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Measure: CMS147

Preventive Care and Screening: Influenza Immunization

Measure Versions

eMeasure Code Measure Year Full Version Number Title
CMS147v12 2023 12 Preventive Care and Screening: Influenza Immunization
CMS147v11 2022 11.0.000 Preventive Care and Screening: Influenza Immunization
CMS147v10 2021 10.2.000 Preventive Care and Screening: Influenza Immunization
CMS147v9 2020 9.1.000 Preventive Care and Screening: Influenza Immunization
CMS147v8 2019 8.1.000 Preventive Care and Screening: Influenza Immunization
CMS147v7 2018 7.2.000 Preventive Care and Screening: Influenza Immunization
CMS147v6 2017 6.1.000 Preventive Care and Screening: Influenza Immunization

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

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. Due to the changing stance of the CDC/ACIP recommendations regarding the live attenuated influenza vaccine (LAIV) for a particular flu season, this measure will not include the administration of this specific formulation of the flu vaccination. Given the variance of the timeframes for the annual update cycles, program implementation, and publication of revised recommendations from the CDC/ACIP, it has been determined that the coding for this measure will specifically exclude this formulation, so as not to inappropriately include this form of the vaccine for flu seasons when CDC/ACIP explicitly advise against it. However, it is recommended that all eligible professionals or eligible clinicians to review the guidelines for each flu season to determine appropriateness of the LAIV and other formulations of the flu vaccine. Should the LAIV be recommended for administration for a particular flu season, eligible professional or clinician may consider one of the following options: 1) satisfy the numerator by reporting either previous receipt or using the CVX 88 for unspecified formulation, 2) report a denominator exception, either as a patient reason (e.g., for patient preference) or a system reason (e.g., the institution only carries LAIV). Patient self-report for procedures as well as immunizations should be recorded in 'Procedure, Performed' template or 'Immunization, Administered' template in QRDA-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 (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Patient Group Definitions

Group Description Instructions Links
Initial PopulationAll patients aged 6 months and older seen for a visit during the measurement periodWebchart Instructions
DenominatorEquals Initial Population and seen for a visit between October 1 and March 31Webchart Instructions
Denominator ExclusionsNone
NumeratorPatients who received an influenza immunization OR who reported previous receipt of an influenza immunizationWebchart Instructions
Numerator ExclusionsNot ApplicableWebchart Instructions
Denominator ExceptionsDocumentation of medical reason(s) for not receiving influenza immunization (e.g., patient allergy, other medical reasons). Documentation of patient reason(s) for not receiving influenza immunization (e.g., patient declined, other patient reasons). Documentation of system reason(s) for not receiving influenza immunization (e.g., vaccine not available, other system reasons).Webchart Instructions

Details

Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS147v11 2022 11.0.000 0041e a244aa29-7d11-4616-888a-86e376bfcc6f
Steward Developer Endorsed By
National Committee for Quality Assurance National Committee for Quality Assurance 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

Influenza vaccination is the most effective protection against influenza virus infection (Centers for Disease Control and Prevention [CDC], 2019). Influenza may lead to serious complications including hospitalization or death (CDC, 2019). Influenza vaccine is recommended for all persons aged >=6 months who do not have contraindications to vaccination. However, data indicate that less than half of all eligible individuals receive an influenza vaccination (CDC, 2019). This measure promotes annual influenza vaccination for all persons aged >= 6 months.

Clinical Recommendation Statement

Routine annual influenza vaccination is recommended for all persons aged >= 6 months who do not have contraindications. Optimally, vaccination should occur before onset of influenza activity in the community. Although vaccination by the end of October is recommended, vaccine administered in December or later, even if influenza activity has already begun, is likely to be beneficial in the majority of influenza seasons (CDC/Advisory Committee on Immunization Practices [ACIP], 2020).

Definition

Previous Receipt - receipt of the current season's influenza immunization from another provider OR from same provider prior to the visit to which the measure is applied (typically, prior vaccination would include influenza vaccine given since August 1st)

Transmission Format

TBD

Applicable Value Sets

Category Value Set OID
Allergy/Intolerance Egg Substance 2.16.840.1.113883.3.526.3.1537
Allergy/Intolerance Influenza Vaccination 2.16.840.1.113883.3.526.3.402
Allergy/Intolerance Influenza Vaccine 2.16.840.1.113883.3.526.3.1254
Diagnosis Allergy to Eggs 2.16.840.1.113883.3.526.3.1253
Diagnosis Allergy to Influenza Vaccine 2.16.840.1.113883.3.526.3.1256
Diagnosis Intolerance to Influenza Vaccine 2.16.840.1.113883.3.526.3.1257
Encounter, Performed Annual Wellness Visit 2.16.840.1.113883.3.526.3.1240
Encounter, Performed Care Services in Long-Term Residential Facility 2.16.840.1.113883.3.464.1003.101.12.1014
Encounter, Performed Discharge Services - Nursing Facility 2.16.840.1.113883.3.464.1003.101.12.1013
Encounter, Performed Encounter-Influenza 2.16.840.1.113883.3.526.3.1252
Encounter, Performed Home Healthcare Services 2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed Nursing Facility Visit 2.16.840.1.113883.3.464.1003.101.12.1012
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 Outpatient Consultation 2.16.840.1.113883.3.464.1003.101.12.1008
Encounter, Performed Patient Provider Interaction 2.16.840.1.113883.3.526.3.1012
Encounter, Performed Preventive Care - Established Office Visit, 0 to 17 2.16.840.1.113883.3.464.1003.101.12.1024
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 Preventive Care- Initial Office Visit, 0 to 17 2.16.840.1.113883.3.464.1003.101.12.1022
Encounter, Performed Telephone Visits 2.16.840.1.113883.3.464.1003.101.12.1080
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
Procedure, Not Performed Influenza Vaccination 2.16.840.1.113883.3.526.3.402
Procedure, Performed Hemodialysis 2.16.840.1.113883.3.526.3.1083
Procedure, Performed Influenza Vaccination 2.16.840.1.113883.3.526.3.402
Procedure, Performed Peritoneal Dialysis 2.16.840.1.113883.3.526.3.1084

References

CITATIONCenters for Disease Control and Prevention. (2019, September 5). About Flu. Retrieved from
https://www.cdc.gov/flu/about/index.html
CITATIONCenters for Disease Control and Prevention. (2019, September 26). Flu Vaccination Coverage: United States, 2018-19 Influenza Season. Retrieved from 
https://www.cdc.gov/flu/fluvaxview/coverage-1819estimates.htm
CITATIONGrohskopf, L.A., Alyanak, E., Broder, K. R., Blanton, L. H. , Fry, A. M., Jernigan, D. B, Atmar, R. L. (2020).  Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2020–21 Influenza Season. MMWR Recommendations and Reports; 69(No. RR-8):1–24. DOI: http://dx.doi.org/10.15585/mmwr.rr6908a1.

Disclaimer

The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Copyright

This Physician Performance Measure (Measure) and related data specifications are owned by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. The PCPI’s and AMA’s significant past efforts and contributions to the development and updating of the measure are acknowledged. (C) 2012-2020 National Committee for Quality Assurance. All Rights Reserved.

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2020 American Medical Association. LOINC(R) copyright 2004-2020 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2020 International Health Terminology Standards Development Organisation. ICD-10 copyright 2020 World Health Organization. All Rights Reserved.

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