Brief description of measure CMS138: ​Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user. Three rates are reported: a. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period b. Percentage of patients aged 18 years and older who were identified as a tobacco user during the measurement period who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period c. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user Description of issue ​The Measure Developer received a request from CMS to combine QID226 (CMS138): Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention and QID402: Tobacco Use and Help with Quitting Among Adolescents into a single measure for performance period 2024. We are proposing to combine the two measures by lowering the age boundary in CMS138 to age 12. Goal of review Obtain clinical and technical feedback

Proposed solution ​​Description BEFORE: Percentage of patients aged 18 years and older [...] Three rates are reported:  a. Percentage of patients aged 18 years and older [...] b. Percentage of patients aged 18 years and older [...] c. Percentage of patients aged 18 years and older[...] AFTER: Percentage of patients aged 12 years and older [...] Three rates are reported:  a. Percentage of patients aged 12 years and older [...] b. Percentage of patients aged 12 years and older [...] c. Percentage of patients aged 12 years and older [...] Clinical Recommendation Statement BEFORE: [...] AFTER: (Existing statements will remain; additional statements to add are noted below) [...] The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents (Grade B Statement) (U.S. Preventive Services Task Force, 2020). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care--feasible interventions for the cessation of tobacco use among school-aged children and adolescents (Grade I Statement) (U.S. Preventive Services Task Force, 2020). All patients should be asked if they use tobacco and should have their tobacco use status documented on a regular basis. Evidence has shown that clinic screening systems, such as expanding the vital signs to include tobacco use status or the use of other reminder systems such as chart stickers or computer prompts, significantly increase rates of clinician intervention. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008) All physicians should strongly advise every patient who smokes to quit because evidence shows that physician advice to quit smoking increases abstinence rates. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008). Minimal interventions lasting less than 3 minutes increase overall tobacco abstinence rates. Every tobacco user should be offered at least a minimal intervention, whether or not he or she is referred to an intensive intervention. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008). The combination of counseling and medication is more effective for smoking cessation than either medication or counseling alone. Therefore, whenever feasible and appropriate, both counseling and medication should be provided to patients trying to quit smoking. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008). Initial Population header BEFORE: All patients aged 18 years and older [...] AFTER: All patients aged 12 years and older [...] Initial Population 1, 2, & 3 Population criteria logic BEFORE: define "Initial Population 1": AgeInYearsAt(date from start of "Measurement Period")>= 18 [...] define "Initial Population 2": AgeInYearsAt(date from start of "Measurement Period")>= 18 [...] define "Initial Population 3": AgeInYearsAt(date from start of "Measurement Period")>= 18 [...] AFTER: define "Initial Population 1": AgeInYearsAt(date from start of "Measurement Period")>= 12 [...] define "Initial Population 2": AgeInYearsAt(date from start of "Measurement Period")>= 12 [...] define "Initial Population 3": AgeInYearsAt(date from start of "Measurement Period")>= 12 [...] Rationale for change ​The motivator for this change is to reduce the number of individual measures focused on tobacco screening in MIPS and increase the robustness of a single measure (in this case, CMS138).