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

Last updated: May 4, 2017

CMS Measure ID: CMS140v3
Version: 3
NQF Number: 0387
Measure Description:

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

Initial Patient Population:

All female patients aged 18 years and older with a diagnosis of breast cancer

Denominator Statement:

Equals Initial Patient Population with stage IC through IIIC, estrogen receptor (ER) or progesterone receptor (PR) positive breast cancer

Denominator Exclusions:

None

Numerator Statement:

Patients who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting period

Numerator Exclusions:

Not Applicable

Denominator Exceptions:
  • Documentation of medical reason(s) for not prescribing tamoxifen or aromatase inhibitor (eg, patient’s disease has progressed to metastatic, patient is receiving a gonadotropin-releasing hormone analogue, patient has received oophorectomy, patient is receiving radiation or chemotherapy, patient’s diagnosis date is within 120 days of the end of the 12 month reporting period, other medical reason)
  • Documentation of patient reason(s) for not prescribing tamoxifen or aromatase inhibitor (eg, patient refusal, other patient reasons)
  • Documentation of system reason(s) for not prescribing tamoxifen or aromatase inhibitor (eg, patient is currently enrolled in a clinical trial, other system reasons)
Measure Steward: American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
Domain: Effective Clinical Care
Next Version: Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
Measure Score: Proportion
Score Type: Process
Improvement Notation:

Higher score indicates better quality

Guidance:

For the eCQM version of this measure, the initial patient population for this measure has been limited to patients with a first recorded breast cancer diagnosis within the past 5 years, as opposed to accounting for that patient population through the use of an exception (as is the case for claims implementation). The numerator captures patients who are prescribed adjuvant tamoxifen or AI, or received adjuvant tamoxifen or AI during the 12 month period. Date of breast cancer diagnosis is defined as date of pathologic diagnosis.

The requirement of Count >=2 of Encounter, Performed is to establish that the eligible professional has an existing relationship with the patient.

Specifications

External Resources