Hello,
Please find attached the 2 emails shared with stakeholders within AMA. After review, we felt the best way to accomodate the desired behavior was to move back the Stage 1 logic where the numerators are broken out based on the status of the smoker. Attached is the Stage 1 spec. This would prevent from having to modify the value sets and the outcome of the measures is more desireable. Many of our providers are used to the Stage 1 specification and prefer this logic over the 2014 specification.

Additionally, the same question/issue was raised to the Pioneer ACO team. Below is their response. Based on their response, their interpretation does not seem to be consistent with what the measure logic indicates.

Question:
We will need further clarification on this measure. As I noted in my original e-mail, a patient may purposefully have tobacco user and non-user statuses documented on the same day at the same visit since it is possible to be a non-smoker but also be a chewing tobacco user. It is not a medical record inconsistency to have both statuses documented and active in the EHR simultaneously. It is clinically necessary in order to provide appropriate care. Furthermore, a patient may have a tobacco user status that has been documented in the EHR within the past 24 months and is still in an active status (i.e. it has not been resolved or transitioned to a non-user status), and then at a later date have a tobacco non-user status added. Again, the easiest example to give is a patient who chews tobacco but is a non-smoker. Both statuses are current. One was documented more recently, but that does not negate that the other status is also still current. For ACO #17, in instances where a patient appropriately has tobacco user and non-user statuses documented within the past 24 months and both remain active at the end of the measurement period, whether those statuses were documented on the same day or at different visits on different days, are we to consider that patient a tobacco user or a tobacco non-user?

Answer:
For your example where a patient chews tobacco but is a non-smoker, according to this measure, the patient IS a current tobacco user. You are to count that patient as a tobacco user who should have received tobacco cessation intervention. For this measure, Tobacco use may include: Any type of tobacco: tobacco smoking, cigarette/tobacco/pipe smoking/smoker, cigarette dependence, tobacco use disorder, chew tobacco, smokeless tobacco, snuff Within 24 months is defined as: The 24-month look-back period of time from the most recent visit in the measurement period

If you have any questions please let me know.