Connect

Connect

with a Cardinal Health representative

866.476.1340

Thank you for connecting with us.
 
 
 
 
 
*
 
 
   
Please fill out this field

Measuring up: Which quality measures should your practice be tracking?

Back in 2006, the Centers for Medicare & Medicaid Services (CMS) introduced the Physician Quality Reporting Initiative (PQRI), offering bonus payments to physicians who voluntarily reported scores on specific quality measures.

PQRI now has evolved into the Physician Quality Reporting System (PQRS), which imposes a 2 percent cut on all Medicare Physician Fee Schedule payments for physicians who fail to report in the required manner. Failure to report through PQRS also subjects a physician to the maximum 4 percent penalty under the Medicare Value Modifier (VM) Program. 

Members Login

Sign in to the members-only section of VitalSource™ GPO

Your portal to valuable resources designed to help maximize profitability and optimize efficiency.

2016 Performance, 2017 reporting, 2018 payment adjustments

To avoid these penalties in 2018, a specialty care provider (either individually or as part of a group practice) will need to submit data on his or her 2016 performance during the first quarter of 2017. Specifically, a physician must report on at least nine measures selected from a list of more than 270 PQRS-approved measures. The nine selected measures must cover at least three of the six National Quality Forum domains (patient safety; person and caregiver-centered experience and outcomes; communication and care coordination; effective clinical care; community/population health; and efficiency and cost reduction). Also, at least one of the reported measures must appear on CMS’ list of 23 “cross-cutting” measures unless the physician has no face-to-face encounter with a Medicare beneficiary during the performance year. 

For each PQRS-approved measure, CMS provides specifications on how a physician or group practice should compile and report data. Failure to meet these specifications for any reported measure will result in rejection of the physician’s or group’s submission.

To assist physicians in identifying appropriate measures on which to report, CMS has developed 17 preferred specialty measure sets, including one for oncology/hematology. An oncologist is not required to report on the eight measures included in the set; CMS has compiled the specialty sets for purposes of guidance only:  

Measure title

Description

Hematology: Myelodysplastic Syndrome (MDS) and Acute Leukemias: Baseline Cytogenetic Testing Performed on Bone Marrow

Percentage of patients aged 18 years and older with a diagnosis of myelodysplastic syndrome (MDS) or an acute leukemia who had baseline cytogenetic testing performed on bone marrow

Hematology: Myelodysplastic  Syndrome (MDS): Documentation of Iron Stores in

Patients Receiving Erythropoietin Therapy

Percentage of patients aged 18 years and older with a diagnosis of myelodysplastic syndrome (MDS) who are receiving erythropoietin therapy with documentation of iron stores within 60 days prior to initiating erythropoietin therapy

Hematology: Multiple Myeloma:

Treatment with Bisphosphonates

Percentage of patients aged 18 years and older with a diagnosis of multiple myeloma, not in remission, who were prescribed or received intravenous bisphosphonate therapy within the 12-month reporting period

Hematology: Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry

Percentage of patients aged 18 years and older seen within a 12 month reporting period with a diagnosis of chronic lymphocytic leukemia (CLL) made at any time during or prior to the reporting period who had baseline flow cytometry studies performed and documented in the chart

Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer

Percentage of female patients aged 18 years and older with Stage IC through IIIC, ER or PR positive breast cancer who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting period

Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer Patients

Percentage of patients aged 18 through 80 years with AJCC Stage III colon cancer who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or have previously received adjuvant chemotherapy within the 12-month reporting period

Oncology: Medical and Radiation – Pain Intensity Quantified

Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified

Oncology: Medical and Radiation – Plan of Care for Pain

Percentage of visits for patients, regardless of age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy who report having pain with a documented plan of care to address pain

Become a member today

VitalSource™ GPO is a consultative partner who delivers meaningful solutions to make your business more successful.

Join now

2017 Performance, 2018 reporting, 2019 payment adjustment

Beginning next year, both PQRS and the VM Program will be replaced by the Merit-Based Incentive Payment System (MIPS), with its own set of quality measures and reporting requirements. Like PQRS, the MIPS proposed rule includes a list of several hundred quality measures from which a physician may select. Unlike PQRS, a physician will be required to report on only six measures, including one cross-cutting and one outcome-based measure.

In a previous article, we detailed the significant impact MIPS will have on all physicians, including specialty care providers.  Thus, it is critically important that specialty care providers begin work now on performance improvement initiatives to maximize their MIPS scores. As a first step, practices should identify specific quality measures and implement processes to ensure qualifying patients receive the prescribed evaluation or treatment.

The MIPS proposed rule includes 23 specialty-specific measure sets, but CMS did not include a measure set for oncology.  As oncologists prepare to master MIPS, there are three sources of relevant measures:

1.       Six of the eight measures included in the 2016 PQRS specialty measure set for hematology/ oncology are included on the proposed list of MIPS quality measures. The two excluded measures are (1) Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer and (2) Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer Patients

2.       CMS published seven core measure sets earlier this year. Developed by the Core Quality Measures Collaborative (CQMC), the measure sets include a fourteen-measure set for medical oncology. The CQMC utilized a multi-stakeholder approach to identify measure sets that are meaningful to patients, payers, and providers. Initially focusing on breast, colorectal, and prostate cancer, as well as hospice and end-of-life care, the measures concentrate predominantly on processes and treatment utilization.

