Tuberculosis (TB) Prevention for Patients with Psoriasis, Psoriatic Arthritis, and Rheumatoid Arthritis Patients on a Biological Immune Response Modifier
Percentage of patients whose providers are ensuring active tuberculosis prevention either through yearly negative standard tuberculosis screening tests or are reviewing the patient’s history to determine if they have had appropriate management for a recent or prior positive test.
ACP does not support MIPS measure ID# 337: “Psoriasis: Tuberculosis Prevention for Patients with Psoriasis, Psoriatic Arthritis, and Rheumatoid Arthritis Patients on a Biological Immune Response Modifier” because the measure addresses a very narrow scope with limited opportunity for improvement. Furthermore, developers cite soft evidence (level B) to form the basis of the measure. Moreover, we are concerned with some aspects of the specifications. First, the developers do not define which TB tests are acceptable to meet the requirements of the measure. Second, it seems that confirmation of TB test through the EHR would be reasonable as opposed to confirmation via letter. Third, the time interval is consensus based. While we agree it is important for clinicians to screen for TB prior to initiation of treatment with anti-tumor necrosis factor therapy, we are not aware of any evidence to support the annual testing frequency. Fourth, developers should revise the specifications to include QuantiFERON®-TB Gold as a screening option. Finally, the documentation requirements are illogical unless this measure is facilitated by a registry.