Oncology Medical Home Measure Specification Data

Transcription

1 Oncology Medical Home Measure Specification Data Measure Name Chemotherapy pathway compliance Measure # 1 Measure Description % of chemotherapy treatments that have adhered to NCCN guidelines or pathways. Numerator Statement Use of any of the below and with a treatment that involved NCCN chemotherapy treatment guidelines of 2B or above. Denominator Statement Visits with one of the following criteria: Physician office: Initial chemotherapy injections, pushes, or infusions, (CPT codes 96413, 96401, 96402, 96409, 96413, 96416) and oral chemotherapy if initiated/ordered through an EMR. Hospital inpatient: DRG or Hospital outpatient: revenue codes: 331 chemotherapy injection or 335 chemotherapy infusion Measure Type Quality X Value Outcomes Community Oncology Alliance Contact bgamble@coacancer.org A mechanism will be needed to identify the regimen as an NCCN approved 2B plan and a calculation of 2B regimens as a percentage of all regimens. This would apply to chemotherapy infusions, injections, pushes and oral chemotherapy ordered/initiated through an oncology EMR system. (Oral chemotherapy edits may be subject to technology advancements in EMR vendors.) Reproduced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ) 2012 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines and illustrations herein may not be reproduced in any form for any purpose without the express written permission of the NCCN. To view the most recent and complete version of the NCCN Guidelines, go online to NCCN.org< NATIONAL COMPREHENSIVE CANCER NETWORK, NCCN, NCCN GUIDELINES, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

2 Measure Name Cancer staging documented. Measure # 2 Measure Description % of cancer patients with documented clinical or pathologic staging prior to initiation of first course of treatment. Numerator Statement Occurrences where AJCC cancer stage AND AJCC TNM values are present (T = tumor, N = nodes, M = metastases) are present when patient chemotherapy is initiated. Denominator Statement Patients with a ICD- 9 codes of Measure Type Quality X Value Outcomes American Medical Association - Physician Consortium for Performance Improvement Contact mark.antman@ama-assn.org EMR vendors will need some type of audit in their systems for the initiation of the chemotherapy order. It would be preferable for the EMR system to STOP the chemotherapy ordering process if AJCC staging is not present. The user could receive a possible warning of Quality cancer treatment requires AJCC cancer staging be applied prior to the initiation of chemotherapy. Press CONTINUE if you wish to continue without staging. Press CANCEL if wish to obtain staging first. Press IGNORE to allow the physician to bypass the scoring system and input their estimated staging. The quality score will be impacted if the user enters CONTINUE or IGNORE. Staging required for diseases staged per AJCC guidelines and the audit should be against stage scoring system and not just the presence of a stage. (i.e., Presence of staging to be determined by TNM or other systematic scoring system. )

3 Measure Name Emergency room utilization Measure # 3 Measure Description # of emergency room visits per chemotherapy patient per year Numerator Statement Patients in the denominator list that also had an ER claim filed in the same period and within 30 days of a chemotherapy encounter. ER visits are identified as any UB92 claim that includes revenue codes for emergency room services OR emergency room professional fee revenue code of 981. AND Denominator Statement Primary diagnosis codes, or ranges of codes that are related to cancer, chemotherapy side effects, and symptom management related to either. Payers have their own list of these codes and the intent is to provide a complete and exhaustive list that is developed and endorsed by physicians from payers and cancer care communities and subsequently used by payers and providers. Depending on the reporting entity, the # of patients that have had at least one of the following in the reporting period. Hospital outpatient: revenue codes: 331 chemotherapy injection or 335 chemotherapy infusion or 332 for oral chemotherapy. Physician: Initial chemotherapy injections, pushes, or infusions, (CPT codes 96413, 96401, 96402, 96409, 96413, 96416) or any oral chemotherapy code QXXXX. Measure Type Quality Value X Outcomes This is a NCQA PCMH focus however; no detail is listed on how to gather this numerator. Likewise on NQF, there is mention of measuring with respect to other conditions but there is no mention on how to gather and who produces this information.. Contact Cancer centers are encouraged to gather this information for all of their patients regardless of payer. And, to use whatever mechanism to gather this information. Ideas to consider in order to gather this information include but are not limited to: 1) Automated or manual reporting from the hospital(s) to the cancer centers. 2) Utilization of an information exchange engine to gather and report this information. 3) Patient questionnaires at the time of the visit to the cancer center to determine if the patient has had a visit to an emergency room since their last visit. 4) Prompts, such a reminder attached to insurance cards, that would remind the patient, family or ER provider to contact the patient s oncology care team prior to providing emergency room services.

