Influenza (flu) viruses typically spread in the fall and winter, with activity peaking between December and February. Ensuring patients receive routine vaccinations keeps communities healthy. As such, the Centers for Medicare & Medicaid Services (CMS) has included Influenza Immunization as a quality measure across various quality reporting programs, defined as:
Given the timing of the flu season, it is important to focus on this quality measure early in the fall and winter. The measure assesses influenza vaccinations typically beginning in August of the prior reporting year and ending in March of the current reporting year. Due to the changing nature of the CDC/ACIP recommendations, it is recommended that clinicians review guidelines for each flu season to determine appropriateness of various vaccine formulations.
For organizations participating in a Medicare Shared Savings Program (MSSP) ACO and reporting quality measures using the CMS Web Interface, medical record documentation is necessary to support information submitted for PREV-7 (NQF 0041): Preventive Care and Screening: Influenza Immunization.
Web Interface Quality Reporting for 2024PY is officially underway January until March 2025. This measure is unique since it crosses performance years and qualified encounters must occur during defined time frames for the patient to be included in the reporting for each flu season. To ensure accurate and complete reporting, follow the below best practices:
- If the CMS Web Interface has been prefilled with “Yes” based on claims data, no further action is required for reporting
- Documentation of patient reported influenza immunization is acceptable during the flu season
- If a patient did not receive an influenza immunization, review the medical record to see if there is a qualifying denominator exception, such as:
- Medical reason(s) – example: patient allergy, other medical reasons
- Patient reason(s) – example: patient declined, other patient reasons
- System reason(s) – example: vaccine not available, other system reasons
The influenza vaccine is also a component of Childhood Immunization Status in some quality reporting programs. The CDC’s Child and Adolescent Immunization Schedule by Age provides guidance on recommended vaccines by age, including intervals for catch-up and additional guidance for special situations.
For free flu communication resources to share with your patients, visit https://www.cdc.gov/flu/resource-center/index.htm and https://www.chesshealthsolutions.com/2024/10/02/the-power-of-prevention-encouraging-influenza-vaccinations/.
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