MIPS # PIMSH1 Advance Care Planning in Metastatic Cancer Patients

2025 measure specifications changes from 2024 highlighted below.

Coding changes and updates in Practice Insights are pending.

MEASURE DESCRIPTION

Percentage of patients with metastatic (stage 4) cancer who have a documented Advance Care Planning discussion in the first 6 months after metastatic diagnosis to inform treatment decisions and end-of-life care.

 Numerator

Patients who have had an advance care plan discussion with an advance care plan or surrogate decision maker documented in the medical record or documentation that an advance care plan was discussed but patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan within the first 6 months after their metastatic diagnosis.

 Numerator Note: If an existing Advance Care Plan exists, this must be reviewed with the patient during the 6-months proceeding a metastatic cancer diagnosis.

Services typically provided under CPT codes 99497 and 99498 satisfy the requirement of Advance Care Planning; however, utilizing these billing codes are not required for the purpose of this measure.

Denominator

All patients with stage 4 cancer diagnosed between July 1st of the previous performance period through June 30th of the current performance period and had an E/M visit within the measurement period.

 Exclusion

Hospice services received by the patient at any time during the measurement period.

Telehealth included: Yes

VBC Rational:

Patients engaged in meaningful discussions about their values and goals for care are better enabled to participate in shared decision-making events, especially when values include personal preferences for care at the end of life. ACP allows the patient to make decisions about end of life care, reducing unwanted treatments and to document their care plan wishes, in addition, possibly reducing total cost of care.

 Scoring

Up to 10 points

 RESOURCES

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