4 5) Any other means available to gather and report for the entire practice. A listing of proposed diagnosis codes for this measure and the hospital admissions measure will be proposed as a separate document. This document will require careful scrutiny by all participants on the OMH Steering Committee. The end goal will be a comprehensive list of filtered diagnosis codes that can be used by all providers, payers and the information systems that will be used to assist in these measures.

5 Measure Name Hospital admission rate Measure # 4 Measure Description # of hospital admissions per chemotherapy patient per year. Numerator Statement Patients in the denominator list that also had a hospital admission within 30 days of chemotherapy visit. Hospital admission visits are identified as any UB92 claim with a bill type (FL 4) of 111. AND Primary diagnosis codes, or ranges of codes that are related to cancer, chemotherapy side effects, and symptom management related to either. Payers have their own list of these codes and the intent is to provide a complete and exhaustive list that is developed and endorsed by physicians from payers and cancer care communities and subsequently used by payers and providers. Denominator Statement Depending on the reporting entity, the # of patients that have had at least one of the following in the reporting period. Hospital outpatient: revenue codes: 331 chemotherapy injection or 335 chemotherapy infusion or 332 for oral chemotherapy. Physician: Initial chemotherapy injections, pushes, or infusions, (CPT codes 96413, 96401, 96402, 96409, 96413, 96416) or any oral chemotherapy code QXXXX. Measure Type Quality Value X Outcomes This is a NCQA PCMH focus however no detail listed on how to gather numerator. Likewise on NQF, there is mention of measuring with respect to other conditions but there is no mention on how to gather this data and who produces the data. Contact Cancer centers are encouraged to gather this information for all of their patients regardless of payer. And, to use whatever mechanism to gather this information. Ideas to consider in order to gather this information include but are not limited to: 1) Automated or manual reporting from the hospital(s) to the cancer centers. 2) Utilization of an information exchange engine to gather and report this information. 3) Patient questionnaires at the time of the visit to the cancer center to determine if the patient has had a visit to an admission since their last visit. 4) Prompts, such a reminder attached to insurance cards, that would remind the patient, family or admitting office staff to contact the patient s oncology care team prior to admitting the patient. 5) Any other means available to gather and report this information for the entire practice. A listing of proposed diagnosis codes for this measure and the emergency room measure will be proposed as a separate document. This document will require

6 careful scrutiny by all participants on the OMH Steering Committee. The end goal will be a comprehensive list of filtered diagnosis codes that can be used by all providers, payers and the information systems that will be used to assist in these measures.

7 Measure Name Deaths of cancer patients while in a hospital. Measure # 5 Measure Description % of cancer patient deaths where the patient died in an acute care setting. Numerator Statement Of the cancer patients with recorded deaths in the reporting period (as defined in the numerator) the patients that died in an acute care setting. Denominator Statement Patients with a primary admission or principal discharge diagnosis code of cancer - ICD- 9 codes of or any other diagnosis code(s) directly related to cancer, treatment or side effects of either. (Specific diagnosis codes to be determined by all physicians on the OMH Steering Committee.) AND A death recorded in a specific time frame. The selection should be from the date and time the patient s date and location of death was recorded. Patients that expired in a skilled nursing facility. Measure Type Quality Value Outcomes X Listed as NQF measure 214 and with ASCO listed as steward but after steward listed as Institute for Clinical and Evaluative Sciences Contact EMR vendors are encouraged to do periodic sweeps of the National Death Registry to capture expiration data after a pre-determined number of missed appointments. Data capture process would also need to be sensitive of when death information was obtained and not just when patient expired. (Record the date of date and the date the death was recorded.) The listing of proposed diagnosis codes will be the same list used for emergency room visit and hospital admissions.

