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 Tags: PQRS

November 12, is World Pneumonia Day. While it is not the type of day you go out and buy a greeting card for, World Pneumonia Day was established in 2009 to raise awareness about the toll of pneumonia—a leading killer of children around the world—and to advocate for global action to protect against, help prevent, and effectively treat this deadly illness.

Pnemonia Day.jpgIn addition to being a leading killer of children, pneumonia is a common cause of illness and death in the elderly and persons with certain underlying conditions such as heart failure, diabetes, cystic fibrosis, asthma, sickle cell anemia, or chronic obstructive pulmonary disease. Pneumococcal disease remains a substantial burden among older US adults, despite increased coverage with 23-valent pneumococcal polysaccharide vaccine, (PPV23) and indirect benefits afforded by PCV7 vaccination of young children. 

Using Physician Quality Reporting System (PQRS) GPRO reporting, CMS is measuring the percentage of patients 65 years of age or older who have ever received a pneumococcal vaccine using the measure GPRO Prevention Measure 8 (PREV-8 (ACO 15)): Pneumonia Vaccination Status for Older Adults.

In many respects this is a very straightforward measure. Has the patient ever had a pneumococcal vaccine? However, like all measures, there are some new twists, techniques and tips to be aware of.

For this measure there is no statute of limitations. If you can see documentation of a vaccine anywhere on the patient’s record, that is all it takes.

Where can you find vaccine documentation?

  1. EMR immunization module – Go to your EMRs immunization module, if your EMR has one and if in fact you use it. It is amazing how often this feature goes unutilized.
  2. Physician Notes – Scan for immunization history.
  3. Data Warehouse – Do you have a Data Warehouse? Is immunization recorded?
  4. Billing – You might be able to find evidence of immunizations in the billing records.
  5. Patient History – Self reported patient history could indicate a Pneumonia Vaccination

The New Twist
One question posed to QNET, Remedy Incident:INC000001605114, involves patient self-reporting on “history of pneumococcal vaccine” yes or no. The word yes is circled and self-reported by the patient. What option would you select for vaccine received?”

QNET's response was, "The information missing is when did the patient receive the vaccine. If patient reported receipt of vaccine prior to 2015, documentation indicating receipt of a pneumonia vaccination is sufficient. If patient reported receipt of vaccine in 2015 or 2016, documentation indicating the year of the vaccination and confirmation of the type as PPSV23 or PCV13 is required".

In this scenario, the appropriate option would be, "No: Select this option if the patient did not receive an pneumococcal vaccine."

The New Technique
Starting this year, asking if the patient was vaccinated is no longer enough. According to correspondence with Quality Net (QNET): “If patient reported receipt prior to 2015, documentation indicating receipt of a pneumonia vaccination is sufficient. If patient reported receipt in 2015 or 2016, documentation indicating the year of the vaccination and confirmation of the type as PPSV23 or PCV13 is required.

The Tip
Because patients can walk into their local pharmacy or retail stores and get the vaccination, the news does not always get back to the PCP and the record does not always get updated. Make sure you are asking your patients about immunizations (most importantly the date and type of) every time they come in. 

Learn more about how to get involved with World Pneumonia Day at http://worldpneumoniaday.org/.

It can be challenging to understand all the measures and their latest requirements, and reporting errors can cost you greatly. Let our team of experienced abstraction experts assist you. Email Gayle Burton to set up a FREE 30-minute consulation on how we can help your team with Quality Reporting.

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