Preventative Care and Screening: Influenza Immunization CMS Quality - - PowerPoint PPT Presentation

Preventative Care and Screening: Influenza Immunization

CMS Quality ID 110

Kelley Montague RN, BSN Quality Improvement Advisor TCPi- GLPTN

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Childhood Immunization Status- Quality ID 240 Preventative Care and Screening: Influenza Immunization- Quality ID 110

Influenza MIPS Quality Measures:

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Did You Know?

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Since 2010 the CDC estimates that annually influenza has resulted in:

• between 9.2 million and 60.8 million illnesses
• between 140,000 and 710,000 hospitalizations
• between 12,000 and 56,000 related deaths

For the 2015-2016 influenza season, CDC estimates that the influenza vaccination prevented:

• 5.1 million influenza illnesses
• 2.5 million influenza-associated medical visits
• 71,0000 influenza-associated hospitalizations
• between 3,000 and 12,000 deaths

https://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm https://www.cdc.gov/flu/about/disease/2015-16.htm

Did You know?

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CDC report June 8,2018- CDC Reported Flu Deaths in Children Exceeds Seasonal High

• Another pediatric flu-related death reported that week- Total 172

for the 2017-2018 Flu Season

• 80% of these deaths occurred in children who had not received

a flu vaccination this season.

• 2017-2018 season is described by the CDC as a “high severity

season”

• 2009 H1N1 pandemic 358 pediatric deaths
• 2012-2013 season was similar to the 2017-2018- H3N2

predominated

• H3N2 predominate flu seasons are typically associated with

more severe outcomes

https://www.cdc.gov/flu/spotlights/reported-flu-children-deaths.htm

Did you know?

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CDC Reports for the 2017-2018 Influenza Season:

• Overall High severity season
• A (H3N2) predominate season
• Third overall high severity season since 2003-2004
• First classified high severity for all age groups
• Mortality (P&I) remained above epidemic threshold for 16

consecutive weeks, peaking at 10.8%

https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a4.htm

Did You know?

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https://www.odh.ohio.gov/en/seasflu/Ohio-Flu-Activity

Did You know?

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Did You know?

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https://www.odh.ohio.gov/en/seasflu/Ohio-Flu-Activity

MEASURE SPECS

For Preventative Care and Screening: Influenza Immunization

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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 Denominator: All patients 6 months and older seen for a visit during the measure period Numerator: Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization

Preventative Care and Screening: Influenza Immunization

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Denominator Encounter Criteria (Eligible Cases) Patients age >/= 6 months seen for a visit between October 1 and March 31 AND Patient encounter during January thru March and/or October thru December with eligible CPT or HCPCS (See next slide for CPT or HCPCS) Preventative Care and Screening: Influenza Immunization

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Encounters Meeting Criteria for Denominator

99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99243*, 99244*, 99245*, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 90945, 90947, 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958, 90959, 90960, 90961, 90962, 90963, 90964, 90965, 90966, 90967 90968, 90969, 90970, 96160, 96161, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99381*, 99382*, 99383*, 99384*, 99385*, 99386*, 99387*, 99391*, 99392*, 99393*, 99394*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, 99512*, G0438, G0439 Found addition added 99242* WITHOUT: Telehealth Modifier: GQ, GT, 95, POS 02

Preventative Care and Screening: Influenza Immunization

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Denominator Exclusions: None Numerator Exclusions: Not applicable Denominator Exceptions G8482:

• Documentation of medical reason(s) for not receiving

influenza immunization (eg, patient allergy, other medical reasons)

• Documentation of patient reason(s) for not receiving the

influenza immunization (eg, patient declined, other patient reasons)

• Documentation of system reason(s) (eg, vaccine not

available, other system reasons

Preventative Care and Screening: Influenza Immunization

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Numerator Can be Met G8482 by: Submitting administration of an influenza vaccination OR Patient reporting receipt of the current season’s influenza immunization If the performance of the numerator is not met, an eligible clinician can submit a valid denominator exception for not having administered an influenza vaccination. Preventative Care and Screening: Influenza Immunization

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If you successfully report a measure for less than 60 percent of your patients, you will earn points based on your practice size:

• Small practices (≤ 15 clinicians) will receive 3 points,
• Larger practices (> 15 clinicians) will receive 1 point.