8 Measure Name Days in hospice care Measure # 6 Measure Description Average # of days under hospice care (home or inpatient) at time of death. Numerator Statement Numerator is not applicable with this calculation of average days. Each patient that meets the below criteria should be used to determine an average. Denominator Statement The Patients with a primary/principal diagnosis code of cancer - ICD- 9 codes of or any other diagnosis code(s) directly related to cancer, treatment or side effects of either. (Specific diagnosis codes to be determined by all physicians on the OMH Steering Committee.) AND Patients placed in an inpatient or at home hospice program. AND Recorded date of death in the reporting period. This measure selection should be from when the patient s recorded date of death. Patients in a skilled nursing facility. Measure Type Quality X Value X Outcomes National Cancer Institute through NQF measure 216 Contact clausers@mail.nih.gov EMR vendors are encouraged to develop and maintain data fields specific to hospice care, include place of death. EMR vendors are also encouraged to sweep the National Death Registry to gather date of death information for patients. Meaningful use requires outbound transitions. The above need should be considered in the implementation of Meaningful Use. Reporting procedures should allow for when the death data is received as well as when the patient expired. This procedure would assist with the timing delays for when this data is received. Practices should use whatever means available to capture and report hospice utilization data for their patients. Suggestions include: 1) Automated or manual reporting from the hospice to the cancer centers. 2) Utilization of an information exchange engine to gather and report this information. 3) Prompts, such a reminder attached to insurance cards, that would remind the patient, family or hospice staff to contact the patient s oncology care team prior to admitting the patient to hospice. 4) Any other means available to gather and report this information for the entire practice. The listing of diagnosis codes will be the same list used for emergency room visits, hospital admissions and expirations in an acute care setting.

9 Measure Name End of life discussions Measure # 7 Measure Description % of patients that have newly diagnosed Stage IV disease who have had advance care planning discussions documented. Numerator Statement The number of patients from the denominator that have a documented, comprehensive and appropriate discussion regarding choices and decisions regarding their care. Although topics are suggested below, the discussion will be at the direction and discretion of the provider. The communication must be documented, separate or within the physician note. Suggested topics include: Designated person to make decisions for the patient. The types of medical care preferred. The comfort level that is preferred. Preferred place of care. How the patient prefers to be treated by others. What the patient wishes others to know. Timeframes New diagnosis of stage IV disease: Within 60 days of initial treatment Denominator Statement Patients being measured in this category are cancer patients (with ICD-9 diagnosis code of ) AND stage IV disease. Stage IV to be determined as progressive staging or initial diagnosis and within the reporting period indicated. Measure Type Quality Value X Outcomes University of NC Chapel Hill through NQF measure 1641 Contact lhanson@med.unc.edu The payers on the OMH Steering Committee are very sensitive to this measure and request this measure goes beyond a simple Y/N answer that the provider discussed end of life issues with the patient. The definition and components of end of life discussions needs to be defined in this measure. The above is taken from the 5 Wishes program. 5 Wishes is a patient friendly living will program that is legally accepted in 40 states. This measure will require the top three components for this measure regardless of whether 5 Wishes is used for this measure. More information on 5 Wishes can be found at:

10 Measure Name Breast cancer survival rates Measure # 8 Measure Description Survival rates of stage I through IV breast cancer patients Numerator Statement There will not be a numerator in this measure. This measure will be the total percentage of breast cancer patients that have lived beyond 5 years. Denominator Statement The selection criteria for patients in this measure will include patients with any diagnosis code of through AND were reported as deceased during the reporting period OR were alive during the reporting period. If the patient was deceased during the reporting period the survival rate would be calculated from date of death to the diagnosis date. If the patient is alive the survival rate would be calculated from the current date to the diagnosis date. The five year survival rate by stage would be calculated from a sort and grouping of all of these patients by initial stage that have lived five years or beyond as a percentage of all breast cancer patients listed. Measure Type Quality Value Outcomes X Community Oncology Alliance Contact bgamble@coacancer.org 5 years survival rates seem to be the accepted standard measurement and easier to embrace than an average life expectancy calculation. The ratio should be the % of patients from their initial stage and that have lived beyond 5 years from their initial diagnosis date and initial stage. Staging will be determined accurate if automated by the appropriate staging software. EMR vendors are encouraged to sweep the National Death Registry for date of death information for patients as appropriate.

