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 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
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.
Patient Group Definitions
| Group |
Description |
Instructions Links |
| Initial Population | All patients aged 18 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 and identified as a tobacco user
Population 3:
Equals Initial Population | Webchart Instructions |
| Denominator Exclusions | None | |
| Numerator | 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 | Webchart Instructions |
| Numerator Exclusions | Not Applicable | Webchart Instructions |
| 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) | Webchart Instructions |
Details
| Full eMeasure Code |
eMeasure Identifier |
Measure Year |
Version |
NQF # |
GUID |
| CMS138v6 |
138 |
2018 |
6.1.000 |
0028 |
e35791df-5b25-41bb-b260-673337bc44a8 |
| Steward |
Developer |
Endorsed By |
| American Medical Association (AMA) |
PCPI(R) Foundation (PCPI[R]) |
National Quality Forum |
| 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 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 adults who use tobacco. (Grade A Recommendation) (U.S. Preventive Services Task Force, 2015)
The USPSTF recommends that clinicians ask all pregnant women about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant women who use tobacco. (Grade A Recommendation) (U.S. Preventive Services Task Force, 2015)
The USPSTF concludes that the current evidence is insufficient to recommend electronic nicotine delivery systems for tobacco cessation in adults, including pregnant women. The USPSTF recommends that clinicians direct patients who smoke tobacco to other cessation interventions with established effectiveness and safety (previously stated). (Grade I Statement) (U.S. Preventive Services Task Force, 2015)
Definition
Tobacco Use - Includes any type of tobacco
Tobacco Cessation Intervention - Includes brief counseling (3 minutes or less), and/or pharmacotherapy -- Note: Concepts aligned with brief counseling (eg, 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 (eg, brochures, pamphlets) and complementary/alternative therapies are not included in the value set and do not qualify for the numerator.
Transmission Format
TBD
Applicable Value Sets
| Category |
Value Set |
OID |
| Assessment, Performed |
Medical Reason |
2.16.840.1.113883.3.526.3.1007 |
| Assessment, Performed |
Tobacco Use Screening |
2.16.840.1.113883.3.526.3.1278 |
| Diagnosis |
Limited Life Expectancy |
2.16.840.1.113883.3.526.3.1259 |
| Encounter, Performed |
Annual Wellness Visit |
2.16.840.1.113883.3.526.3.1240 |
| Encounter, Performed |
Face-to-Face Interaction |
2.16.840.1.113883.3.464.1003.101.12.1048 |
| Encounter, Performed |
Health & Behavioral Assessment - Individual |
2.16.840.1.113883.3.526.3.1020 |
| Encounter, Performed |
Health and Behavioral Assessment - Initial |
2.16.840.1.113883.3.526.3.1245 |
| Encounter, Performed |
Health and Behavioral Assessment, Reassessment |
2.16.840.1.113883.3.526.3.1529 |
| Encounter, Performed |
Home Healthcare Services |
2.16.840.1.113883.3.464.1003.101.12.1016 |
| 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 |
Ophthalmological Services |
2.16.840.1.113883.3.526.3.1285 |
| 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 - Other |
2.16.840.1.113883.3.464.1003.101.12.1030 |
| 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 |
| Intervention, Performed |
Medical Reason |
2.16.840.1.113883.3.526.3.1007 |
| 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 |
Medical Reason |
2.16.840.1.113883.3.526.3.1007 |
| 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
Siu AL; U.S. Preventive Services Task Force. Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2015 Oct 20;163(8):622-34.
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Source:
https://ecqi.healthit.gov/ecqm/measures/cms138v6