTF recommendation references the US Food and Drug Administration definition of tobacco which includes "any product made or derived from tobacco intended for human consumption (except products that meet the definition of drugs), including, but not limited to, cigarettes, cigars (including cigarillos and little cigars), dissolvables, hookah tobacco, nicotine gels, pipe tobacco, roll-your-own tobacco, smokeless tobacco products (including dip, snuff, snus, and chewing tobacco), vapes, electronic cigarettes (e-cigarettes), hookah pens, and other electronic nicotine delivery systems." The 2021 USPSTF recommendation describes smoking as generally referring to "the inhaling and exhaling of smoke produced by combustible tobacco products such as cigarettes, cigars, and pipes." The 2021 USPSTF recommendation describes vaping as "the inhaling and exhaling of aerosols produced by e-cigarettes." In addition, it states, "vaping products (i.e., e-cigarettes) usually contain nicotine, which is the addictive ingredient in tobacco. Substances other than tobacco can also be used to smoke or vape. While the 2015 USPSTF recommendation statement used the term 'electronic nicotine delivery systems' or 'ENDS,' the USPSTF recognizes that the field has shifted to using the term 'e-cigarettes' (or 'e-cigs') and uses the term e-cigarettes in the current recommendation statement. e-Cigarettes can come in many shapes and sizes, but generally they heat a liquid that contains nicotine (the addictive drug in tobacco) to produce an aerosol (or 'vapor') that is inhaled ('vaped') by users." Tobacco Cessation Intervention - Includes brief counseling (3 minutes or less), and/or pharmacotherapy Note: Concepts aligned with brief counseling (e.g., minimal and intensive advice/counseling interventions conducted both in person and over the phone) are included in the value set for the numerator. Other concepts such as written self-help materials (e.g., brochures, pamphlets) and complementary/alternative therapies are not included in the value set and do not qualify for the numerator. Counseling also may be of longer duration or be performed more frequently, as evidence shows that higher-intensity interventions are associated with higher tobacco cessation rates (U.S. Preventive Services Task Force, 2021).

Transmission Format

TBD

Applicable Value Sets

Category	Value Set	OID
Assessment, Performed	Tobacco Use Screening	2.16.840.1.113883.3.526.3.1278
Diagnosis	Hospice Diagnosis	2.16.840.1.113883.3.464.1003.1165
Encounter, Performed	Annual Wellness Visit	2.16.840.1.113883.3.526.3.1240
Encounter, Performed	Encounter Inpatient	2.16.840.1.113883.3.666.5.307
Encounter, Performed	Home Healthcare Services	2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed	Hospice Encounter	2.16.840.1.113883.3.464.1003.1003
Encounter, Performed	Nutrition Services	2.16.840.1.113883.3.464.1003.1006
Encounter, Performed	Occupational Therapy Evaluation	2.16.840.1.113883.3.526.3.1011
Encounter, Performed	Office Visit	2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed	Online Assessments	2.16.840.1.113883.3.464.1003.101.12.1089
Encounter, Performed	Ophthalmological Services	2.16.840.1.113883.3.526.3.1285
Encounter, Performed	Physical Therapy Evaluation	2.16.840.1.113883.3.526.3.1022
Encounter, Performed	Preventive Care Services - Established Office Visit, 18 and Up	2.16.840.1.113883.3.464.1003.101.12.1025
Encounter, Performed	Preventive Care Services - Group Counseling	2.16.840.1.113883.3.464.1003.101.12.1027
Encounter, Performed	Preventive Care Services-Individual Counseling	2.16.840.1.113883.3.464.1003.101.12.1026
Encounter, Performed	Preventive Care Services-Initial Office Visit, 18 and Up	2.16.840.1.113883.3.464.1003.101.12.1023
Encounter, Performed	Psych Visit - Diagnostic Evaluation	2.16.840.1.113883.3.526.3.1492
Encounter, Performed	Psych Visit - Psychotherapy	2.16.840.1.113883.3.526.3.1496
Encounter, Performed	Psychoanalysis	2.16.840.1.113883.3.526.3.1141
Encounter, Performed	Speech and Hearing Evaluation	2.16.840.1.113883.3.526.3.1530
Encounter, Performed	Telephone Visits	2.16.840.1.113883.3.464.1003.101.12.1080
Intervention, Order	Hospice Care Ambulatory	2.16.840.1.113883.3.526.3.1584
Intervention, Performed	Hospice Care Ambulatory	2.16.840.1.113883.3.526.3.1584
Intervention, Performed	Tobacco Use Cessation Counseling	2.16.840.1.113883.3.526.3.509
Medication, Active	Tobacco Use Cessation Pharmacotherapy	2.16.840.1.113883.3.526.3.1190
Medication, Order	Tobacco Use Cessation Pharmacotherapy	2.16.840.1.113883.3.526.3.1190
Patient Characteristic Ethnicity	Ethnicity	2.16.840.1.114222.4.11.837
Patient Characteristic Payer	Payer	2.16.840.1.114222.4.11.3591
Patient Characteristic Race	Race	2.16.840.1.114222.4.11.836
Patient Characteristic Sex	ONC Administrative Sex	2.16.840.1.113762.1.4.1

References

CITATIONTobacco Use and Dependence Guideline Panel. Treating Tobacco Use and Dependence: 2008 Update. Rockville (MD): US Department of Health and Human Services; 2008 May. 6, Evidence and Recommendations. Available from: https://www.ncbi.nlm.nih.gov/books/NBK63943/
CITATIONUS Preventive Services Task Force. (2021). Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons. US Preventive Services Task Force Recommendation Statement. JAMA, 325(3), 265-279. doi:10.1001/jama.2020.25019
CITATIONUS Preventive Services Task Force. (2020). Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents. US Preventive Services Task Force Recommendation Statement. JAMA, 2020;323(16):1590-1598. doi:10.1001/jama.2020.4679

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Source: https://ecqi.healthit.gov/ecqm/measures/cmsv1

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