11 Measure Name Colorectal cancer survival rates Measure # 9 Measure Description Survival rates of stage I through IV colorectal cancer patients Numerator Statement There will not be a numerator in this measure. This measure will be the total percentage of colorectal cancer patients that have lived beyond 5 years. Denominator Statement The selection criteria for patients in this measure will include patients with any diagnosis code of through AND were reported as deceased during the reporting period OR were alive during the reporting period. If the patient was deceased during the reporting period the survival rate would be calculated from date of death to the diagnosis date. If the patient is alive the survival rate would be calculated from the current date to the diagnosis date. The five year survival rate by stage would be calculated from a sort and grouping of all of these patients by initial stage that have lived five years or beyond as a percentage of all colorectal cancer patients listed. Measure Type Quality Value Outcomes X Community Oncology Alliance Contact bgamble@coacancer.org 5 years survival rates seem to be the accepted standard measurement and easier to embrace than an average life expectancy calculation. The ratio should be the % of patients from their initial stage that have lived beyond 5 years from their initial diagnosis date and initial stage. Staging will be determined accurate if automated by the appropriate staging software. EMR vendors are encouraged to sweep the National Death Registry for date of death information for patients as appropriate.

12 Measure Name Lung cancer survivor rates Measure # 10 Measure Description Survival rates of stage I through IV NSC lung cancer patients Numerator Statement There will not be a numerator in this measure. This measure will be the total percentage of lung cancer patients that have lived beyond 5 years. Denominator Statement The selection criteria for patients in this measure will include patients with any diagnosis code of through AND were reported as deceased during the reporting period OR were alive during the reporting period. If the patient was deceased during the reporting period the survival rate would be calculated from date of death to the diagnosis date. If the patient is alive the survival rate would be calculated from the current date to the diagnosis date. The five year survival rate by stage would be calculated from a sort and grouping of all of these patients by initial stage that have lived five years or beyond as a percentage of all lung cancer patients listed. Measure Type Quality Value Outcomes X Contact 5 years survival rates seem to be the accepted standard measurement and easier to embrace than an average life expectancy calculation. The ratio should be the % of patients from their initial stage, that have lived beyond 5 years from their initial diagnosis date and initial stage. Staging will be determined accurate if automated by the appropriate staging software. EMR vendors are encouraged to sweep the National Death Registry for date of death information for patients as appropriate.

13 Measure Name Neutropenia risk Measure # 11 Measure Description % of cancer patients undergoing treatment with a chemotherapy regimen with a 20% or more risk of developing neutropenia and also received GCSF/white cell growth factor. Numerator Statement The number of occurrences where a patient received a colony stimulating factor for neutropenia risk of 20% or more with the drugs associated with infusions described in the denominator below. Denominator Statement Physician office: Initial chemotherapy injections, pushes, or infusions, (CPT codes 96413, 96401, 96402, 96409, 96413, 96416) with chemotherapy agents (HCPCS J9XXX) Hospital inpatient: DRG or Hospital outpatient or inpatient: revenue codes: 331 chemotherapy injection or 332 oral chemotherapy or 335 chemotherapy infusion Measure Type Quality X Value Outcomes ASCO via QOPI for specific regimens Contact Robert Hauser In order to be completely accurate this measure should also incorporate inappropriate (or overuse) use of GCSF. See below for a suggested formula that incorporates appropriate and inappropriate use. Neutropenia risk is determined by NCCN will be considered the standard for risks of 20% or more. Although the patient s medical status and condition may have implied risks for neutropenia, this phase of measurement will consider the risk associated with the regimen only. EMR, inventory management, or pathway management tools are expected to assist with the capture and reporting of this information. 20% risk also matches ASCO guidelines. Although a patient s specific comorbities and complications may increase their risk for neutropenia, this definition will be specific to NCCN guidelines only. This will necessitate a benchmark target of 85%.. Suggested formula: (Chemotherapy administrations with a 20% or more risk of febrile neutropenia that also included appropriate use of GCSF/ (chemotherapy administrations that call for GCSF use + GCSF administrations that were not warranted based on documented