If you successfully report a measure for at least 60 percent of your patients, but do not report at least 20 cases, you will receive 3 points. If you report this measure for at least 60 percent of applicable patients and on at least 20 patients during a reporting period, you will earn points based on the decile that corresponds to your performance rate.

How CMS Scores this Measure

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Benchmarks

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EDUCATIONAL MATERIAL

For Preventive Care and Screening: Influenza Immunization

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Vaccine Information Statement

Inactivate Influenza Vaccine (8/7/2015)

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Educational Material

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ODH- Educational Pamphlet

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ODH- “Kids Get Flu Too”

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You can Order Influenza Educational Material

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CDC Information

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GUIDANCE FOR IMPROVING MEASURE

For Preventive Care and Screening: Influenza Immunization

Improving Influenza Vaccination Through Office Efficiency for Practice Administering Flu Vaccine Begin administering vaccine as soon as it arrives (usually the first part of August)

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Be Creative

▪

CMS recognized immunizations given after August 1 for the 2018-2019 Flu Season

▪

Educate and train staff on the influenza vaccine so they feel empowered to answer patients questions and educate them on the importance of receiving the flu vaccine

▪

Send secure portal message to notify patients that the vaccine has arrived

▪

Send education on why patient’s should get immunized via portal message

▪

Create a home web page around influenza and how they can be immunized at your practice (e.g. times and dates of clinics or addition

• ffice hours to accommodate

▪

Send text message to patient’s that the flu vaccine has arrived and with dates and times of clinics

▪

Create a message on the TV Monitor in the waiting room or have posters in the waiting room

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Have an influenza message on the practices “On Hold Message”

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Be Creative

▪

Place educational material in the waiting rooms and exam rooms. Not just to remind those that are there for appointments to receive their flu vaccination but for them to take home and remind them to get their other family members in for vaccination

▪

Offer flu vaccination clinics for your patients- some practices even provide drive-thru clinics for their patients

▪

Open an hour earlier and stay open an hour later for patient’s to receive vaccinations without an appointment on their way to and from work

▪

Ensure that influenza immunizing is a part of every patients planned visit for the day

▪

Have morning huddles to discuss the patients that have not had their vaccinations and the strategy to encourage vaccination

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Improving Influenza Vaccination Through Office Efficiency for Practice Administering Flu Vaccine Begin Administering vaccine as soon as it arrives If your practice administers influenza vaccination does your practice have a Standing Order for Administering the Influenza Vaccination?

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ODH- Standing Orders for Administering Influenza Vaccine to Adults

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Improving Influenza Vaccination Through Office Efficiency for Practice Administering Flu Vaccine Begin Administering vaccine as soon as it arrives If your practice administers influenza vaccination does your practice have a Standing Order for Administering the Influenza Vaccination? Use a Patient Checklist Screening Tool to assist in Screening for Contraindications

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Screening Checklists for Contraindications to Influenza Vaccines

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Improving Influenza Vaccination Through Office Efficiency for Practice Administering Flu Vaccine Begin Administering vaccine as soon as it arrives If your practice administers influenza vaccination does your practice have a Standing Order for Administering the Influenza Vaccination? Use a Patient Checklist Screening Tool to assist in assist in Screening for Contraindications Create a workflow for administering the influenza vaccination and educate your staff

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Workflow for Administering Influenza Vaccination

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Improving Influenza Vaccination Through Office Efficiency for Practice Administering Flu Vaccine Begin Administering vaccine as soon as it arrives If your practice administers influenza vaccination does your practice have a Standing Order for Administering the Influenza Vaccination? Use a Patient Checklist Screening Tool to assist in assist in Screening for Contraindications Create a workflow for administering the influenza vaccination and educate your staff Know where to document

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Is there a template already designed for documentation of administration of the Influenza Vaccination and is this documentation tied to a data field? Is there a template already designed for documenting prior immunization receipt as identified by the patient. Is your staff documenting in all the fields necessary to capture the data? Is there a template that captures the 3 exceptions?:

• Medical reason for not receiving the influenza vaccination
• Patient reason for not receiving the influenza vaccination
• System reason for not receiving the influenza vaccination

Look at Your EHR for Documentation Guidance

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Improving Influenza Vaccination Through Office Efficiency for Practice Administering Flu Vaccine Begin Administering vaccine as soon as it arrives If your practice administers influenza vaccination does your practice have a Standing Order for Administering the Influenza Vaccination? Use a Patient Checklist Screening Tool to assist in assist in Screening for Contraindications Create a workflow for administering the influenza vaccination and educate your staff Know your where to document Know your EHR’s workflow for capture of data

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Know Your EHR Workflow for Documenting

Improving Influenza Vaccination Through Office Efficiency for Practice Administering Flu Vaccine

Begin Administering vaccine as soon as it arrives If your practice administers influenza vaccination does your practice have a Standing Order for Administering the Influenza Vaccination? Use a Patient Checklist Screening Tool to assist in assist in Screening for Contraindications Create a workflow for administering the influenza vaccination and educate your staff Know your where to document Know your EHR’s workflow for capture of data Beginning October 1 thru March 31 confirm that there is documentation of administration, prior receipt or

exception documentation for all eligible encounters

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Improving Influenza Vaccination Through Office Efficiency

▪

Ensure there is a process in your planned visit for review of patients record, prior to rooming patient, to identify if a patient has had the flu vaccination from ▪ Office administering it ▪ Patient reported receipt of immunization ▪ State immunization registry verification ▪ Or patient declination of the vaccination

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Improving Influenza Vaccination Through Office Efficiency for Practice NOT Administering Flu Vaccine

▪

Educated patients on the importance of receiving the influenza vaccine

▪

Many specialist do very well on this measure

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Research and train staff on how to document influenza vaccines administered elsewhere, in the EHR

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Some EHR’s may make it difficult to record the data if you do not know the date of receipt of the flu immunization

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Use state registry database to look up the patient’s vaccine status

▪

Research nearby options where patients can get the flu vaccine

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Medicare Part B Influenza Billing pdf.

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Resources

ODH Influenza Pamphlet https://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/bid/immunizations/influenzaflu2016.pdf?la=en ODH Educational Document https://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/bid/immunizations/whatisinfluenza-111814-final2016.pdf?la=en CDC Information https://www.cdc.gov/flu/ ODH- Standing Order for Administering Influenza Vaccine to adults https://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/bid/immunizations/vaccine-protocol-manual/Final-Protocol-Manual/vaccines/Flu/flu- adult.pdf?la=en ODH- Standing Order for Administering Influenza to children and adolescents https://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/bid/immunizations/vaccine-protocol-manual/Final-Protocol- Manual/vaccines/Flu/fluchild.pdf?la=en Vaccine Information Statement for Inactivated Influenza Vaccine – different languages- large print http://www.immunize.org/vis/vis_flu_inactive.asp ODH Educational Material/Forms Order Form https://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/bid/immunizations/litrequest-private120814.pdf?la=en MDHHS https://www.michigan.gov/mdhhs/0,5885,7-339-73971_4911_4914-138197--,00.html IAC Screening for Contraindications http://www.immunize.org/catg.d/p4066.pdf

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Resources

Workflow for Administering Influenza Vaccine file:///C:/Users/kmontague/Downloads/Influenza%20Vaccination%20Workflow_0%20(1).pdf Medicare Part B Immunization Billing: Seasonal Influenza Virus, Pneumococcal, and Hepatitis B https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/qr_immun_bill.pdf

