Smoking is a major and costly health problem. Because it is such a high priority for CMS, smoking is addressed in the Stage 1 meaningful use requirements by three distinct measures, which has caused a fair amount of confusion. I will try to clarify.
The first is a core meaningful use measure. Therefore, every eligible professional (EP) must satisfy this requirement, unless they can attest to meeting the exclusion.
Core Meaningful Use Measure: Record Smoking Status
More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data.
Exclusion: Any EP who sees no patients 13 years or older.
- Smoking status must be recorded as one of the following 6 categories: current every day smoker; current some day smoker; former smoker; never smoker; smoker, current status unknown; unknown if ever smoked.
- The information does not have to be updated at every visit—it simply has to be in the patient’s record, (i.e., no need to ask a non-smoker whether he has taken up the habit yet!)
The other two smoking-related measures are clinical quality measures. There is a different minimum age for the patient population—18, as opposed to 13—and these measures encompass tobacco use in addition to smoking. EPs must report on 6 CQMs—3 Core CQMs and 3 Additional CQMs. Like all CQMs (for Stage 1 meaningful use), neither of these measures have required thresholds that must be met.
The Core CQM (NQF 0028 – Preventive Care and Screening Measure Pair, defined below) must be reported by all providers—there are no exclusions, even if the EP’s EHR generates zero denominators for this measure. In that case, the EP reports zero and must also select and report on an alternate core CQM. This is a 2-part measure that assesses the intervention/treatment provided related to smoking cessation, e.g., counseling and/or medication, and it is based on a 2-year timeframe.
The Additional CQM: (NQF 0027 – Smoking and Tobacco Use Cessation, Medical Assistance, defined below) is one of the 38 Additional CQMs, from which EPs must select and report on three, so this measure is an option, not a requirement. It sounds a lot like NQF 0028 above, unless you read the extremely detailed measure specifications. (We’ll leave that responsibility to the EHR vendors, since the CQM data EPs report must be generated by the EHR!) The major difference is that this measure only involves advice and counseling—it does not ask about intervention—and it has a shorter measurement period than NQF 0028.
NQF 0028: Core Clinical Quality Measure: Preventive Care and Screening Measure Pair: a. Tobacco Use Assessment, b. Tobacco Cessation Intervention
a) Percentage of patients aged 18 years and older who have been seen for at least 2 office visits who were queried about tobacco use one or more times with 24 months
b) Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months and have been seen for at least 2 office visits who received cessation intervention.
NQF 0027: Additional Clinical Quality measure: Smoking and Tobacco Use Cessation, Medical Assistance: a. Advising Smokers and Tobacco Users to Quit, b. Discussing Smoking and Tobacco Use Cessation Medications, c. Discussing Smoking and Tobacco Use Cessation Strategies
Percentage of patients 18 years of age or older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use, or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods or strategies.
Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.