14 febrile neutropenia risk factors.) Reproduced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ) 2012 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines and illustrations herein may not be reproduced in any form for any purpose without the express written permission of the NCCN. To view the most recent and complete version of the NCCN Guidelines, go online to NCCN.org< NATIONAL COMPREHENSIVE CANCER NETWORK, NCCN, NCCN GUIDELINES, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

15 Measure Name Psycho/social screening and intervention Measure # 12 Measure Description % of chemotherapy patients that received psycho/social screening and received measurable interventions as a result of the psycho/social screening. This screening to be completed through an endorsed and recognizable program or procedure. Numerator Statement Denominator Statement This numerator has two parts; screenings applied to patients eligible for screening (new cancer patients) and patients that received interventions when interventions were appropriate. The denominator for this measure will also have two parts; patients needing screening (new cancer patients) and patients that were screened. (See below for calculations) Follow-up screening is not addressed in this screening. Measure Type Quality X Value Outcomes Community Oncology Alliance Contact bgamble@coacancer.org This area is one of the most sensitive and possibly overlooked and undertreated areas in cancer care. Although it is a QOPI measure, practices often struggle with the screening and the subsequent needed interventions. Screenings should occur within 45 days of a first patient visit and not necessarily to be the first visit. The measure recommends screening and interventions specific to the following areas: Emotions related to cancer Changing behaviors Material and logistical resources Disruptions in work, school or family Financial advice and assistance It is also assumed that these areas, also important to psycho/social screening, are addressed in other patient communication and coordination procedures necessary for quality cancer care: Cancer treatment information Managing the illness When at all possible this process of screening and requesting of interventions should be automated and streamlined via technology based psycho/social screening/intervention tools.

16 An intervention is indicated when a patient requests an intervention. (Example: A cancer patient may indicate depression but may not desire or request intervention at that moment in their journey.) Acceptable interventions would be articles, communications and/or referrals to other professionals. Implementation is very important with this measure. This measure has potential to add financial and administrative burden if efficient tools and technologies are not used in the process. Sample calculation for this measure. The measure is based on eligible patients and not eligible interventions. # of eligible patients (# of new cancer patients) # of new patients that received screening of any type # of new patients that received any interventions. Patients not needing interventions would be counted as an intervention delivered. And using hypothetical numbers of 100 new patients: Example 1: 95 patients got screened and 95 patients received some type of intervention or no intervention was needed = (95/100)*(95/95) = 95% Example 2: 95 patients got screened and 80 patients received some type of intervention or no intervention was needed = (95/100)*(80/95) = 80%

17 Measure Name Patient receives treatment plan Measure # 13 Measure Description % of cancer patients that received a treatment plan prior to the administration of chemotherapy. This treatment plan to either be from a recognized source or to have required elements/components. Numerator Statement Number of components met of the total potential components for the reporting period. Denominator Statement The denominator for this measure will include the quantity of patients that begin chemotherapy and received a treatment plan with the following minimum components. Diagnosis including histology and stage Goal or intent of therapy (Curative, adjuvant etc.) Chemotherapy regimen and starting doses Duration and/or planned number of cycles and frequency. Information on possible side effects of treatment and symptoms of such effects. Listing of cancer-related resources and information. Contact information to all aspects of the care/support team and instructions on who to call for what so that the patient and family receives the best possible outcome with the highest quality and value. Measure Type Quality Value Outcomes AMA through NQF Measure 0381 (Radiation) Contact mark.antman@ama-assn.org Treatment plans and planning is a concept that is used loosely and has broad meaning. A lot of cancer support organizations have their own definition and description of what they are and how they are used. This measure is intended to create a detailed definition and what is included in a treatment summary while also allowing it to be measured. The above is the minimal set of recommended criteria. Cancer centers are encouraged to expand upon this list as appropriate Treatment plans should be friendly, easy to understand and shared with the patient. Guidelines on the content of treatment plans are likely to get more stringent as time passes. Treatment plans should be prepared and presented to patients without requiring additional physician intervention. Proposed calculation:

18 # of eligible patients (# of new cancer patients) # of treatment summary components And using hypothetical numbers of 100 new patients: Example 1: 95 of 100 patients received 6 of 7 treatment plan components = (6*95)/(7*100) 81.4% Example 2: 45 of 100 patients received 7 of 7 treatment plan components and 40 of 100 patients received 6 of 7 components = ((45*7)+(40*6))/(7*100) = 79.3%

19 Measure Name Patient receives survivorship plan. Measure # 14 Measure Description % of cancer patients that received a survivorship plan within 45 days after the completion of chemotherapy. This survivorship plan to either be from a recognized source or to have required elements/components. Numerator Statement Number of components met of the total potential components for the reporting period. Denominator Statement The denominator for this measure will include the quantity of patients that have completed therapy within the last 45 days multiplied by the number of minimum components of a survivorship plan. The minimum components are noted below and are excerpts from the Institute of Medicine and the Commission on Cancer from the American College of Surgeons. Frequency and/or scheduled appointments with the oncologists and diagnostic testing. Listing and schedules of periodic and recommended cancer and other screenings, tests and exams and who would perform them. Information on possible long term side effects of treatment, symptoms of such effects, and how to report them. In addition to other reportable signs and symptoms. Recommendations for healthy behaviors. (Wellness, diet and exercise) Listing of cancer-related resources and information regarding cancer survivorship. Patients that are enrolled in hospice would be excluded from this calculation. Measure Type Quality Value Outcomes Institute of Medicine and American College of Cancer Commission on Cancer Contact SAR@facs.org There seems to be lots of discussion and confusion on the specifics of this item. Some include any discussion, visit or interaction post treatment as a component of a survivorship plan. Since the OMH model includes other measures for end of life issues and psycho/social screening, this measure will focus on the communication, coordination and interaction that should occur with the patient after scheduled chemotherapy is completed. Psycho/social screening and end of life discussions will be referenced in the survivorship plan but will be addressed as their own measures. Minimal requirements for a survivorship plan were defined by the Institute of Health in The American College of Surgeons also acknowledges these standards as the authority for survivorship plans. Refer to the following for more information: Fact-Sheet.pdf

20 NCCN References on survivorship: The above list is a subset of that recommended by these entities. Proposed calculation: # of eligible patients (# of new cancer patients) # of survivorship plan components And using hypothetical numbers of 100 new patients: Example 1: 90 of 100 patients received 4 of 5 treatment plan components = (90*4)/(100*5) = 72% Example 2: 43 of 100 patients received 5 of 5 treatment plan components and 40 of 100 patients received 4 of 5 components = ((45*5)+(40*4))/(5*100) = 73%

21 Measure Name Chemotherapy received near end of life. Measure # 15 Measure Description A measurement of chemotherapy given near end of life. Numerator Statement Physician office: Patients with one of the following Initial chemotherapy billing codes for injections, pushes, or infusions, (CPT codes 96413, 96401, 96402, 96409, 96413, 96416) within 30 days from date of death.. Hospital outpatient or inpatient: Patients with a revenue codes of 331 chemotherapy injection or 335 chemotherapy infusion within 30 days from date of death.. Denominator Statement Patients with a date of death recorded in this reporting period. Oral chemotherapy will be excluded from this calculation. Measure Type Quality X Value X Outcomes NQF measure 210 National Cancer Institute Contact clausers@mail.nih.gov The NQF measure indicates patients that received chemotherapy within the last 14 days of life. However, we feel that this calculation is not aggressive enough in the promotion/support of end of life care and hospice services. Suggested reporting procedure: Select patients with date of death recorded in the reporting period. Report last chemotherapy date for these patients. Record the % of patients with chemotherapy service dates less than or equal to 30 days before the actual date of death.

