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  2. CQM-1005

CVX codes missing from PPV value set in CMS127

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    • Floyd Eisenberg
    • 202-643-6350
    • iParsimony, LLC
    • Changes to logic and value set(s) to correctly address current clinical practice guidelines for the use of pneumococcal vaccine.
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      Response from Measure Developer:
      The focus of NCQA’s Pneumococcal Vaccination for Patients 65 years and Older measure (NQF #0043, PQRS #111) is universal vaccination of patients 65 years of age and older per ACIP recommendations.

      NCQA is aware of the recent change to the Pneumococcal vaccination recommendations. The new guidance recommends an extended period of time between the two vaccinations and a unique vaccination sequence for pneumococcal vaccine naïve patients which creates unique challenges to measure development. We are investigating best possible approaches for integrating these revised guidelines into the measure within regulatory constraints.
      Show
      Response from Measure Developer: The focus of NCQA’s Pneumococcal Vaccination for Patients 65 years and Older measure (NQF #0043, PQRS #111) is universal vaccination of patients 65 years of age and older per ACIP recommendations. NCQA is aware of the recent change to the Pneumococcal vaccination recommendations. The new guidance recommends an extended period of time between the two vaccinations and a unique vaccination sequence for pneumococcal vaccine naïve patients which creates unique challenges to measure development. We are investigating best possible approaches for integrating these revised guidelines into the measure within regulatory constraints.
    • CMS127v3/NQF0043
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      1. Incomplete value set causing a potential that valid and recommended vaccine use will be avoided (i.e., use of PCV 13 vaccine) to comply with the measure - Hence, potentially inappropriate care is suggested if the value set is not complete.
      2. Outdated clinical recommendations are presented in the measure which impacts care.
      Show
      1. Incomplete value set causing a potential that valid and recommended vaccine use will be avoided (i.e., use of PCV 13 vaccine) to comply with the measure - Hence, potentially inappropriate care is suggested if the value set is not complete. 2. Outdated clinical recommendations are presented in the measure which impacts care.

      The measure (NQF 0043) does not address the current recommendations of the Advisory Committee for Immunization Practices (ACIP) guideline recommending both Pneumococcal Conjugate Vaccine, 13 valent (PCV 13 - Prevnar) and Pneumococcal Polysaccharide vaccine (PPSV). The measure logic suggests one vaccine - hence it is out of date related to the guideline. So adding the PCV13 CVX code to the value set will solve one problem, but ideally we need a measure that looks for both vaccines for age > 50, and for those who are immunocompromised age 19-49 (off label use for FDA but included in the ACIP - http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6140a4.htm).

            edave Mathematica EC eCQM Team
            FEisenberg Floyd Eisenberg
            Floyd Eisenberg
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