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Other Resources IAC Cocooning Protects Babies- Patient Handout http://www.immunize.org/catg.d/p4039.pdf Healthcare Declination of Influenza Vaccination http://www.immunize.org/catg.d/p4068.pdf Don’t Take Chances with Your Families Health- Patient Handout http://www.immunize.org/catg.d/p4069.pdf Leading Healthcare Organizations position statements on immunizing healthcare workers http://www.immunize.org/catg.d/p2014.pdf How to Administer Intramuscular, Intradermal and Intranasal Vaccinations http://www.immunize.org/catg.d/p2024.pdf Make sure your child is protected http://www.immunize.org/catg.d/p4312.pdf Vaccination of Influenza Immunization of People with a History of Egg Allergy http://www.immunize.org/catg.d/p3094.pdf Influenza Q&A http://www.immunize.org/catg.d/p4208.pdf Protect yourself from influenza……Get vaccinated http://www.immunize.org/catg.d/p4408.pdf Screening Checklist for Contraindications for Inactivated Injectable Influenza Vaccination http://www.immunize.org/catg.d/p4066.pdf

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Other Resources IAC Screening Checklist for Contraindications for Live Attenuated Intranasal Influenza Vaccination http://www.immunize.org/catg.d/p4067.pdf Seek emergency medical care if….. http://www.immunize.org/catg.d/p4067.pdf Adult Immunization Record- hardcopy http://www.immunize.org/catg.d/p2023.pdf

Questions ???

MIPS Blood Pressure Measures

CMS Quality ID 236,317,373

Why HTN?

For an adult 45 years of age without hypertension, the 40-year risk for developing hypertension is 93% for African Americans, 92% for Hispanics, 86% for whites, and 84% for Chinese adults. (ACC 2017 guidelines) Every adult with hypertension should have a clear, detailed, and current evidence-based plan of care that ensures the achievement

• f treatment and self-management goals; effective management of

comorbid conditions; timely follow-up with the healthcare team; and adheres to CVD evidence-based guidelines. Certain comorbidities may affect clinical decision-making and this includes hypertension. This then is integrated into ALL practices regardless of specialty

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Why HTN?

Hypertension is a very common and dangerous condition that increases risk for heart disease and stroke Compared with other dietary, lifestyle, and metabolic risk factors, high blood pressure is the leading cause of death in women Approximately 1 in 3 U.S. adults or about 70 million people have high blood pressure but only about half (52%) of these people have their high blood pressure under control Additionally, 17.2% of U.S. adults are not aware they have hypertension The estimated cost of high blood pressure is around $50 billion per year

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3 MIPS Measures

Controlling High Blood Pressure Preventive Care and Screening: Screening for High Blood Pressure and Follow-up Documented Hypertension: Improvement in Blood Pressure

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MEASURE SPECS

For Hypertension Measures

Controlling High Blood Pressure

Measure Description: Percentage of patients 18-85 year of age

who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90 mmHg) during the measurement period Denominator: Patients 18-85 years of age on date of encounter AND have a diagnosis of hypertension AND patients have an encounter during performance period Numerator: Patients whose blood pressure at the most recent visit is adequately controlled (<140/90) during the measurement period

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Controlling High Blood Pressure

Denominator Exclusions: Patients having ESRD, dialysis, or renal transplant before or during the measurement period, patients with a diagnosis of pregnancy during the measurement period, and patients whose hospice care overlaps the measurement period Numerator Exclusions: None

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Hypertension: Improvement in Blood Pressure

Measure Description: Percentage of patients aged 18-85 years of age with a diagnosis of hypertension whose blood pressure improved during the measurement period Denominator: All patients aged 18-85 years of age, who had at least one outpatient visit in the first six months of the measurement year, who have a diagnosis of essential hypertension documented during the outpatient visit, and who have uncontrolled baseline blood pressure at the time of that visit Numerator: Patients whose follow-up blood pressure is at least 10mmHG less than their baseline blood pressure or is adequately controlled

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Hypertension: Improvement in Blood Pressure

Denominator Exclusions: Evidence of ESRD on or prior to December 31 of the measurement year, patient with a diagnosis of pregnancy during the measurement year Numerator Exclusions: No applicable Denominator Exceptions: None

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Hypertension: Improvement in Blood Pressure

Guidance: If a follow-up blood pressure reading is not recorded during the measurement year, the patient’s blood pressure is assumed “not improved” Blood pressure readings must be taken while the patient is sitting If multiple measurements occur on the same date, the last systolic and diastolic readings should be used

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Preventative Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