22 Measure Name Appropriate antiemetic for the appropriate treatment. Measure # 16 Measure Description Antiemetic drugs given appropriately with chemotherapy treatments. Numerator Statement The treatments described that received one of the approved antiemetic drugs for the specific chemotherapy drugs given and at the prescribed dose. Denominator Statement Physician office: Initial chemotherapy injections, pushes, or infusions, (CPT codes 96413, 96401, 96402, 96409, 96413, 96416) with chemotherapy agents (HCPCS J9XXX) Hospital inpatient: DRG or Hospital outpatient or inpatient: revenue codes: 331 chemotherapy injection or 332 oral chemotherapy or 335 chemotherapy infusion Oral chemotherapy will be excluded at this time. Measure Type Quality X Value Outcomes Community Oncology Alliance Contact Bo Gamble bgamble@coacancer.org Proper antiemetic is dependent upon the dose of the oncology drug administered. A different antiemetic may be required for the same oncology drug with a higher or lower dose. Specific antiemetics are recommended based on the emetogenic level of a dose of a specific chemotherapy drug. This matrix of possibilities is complicated and is based on a high, moderate, low and minimal levels of risk. Given the complications of this issue and the need for standardization in this measure, NCCN indications will be the standard for each regimen. It is highly recommended/suggested that EMR vendors, inventory management tools and pathway management tools facilitate the capture and reporting of proper antiemetic use. NCCN guidelines for antiemetic use can be found at: Reproduced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ) 2012 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines and illustrations herein may not be reproduced in any form for any purpose without the express written permission of the NCCN. To view the most recent and complete version of the NCCN Guidelines, go online to NCCN.org< NATIONAL COMPREHENSIVE CANCER NETWORK, NCCN, NCCN GUIDELINES, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

23 Measure Name Measure Description Numerator Statement Appropriate use of advanced imaging for early stage breast cancer patients. Measure # 17 % of patients with early-stage breast cancer patients that did not receive advanced imaging technologies to determine cancer s spread. Number of patients that fit the denominator description and did NOT HAVE any PET, CT, or MRI CPT codes in the range of Denominator Statement Number of stage 0, I or II breast cancer patients (ICD9-CM codes or or Measure Type Quality Value X Outcomes American Society of Clinical Oncology Contact Newly identified stage I or II breast cancer or ductal carcinoma in situ (DCIS), which are unlikely to have spread beyond the breast and nearby lymph nodes at the time of diagnosis. (In these patients, staging is done according to a physical examination, the size of the tumor and nearby lymph nodes, and common blood tests.) For these patients, the use of advanced imaging technologies to search for cancer spread has not been shown to improve detection of additional tumors or to extend survival. Rather, these tests are known to increase the risk of misdiagnosis or falsepositive results, which can lead to unnecessary invasive procedures or treatments that can ultimately diminish quality of life or even shorten patients' lives.

24 Measure Name Measure Description Numerator Statement Appropriate use of advanced imaging for early stage prostate cancer patients. Measure # 18 % of patients with early-stage prostate cancer patients that did not receive advanced imaging technologies to determine cancer s spread. Number of patients that fit the denominator description and did NOT HAVE any PET, CT, or MRI CPT codes in the range of Denominator Statement Number of stage 0, I or II prostate cancer patients (ICD9-CM code 185) Measure Type Quality Value X Outcomes American Society of Clinical Oncology Contact Newly diagnosed low-grade prostate cancer (Gleason score less than or equal to 6) in men with a PSA level of less than 10 ng/ml. For these patients, the use of advanced imaging technologies to search for cancer spread has not been shown to improve detection of additional tumors or to extend survival. Rather, these tests are known to increase the risk of misdiagnosis or falsepositive results, which can lead to unnecessary invasive procedures or treatments that can ultimately diminish quality of life or even shorten patients' lives.

25 Measure Name Presence of patient performance status prior to treatment Measure # 19 Measure Description % of patients with a documented performance status prior to beginning chemotherapy. Numerator Statement Presence of ECOG or Karnofsky or WHO performance status when patient chemotherapy is initiated. Denominator Statement Patients with a ICD- 9 codes of Measure Type Quality X Value X Outcomes Community Oncology Alliance Contact Bo Gamble bgamble@coacancer.org EMR vendors will need some type of audit in their systems to assure performance status is documented prior to the initiation of the chemotherapy order. It would be preferable for the EMR system to STOP the chemotherapy ordering process if performance status is not present. The user could receive a possible warning of Quality cancer treatment requires patient performance status prior to the initiation of chemotherapy. Press CONTINUE if you wish to continue without this status indicator. Press CANCEL if wish to obtain this indicator first. Press IGNORE to allow the physician to bypass this requirement and input their chemotherapy order. The quality score will be impacted if the user enters CONTINUE or IGNORE.