Form CMS-10431 Oncology Care Measures Paper Submission

PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program

Clinical Process/Oncology Care Measures

Paper Submission for FY2016 and Subsequent Years

(NQF 0382) Oncology: Radiation Dose Limits to Normal Tissues

Q1 Q2 Q3 Q4

Patients who had documentation in medical record that radiation dose limits to normal tissues were established prior to the initiation of a course of 3D conformal radiation for a minimum of two tissues

NUMERATOR

DENOMINATOR

All patients, regardless of age, with a diagnosis of pancreatic or lung cancer who receive 3D conformal radiation therapy

(NQF 0383) Oncology: Plan of Care for Pain – Medical Oncology and Radiation Oncology

Q1 Q2 Q3 Q4

NUMERATOR

Patient visits that included a documented plan of care to address pain.

Documented plan of care may include: use of opioids, nonopioids analgesics, psychological support, patient and/or family education, referral to a pain clinic, or reassessment of pain at an appropriate time interval

DENOMINATOR

All selected surgical patients with a catheter in place postoperatively

(NQF 0384) Oncology: Pain Intensity Quantified- Medical Oncology and Radiation Oncology

Q1 Q2 Q3 Q4

NUMERATOR

Patient visits in which pain intensity is quantified.

Pain intensity should be quantified using a standard instrument, such as a 0-10 numerical rating scale, a categorical scale, or the pictorial scale

All visits for patients, regardless of age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy

DENOMINATOR

(NQF 0389) Prostate Cancer: Avoidance of Overuse Measure- Bone Scan for Staging Low-Risk Patients

Q1 Q2 Q3 Q4

Patients who did not have a bone scan performed any time since diagnosis of prostate surgery

NUMERATOR

All patients, regardless of age, with a diagnosis of prostate cancer, at low risk of recurrence, receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy

DENOMINATOR

(NQF 0390) Prostate Cancer: Adjuvant Hormonal Therapy for High-Risk Patients

Q1 Q2 Q3 Q4

Patients who were prescribed adjuvant hormonal therapy (GnRH) [gonadotropin-releasing hormone] agonist or antagonist)

NUMERATOR

All patients, regardless of age, with a diagnosis of prostate cancer, at high risk of recurrence, receiving external beam radiotherapy to the prostate

DENOMINATOR

(*) indicates required for providers participating in the PPS-Exempt Cancer Hospital Quality Reporting Program.

* Facility Name:

* CEO Signature: *Date:

* CEO Email Address:

Complete and submit this form via email to: [email protected].

Following receipt of the request form, an email acknowledgement will be sent confirming the form has been received.

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