CMS' Core Oncology Measures - A Work in Progress

CMS, in collaboration with America’s Health Insurance Plans (AHIP); the National Quality Forum; and several physician, employer, and consumer-led organizations has initiated the development of core sets of quality measures to be reported by payers. The goal of the initiative is to identify actionable information and avoid unnecessary duplication of physician efforts through redundant measures—the result of misaligned payer requirements.

Along with 6 disease states, the seventh set are primary care measures that are tailored for accountable care organizations and patient-centered medical homes. The following table summarizes the Medical Oncology Measures established by the Collaborative. These measures are specifically developed for breast cancer, colorectal cancer, prostate cancer, and hospice/end of life.

Measure

Steward

Analysis by

Consensus

Breast Cancer

Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 years with AJCC T1c, or Stage II or III hormone receptor-negative breast cancer

ACS

Facility

Include measure in core set if data available through EHR or provider self-report

Patients with breast cancer and negative or undocumented HER2 status who are spared treatment with trastuzumab

ASCO

Clinician

Include measure in core set

Trastuzumab administered to patients with AJCC stage I (T1c) to III and HER2 positive breast cancer who receive adjuvant chemotherapy

ASCO

Clinician

Include measure in core set

Colorectal Cancer

Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis to patients under the age of 80 with AJCC III (lymph node positive) colon

cancer

CoC, ACS

Facility

Include measure in core set if data available through HER or provider self-report

KRAS gene mutation testing performed for patients with metastatic colorectal cancer who receive anti-epidermal growth factor receptor monoclonal antibody therapy

ASCO Clinician

ASCO

Clinician

Include measure in core set

Patients with metastatic colorectal cancer and KRAS gene mutation spared treatment with anti-EGFR monoclonal antibodies

ASCO

Clinician

Include measure in core set

Prostate Cancer

Avoidance of overuse of bone scan for staging low-risk prostate cancer patients

AMA-PCPI

Clinician

Include measure in core set if data available through HER or provider self-report

Radical prostatectomy pathology reporting

College of

American

Pathologists

Clinician

Include measure in core set

Hospice/End of Life

Proportion receiving chemotherapy in the last 14 days of life

ASCO

Clinician

Include measure in core set

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

ASCO

Clinician

Include measure in core set

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

ASCO

Clinician

Include measure in core set

Proportion not admitted to hospice

ASCO

Clinician

Include measure in core set

Proportion admitted to hospice for less than 3 days

ASCO

Clinician

Include measure in core set

Oncology: Pain Intensity Quantified — Medical Oncology and Radiation Oncology

AMA-PCPI

Clinician

Include measure in core set

ASCO, American Society of Clinical Oncology; CoC, Commission on Cancer; EGFR, epidermal growth factor receptor; EHR, electronic health record; HER2, human epidermal growth factor receptor 2.

ACS indicates American College of Surgeons; AMA-PCPI, American Medical Association-Physician Consortium for Performance Improvement;

The Collaborative has acknowledged that there were significant data challenges for several measures as health plans do not have access to pharmacy data, patient charts, or date of death information. Additionally, with the rapid growth and innovation observed in oncology, the working group members have highlighted the need to continually reassess based on changing treatment protocols. The working group has also developed a list of areas for which measure sets will be developed, including pain control, quality of life, shared decision-making, patient experience, etc.