MEASURE DESCRIPTION

The Centers for Medicare & Medicaid Services (CMS), through its Center for Medicare and Medicaid Innovation (The Innovation Center), respecified a quality measure to assess complications occurring for cancer patients receiving outpatient chemotherapy. This measure is intended for practices participating in the Enhancing Oncology Model (EOM).

Relevance to Value Based Care

To encourage quality improvement efforts to reduce potentially preventable inpatient hospital admissions and ED visits for beneficiaries. Evidence suggests that measurement of admissions and ED visits for patients receiving outpatient chemotherapy should encourage facilities to take steps to prevent and improve the management of side effects and complications from cancer treatment. To encourage a reduction in unplanned admissions and ED visits due to chemotherapy-related symptoms and complications, thereby reducing patient distress, ED crowding, and financial burden.

Numerator

The numerator/outcome definitions are the number of patients admitted at least once as an inpatient or seen in an ED within 30 days after a qualifying chemotherapy treatment in an outpatient setting for one of ten qualifying conditions. The ten conditions are anemia, dehydration, diarrhea, emesis, fever, nausea, neutropenia, pain, pneumonia, and sepsis, and must be in the primary discharge diagnosis position or as a secondary diagnosis with cancer as primary diagnosis. Outcomes are counted separately for the inpatient and ED categories; a patient can qualify for an outcome in either category, but not both. Patients who experience both an inpatient admission and an ED visit during the performance period are counted towards the inpatient admission outcome.

Denominator

The denominator is six-month patient-episodes for patients with a diagnosis of one of the following seven specific cancer types and receiving chemotherapy treatment. The seven cancer types are: breast cancer, chronic leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer, and small intestine/colorectal cancer.

Exclusion/Exceptions

Qualifying chemotherapy claims occurring less than 31 days before the end of the episode will not be considered as chemo events that could start a 30-day outcome assessment period.
Patients with CAR-T therapy at any point during the episode

This measure is claims-based reporting, each 6-month performance period.

Scoring

Up to 12 points

Risk Adjustment

Statistical model within a measure that accounts for how sick patients are so that providers can be fairly compared to each other, even if one provider takes care of patients who are sicker. The risk-adjustment model intends to “adjust for” factors so that differences in performance on the measure are due to quality of care rather than patient and provider characteristics. The goal of risk adjustment is to make the comparison of providers fairer and more meaningful.

RESOURCES