All but two of the fourteen measures are included on the proposed list of MIPS quality measures:

NQF #

Measure description

MIPS?

0559

Combination chemotherapy is considered or administered within four months (120 days) of diagnosis for women under 70 with AJCC T1c, or Stage II or III hormone receptor negative breast cancer.

No

1857

Patients with breast cancer and negative or undocumented human epidermal growth

factor receptor 2 (HER2) status who are spared treatment with trastuzumab

Yes

1858

Trastuzumab administered to patients with AJCC stage I (T1c) – III and human

epidermal growth factor receptor 2 (HER2) positive breast cancer who receive adjuvant chemotherapy

Yes

0223

Adjuvant chemotherapy is considered or administered within four months (120 days) of diagnosis to patients under the age of 80 with AJCC III (lymph node positive) colon

cancer

No

1859

KRAS gene mutation testing performed for patients with metastatic colorectal cancer

who receive anti-epidermal growth factor receptor monoclonal antibody therapy

Yes

1860

Patients with metastatic colorectal cancer and KRAS gene mutation spared treatment

with anti-epidermal growth factor receptor monoclonal antibodies

Yes

0210

Proportion receiving chemotherapy in the last 14 days of life

Yes

0211

Proportion with more than one emergency room visit in the last 30 days of life

Yes

0213

Proportion admitted to the ICU in the last 30 days of life

Yes

0215

Proportion not admitted to hospice

Yes

0216

Proportion admitted to hospice for less than three days

Yes

0384

Oncology: Pain Intensity Quantified – Medical Oncology and Radiation Oncology

Yes

0389

Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate

Cancer Patients

Yes

1853

Radical Prostatectomy Pathology Reporting

Yes

The CQMC indicated its work in medical oncology is ongoing, and the group intends to develop additional core measures addressing the following: 

  • Pain control
  • Functional status or quality of life
  • Shared decision-making
  • Appropriate use of chemotherapy
  • Under or overtreatment
  • ER utilization
  • Inpatient hospital admission rate
  • Reporting of cancer stage
  • Disease- free survival for specified number of years
  • Patient experience/PRO for level of pain experience by patient
  • Cost measures
  • Lung cancer
  • Five year cure rate

3.        CMS announced the 196 oncology practices to participate in the Oncology Care Model late last month. As part of the formal Participation Agreement these practices were required to sign, CMS identified the 16 required quality measures. Nine of the 16 measures are included on the proposed list of MIPS quality measures:    

NQF #

Measure description

MIPS?

0559

Breast Cancer: Combination chemotherapy is considered or administered within four months (120 days) of diagnosis for women under 70 with AJCC T1c, or Stage II or Stage III hormone receptor negative breast cancer in OCM-FFS beneficiaries

No

0223

Colon Cancer: Adjuvant chemotherapy is considered or administered within fourmonths (120 days) of surgery to OCM-FFS beneficiaries under the age of 80 with AJCC III (lymph node positive) colon cancer

No

0387

Breast Cancer: Hormonal therapy for Stage IC-IIIC (ER/PR) Positive Cancer in OCM-FFS beneficiaries

Yes

0390

Prostate Cancer: Adjuvant hormonal therapy for high-risk OCM-FFS beneficiaries

Yes

N/A

Risk-adjusted proportion of OCM beneficiaries with all-cause hospital admissions within the six-month episode

No

0383

Oncology: Plan of Care for Pain

Yes

0418

Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan

Yes

N/A

Patient-reported Experience of Care

No

1858

Trastuzumab administered to patients with AJCC stage I (T1c) - III and human epidermal growth factor receptor 2 (HER2) positive breast cancer who receive adjuvant chemotherapy

Yes

N/A

Chemotherapy intent documented

No

N/A

Risk-adjusted proportion of OCM beneficiaries with all-cause ED visits that did not result in a hospital admission within the six-month episode

No

N/A

Proportion of OCM beneficiaries who died who were admitted to hospice for three days or more

No

N/A

Documentation of current medication in the medical record

Yes

0326

Advance care plan

Yes

N/A

Closing the Referral Loop: Receipt of specialist report

Yes

0384

Oncology: Pain Intensity Quantified - Medical Oncology and Radiation Oncology

Yes

Interestingly, only one measure appears on all four lists – the 2016 PQRS hematology/oncology specialist list, the CQMC Core Measures for medical oncology, OCM measures, and the proposed list of MIPS quality measures:

Measure title

Description

Oncology: Medical and Radiation: Pain Intensity Quantified (NQF 0384/PQRS 143)

Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified

With this background on options for quality reporting, we will discuss strategies for proper measures selection, including performance improvement initiatives, in a future article.