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: CMS140v4
Version: 4
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 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 I (T1b)-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
Previous Version: Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
Measure Score: Proportion
Improvement Notation:

Higher score indicates better quality

Guidance:

For the eCQM version of this measure, the initial 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

Release Notes

Header

  • Clinical Recommendation Statement updated.
  • Copyright updated.
  • Disclaimer updated.
  • eMeasure version number incremented.
  • References updated.

Logic

  • Changed data type of 'result' or 'finding' to 'performed'.
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced 'Intersection' clause to build clause logic.
  • Introduced occurrencing on variables to enforce that the same instance of a clinical event is used throughout the measure when the logic within the variable does not limit the event to a single instance, e.g., FIRST or MOST RECENT.
  • Introduced the new timing operator 'overlaps' to replace two lines of logic (AND/AND NOT) or to enforce when an event or set of events occur to meet the measure intent.
  • Introduced variable $OVorF2FEncounter to allow re-use of logical expressions and reduce redundancy/complexity.
  • Replaced 'Measurement Start Date' and 'Measurement End Date' with 'Measurement Period' and as necessary replaced existing timing operator (e.g., replacing 'starts before start of' with 'starts before end of').
  • Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
  • Replaced 'starts before or during' (SBOD) with 'starts before end of' (SBE).
  • The top level logical operator for the Numerator Exclusions, Denominator Exclusions, Denominator Exceptions, and Measure Population Exclusions defaults to 'OR'.

Value Sets

  • Value set Patient Reason (OID 2.16.840.1.113883.3.526.3.1008): Deleted 1 SNOMED code (30164005).

External Resources