SCGhealth Blog


2017-2018 Influenza Vaccine Recommendations

Wednesday, October 18, 2017

By Audrey Landers, Intern

For those in the medical community, autumn brings endless sniffles, coughs and most importantly, the annual influenza season. Since 2010, the Center for Disease Control & Prevention (CDC) has recommended that Americans 6 months and older receive the influenza vaccine in order to control the spread of the disease. Suppliers began shipping out vaccines for the 2017-2018 influenza season in September.

Keep your patients strong. Vaccinate. Fight Flu.

Recommended 2017-2018 Vaccines
Vaccines for the 2017-2018 flu season will be available in the forms of a needle injection, a jet injection and an intranasal spray. These include the Inactivated Influenza Vaccines (IIVs) as well as Recombinant Influenza Vaccines (RIVs) in both trivalent and quadrivalent formulas. For this coming flu season, the CDC has recommended only the injectable influenza vaccines with the following options:

  • Standard dose injections
  • High dose injections
  • Injections made with adjuvant
  • Injections made with virus grown in cell culture
  • Injections made with vaccine production technology that does not require the flu virus

All of the flu vaccines licensed in the United States for the 2017-2018 season will contain the following influenza strains:

  • An A/Michigan/45/2015(H1N1)pdm09-like virus
  • An A/Hong Kong/4801/2014(H3N2)-like virus
  • A B/Brisbane/60/2008-like virus
  • A B/Phuket/3073/2013-like virus (quadrivalent only)

No single recommended vaccine is preferred over the others. If you have more than one vaccine type available, you may use your own discretion to select what is appropriate for each patient.

Not Recommended
Due to its ineffectiveness during the 2013-2014 and 2015-2016 flu seasons, intranasal sprays, also known as Live Attenuated Influenza Vaccines (LAIV4), are not recommended for the coming 2017-2018 flu season. Currently the only LAIV4 vaccine on the market is FluMist Quadrivalent, produced by MedImmune. If your practice has access to this vaccine, note that it is not recommended by the CDC.

Quality Reporting with MIPS #110: Preventative Care and Screening- Influenza Immunization
MIPS #110: Preventative care and Screening- Influenza Immunization is the percentage of patients aged 6 months and older seen for an in office visit between January 1 and March 31 AND October 1 and December 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization.

 

 Office Visit
 Quality Data Code
 Service Provided
 January 1, 2017 - March 31, 2017

AND

October 1, 2017 - December 31, 2017
 G8482
 

An influenza immunization is administered to the patient during the months of August through December or 2016 or January through March of 2017.
AND
An influenza immunization is administered to the patient during the months of August through December 2017.



 Any  G8483

 An influenza immunization was not administered for reasons documented by the clinician.



 Any  G8484

 An influenza immunization was not administered with no reason documented.



 

 

For more information, you can view the entire measure here.

Due to the difficulty some physicians may face in reporting this measure twice in one year, SCG Health strongly recommends that this measure be reported through electronic clinical quality measures (eCQM) using CMS measure ID CMS 147v6. The eCQM version only requires the measure be reported for one flu season during the calendar year.


Medicare patients still worse than others when it comes to getting preventive visits done

Tuesday, February 24, 2015

By Scott Kraft

More Medicare patients have taken advantage of covered annual preventive services since implementation of the Affordable Care Act (ACA), according to a recent study in the journal Health Affairs.

The study revealed that nearly 28 percent of Medicare fee-for-service patients at the Palo Alto Medical Foundation received annual preventive visits following the ACA, compared to 1.4 percent before. Despite this progress, the numbers still lag behind the 53 percent rate of Medicare Advantage patients and the 44 percent rate of patients aged 65-75 with private insurance.

The study concludes that one way to drive expanded use of Medicare’s annual preventive visits is to make the benefit better – after all, the ACA improved the benefit by making sure patients were able to get the annual preventive visit with no out-of-pocket expense.

It may not entirely be a question of money – our analysis shows that the RVUs for Medicare’s annual preventive visits are consistent with the CPT preventive services codes, though to be fair Medicare often pays a lower conversion factor than private insurance.

A key challenge may be that, despite an initial Medicare preventive visit being available since 2005 and an annual visit since 2011, these visits are still not well understood by patients and providers alike because they are fundamentally different from preventive physicals covered by most other insurance.

The biggest difference is that Medicare rules use these visits to drive the patient toward other screening and preventive visits covered by Medicare, such as colonoscopies and mammographies. This creates different requirements for collection of documentation, including which information is collected by the doctors versus the ancillary staff.

In addition, while the Medicare preventive visits require an examination of the patient, it is to the discretion of the practitioner as to which systems are examined. Much of the work of the Medicare preventive visit can be done by licensed practical nurses, though physicians often want to be involved in this element of patient care. A non-physician practitioner is able to do the entire service.

There are three different types of Medicare annual preventive visit:

  1. Initial Preventive Physical Exam (IPPE): This service must be given within the patient’s first 12 months of Medicare eligibility and is billed with code G0402. Payment is approximately $169, subject to regional adjustment.
  2. Initial Annual Wellness Visit (AWV): This is the initial annual wellness visit the patient receives after the IPPE, following the first 12 months of Medicare eligibility. The patient can receive this service any time after the first year of eligibility, but Medicare will pay for only one initial AWV in the patient’s lifetime. The payment is approximately $175.
  3. Subsequent Annual Wellness Visit (AWV): This is a subsequent annual wellness visit the patient may receive once annually after the first AWV. There must be at least 11 months in-between each AWV service a patient receives.

For each of the services, Medicare will waive the copayment and deductible so that the patient has no out-of-pocket expenses to pay.

Initial Preventive Physical Examination (IPPE)
As noted above this service must be given to a patient within his or her first 12 months of Medicare eligibility. Once 12 months have passed, the patient is no longer eligible for this service, but still may receive an initial AWV.

In order to bill an IPPE, the practice must document the patient’s medical and social history, risk factors for depression and other mood disorders and a review of the patient’s safety level and functional ability.

The practice must document the patient’s vital signs, including body mass index and a visual acuity screen. The patient has the option of getting end-of-life planning. Finally, the patient should be given education and counseling based on the findings of the exam, a referral for an ECG and other appropriate screenings covered by Medicare based on the patient’s eligibility.



SCG Health blog by Email

Recent Posts


Archive


Tags

SCG Health is a tradename of the Searfoss Consulting Group, LLC. You may reproduce materials available on this site for your own personal use and for noncommercial distribution. For more information, please read the Content Sharing Policy. Art & design by SCG Health. DISCLAIMER: You should consult an attorney for individual advice regarding a particular set of facts and circumstances. SCG Health reserves the right to change the information on this website without notice.