Measure Description: Percentage of patients aged 18 years and

• lder seen during the reporting period who

were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure reading as indicated Denominator: Equals Initial Patient Population Numerator: Patients who were screened for high blood pressure AND have a recommended follow- up plan documented, as indicated if the blood pressure is pre-hypertensive or hypertensive

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Preventative Care and Screening : Screening for High Blood Pressure and Follow-Up Documented

Denominator Exclusions: Patient has an active diagnosis of hypertension Numerator Exclusions: Not Applicable Denominator Exceptions: Patient Reason(s) (e.g. Patient refuses to participate OR Medical Reason(s) (e.g. Patient is in an urgent or emergent medical situation where time is of the essence

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Preventative Care and Screening : Screening for High Blood Pressure and Follow-Up Documented

Guidance: Both the systolic and diastolic blood pressure measurements are required for inclusion If there are multiple blood pressures on the same date of service, use the lowest systolic and lowest diastolic blood pressure on that date as the representative blood pressure Blood pressure screening must be performed at the time of a qualifying visit and may not be obtained measurements from external sources The documented follow-up plan must be related to the current BP reading as indicated, (e.g. Patient referred to primary care provider for BP management)

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BLOOD PRESSURE MANAGEMENT

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New BP guidelines from AHA

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Helpful guidelines in assessing HTN

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How to get an accurate result

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Helpful clinic guidelines in assessing HTN

1. If elevated BP at beginning of visit, retake BP at the end of the visit to assess for white coat syndrome 2. Verify with patient home monitoring 3. Use an Automated oscillomettric device

• 4. Re-educate staff on proper technique
• 5. Calibrate equipment for accuracy
• 6. Educate patients of the health risks of high blood

pressure 7. Provide community resources and education material 8. Document plan of care

• 9. Specialists role;
• a. Screen patients for high blood pressure
• b. Evaluate patient for “white coat syndrome”
• c. Document follow up plan for elevated BP (e.g. referral to

PCP for management)

• d. Educate patients of the health risks of high blood

pressure

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Home Monitoring Devices

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EDUCATIONAL MATERIAL

Ohio Department of Health- Program

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Ohio Department of Health- ODH

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Ohio Department of Health

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American Heart Association- AHA

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American Heart Association (AHA)

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Heart Risk Calculator

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National Institute of Health

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National Institute of Health

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Questions ???

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Resources

American College of Cardiology2017 Guideline for Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults http://www.onlinejacc.org/guidelines/highbloodpressure http://www.acc.org/guidelines/hubs/high-blood-pressure UpToDate Dietary Changes for Hypertension https://www.uptodate.com/contents/high-blood-pressure-diet-and-weight-beyond-the-basics CDC Patient Educational Material https://www.cdc.gov/bloodpressure/materials_for_patients.htm Dash Diet https://www.nhlbi.nih.gov/health-topics/dash-eating-plan The AHA Guideline document to new BP Categories http://www.heart.org/HEARTORG/Conditions/Patient-Education-Resources-for-Healthcare- Professionals_UCM_441960_SubHomePage.jsp Self (Home) Monitoring BP Devices https://millionhearts.hhs.gov/files/MH_SMBP_Clinicians.pdf ODH Tracker https://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/health/heart-disease-and-stroke/HBP-Toolkit/For- Families/Blood_Pressure_Tracker_v1-4.pdf?la=en AHA- What is High Blood Pressure? https://www.heart.org/-/media/data-import/downloadables/pe-abh-what-is-high-blood-pressure- ucm_300310.pdf?la=en&hash=CAC0F1D377BDB7BC3870993918226869

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Resources

Dash Diet https://www.nhlbi.nih.gov/files/docs/public/heart/hbp_low.pdf Why Should I be Physically Active? https://www.heart.org/-/media/data-import/downloadables/pe-abh-why-should-i-be-physically-active-ucm_300469.pdf Heart Risk Calculator http://www.cvriskcalculator.com/

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Kelley Montague

kmontague@medadvgrp.com

Beth Hickerson

bhickerson@medadvgrp.com

Shannon Kiffer

skiffer@medadvgrp.com

Ashley Tuley

atuley@medadvgrp.com