Bone density evaluation for patients with prostate cancer and receiving androgen deprivation therapy

Measure Information	2022 Performance Period
CMS Measure ID	CMS645v5
NQF Number	Not Applicable
Measure Description	Patients determined as having prostate cancer who are currently starting or undergoing androgen deprivation therapy (ADT), for an anticipated period of 12 months or greater and who receive an initial bone density evaluation. The bone density evaluation must be prior to the start of ADT or within 3 months of the start of ADT.
Initial Population	Male patients with a qualifying encounter in the measurement period AND with a diagnosis of prostate cancer AND with an order for ADT or an active medication of ADT with an intent for treatment greater than or equal to 12 months during the measurement period
Denominator Statement	Equals Initial Population
Denominator Exclusions	None
Numerator Statement	Patients with a bone density evaluation within the two years prior to the start of or less than three months after the start of ADT treatment
Numerator Exclusions	Not Applicable
Denominator Exceptions	Patient refused recommendation for a bone density evaluation after the start of ADT therapy
Measure Steward	Oregon Urology
Quality Domain	Effective Clinical Care
Measure Scoring	Proportion measure
Measure Type	Process measure
Improvement Notation	A higher score indicates better quality
Guidance	In order to capture the practitioner's intent of androgen deprivation therapy (ADT) for a period of 12 months or greater, SNOMEDCT 456381000124102 which is Injection of leuprolide acetate for twelve month period (regime/therapy) is the correct code. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
MIPS Quality ID	462
Meaningful Measure	Management of Chronic Conditions
Telehealth Eligible	Yes
Next Version	CMS645v6
Previous Version	CMS645v4

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Measure Information	2021 Performance Period	2022 Performance Period	2023 Performance Period
CMS Measure ID	CMS645v4	CMS645v5	CMS645v6
NQF Number	Not Applicable	Not Applicable	Not Applicable
Measure Description	Patients determined as having prostate cancer who are currently starting or undergoing androgen deprivation therapy (ADT), for an anticipated period of 12 months or greater and who receive an initial bone density evaluation. The bone density evaluation must be prior to the start of ADT or within 3 months of the start of ADT.	Patients determined as having prostate cancer who are currently starting or undergoing androgen deprivation therapy (ADT), for an anticipated period of 12 months or greater and who receive an initial bone density evaluation. The bone density evaluation must be prior to the start of ADT or within 3 months of the start of ADT.	Patients determined as having prostate cancer who are currently starting or undergoing androgen deprivation therapy (ADT), for an anticipated period of 12 months or greater and who receive an initial bone density evaluation. The bone density evaluation must be prior to the start of ADT or within 3 months of the start of ADT.
Initial Population	Male patients with a qualifying encounter in the measurement period AND with a diagnosis of prostate cancer AND with an order for ADT or an active medication of ADT with an intent for treatment greater than or equal to 12 months during the measurement period	Male patients with a qualifying encounter in the measurement period AND with a diagnosis of prostate cancer AND with an order for ADT or an active medication of ADT with an intent for treatment greater than or equal to 12 months during the measurement period	Male patients with a qualifying encounter in the measurement period AND with a diagnosis of prostate cancer AND with an order for ADT or an active medication of ADT with an intent for treatment greater than or equal to 12 months during the measurement period
Denominator Statement	Equals Initial Population	Equals Initial Population	Equals Initial Population
Denominator Exclusions	None	None	None
Numerator Statement	Patients with a bone density evaluation within the two years prior to the start of or less than three months after the start of ADT treatment	Patients with a bone density evaluation within the two years prior to the start of or less than three months after the start of ADT treatment	Patients with a bone density evaluation within the two years prior to the start of or less than three months after the start of ADT treatment
Numerator Exclusions	Not Applicable	Not Applicable	Not Applicable
Denominator Exceptions	Patient refused recommendation for a bone density evaluation after the start of ADT therapy	Patient refused recommendation for a bone density evaluation after the start of ADT therapy	Patient refused the bone density evaluation at the time ordered or did not have it performed within 3 months after the start of ADT
Measure Steward	Oregon Urology	Oregon Urology	Oregon Urology
Quality Domain	Effective Clinical Care	Effective Clinical Care	Effective Clinical Care
Measure Scoring	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process measure	Process measure	Process measure
Improvement Notation	A higher score indicates better quality	A higher score indicates better quality	A higher score indicates better quality
Guidance	In order to capture the practitioner's intent of androgen deprivation therapy (ADT) for a period of 12 months or greater, SNOMEDCT 456381000124102 which is Injection of leuprolide acetate for twelve month period (regime/therapy) is the correct code. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.	In order to capture the practitioner's intent of androgen deprivation therapy (ADT) for a period of 12 months or greater, SNOMEDCT 456381000124102 which is Injection of leuprolide acetate for twelve month period (regime/therapy) is the correct code. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.	In order to capture the practitioner's intent of androgen deprivation therapy (ADT) for a period of 12 months or greater, SNOMEDCT 456381000124102 which is Injection of leuprolide acetate for twelve month period (regime/therapy) is the correct code. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.
MIPS Quality ID	462	462	462
Meaningful Measure	Management of Chronic Conditions	Management of Chronic Conditions	Management of Chronic Conditions
Telehealth Eligible	Yes	Yes	Yes
Next Version	CMS645v5	CMS645v6	No Version Available
Previous Version	No Version Available	CMS645v4	CMS645v5

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Data Element Repository

Data Elements contained within CMS645v5

Value Sets

Value Sets to be used with CMS645v5

Release Notes

CMS645v5-TRN.xlsx

Header

Updated the eCQM version number.

Measure Section: eCQM Version Number

Source of Change: Standards Update
Updated copyright.

Measure Section: Copyright

Source of Change: Annual Update
Updated disclaimer.

Measure Section: Disclaimer

Source of Change: Standards Update

Logic

Added Androgen Deprivation Therapy for Urology Care Medication Order Start Dates definition, revised Androgen Deprivation Therapy for Urology Care Medication Active Start Dates definition and revised Androgen Deprivation Therapy Start Date definition, all referenced in the initial population and numerator, to account for addition of ordered medications to align with measure intent.

Measure Section: Initial Population

Source of Change: Measure Lead
Changed timing in the Androgen Deprivation Therapy Start Date definition from 'overlaps' the measurement period to 'before end of' the measurement period to meet measure intent.

Measure Section: Initial Population

Source of Change: Expert Work Group Review
Updated logic from 'on or before end of' prostate cancer prevalence period to 'during' prostate cancer prevalence period in the Androgen Deprivation Therapy Start Date definition as ADT must occur during the prostate cancer prevalence period, not before.

Measure Section: Initial Population

Source of Change: Measure Lead
Added Androgen Deprivation Therapy for Urology Care Medication Order Start Dates definition and revised Androgen Deprivation Therapy Start Date definition, referenced in the initial population and numerator, to account for ordered medications to align with measure intent.

Measure Section: Numerator

Source of Change: Measure Lead
Added Androgen Deprivation Therapy for Urology Care Medication Order Start Dates definition and revised Androgen Deprivation Therapy Start Date definition, referenced in the initial population and numerator, to account for ordered medications to align with measure intent.

Measure Section: Definitions

Source of Change: Measure Lead
Added Androgen Deprivation Therapy for Urology Care Medication Order Start Dates definition and revised the Androgen Deprivation Therapy Start Date definition to include orders for medication.

Measure Section: Definitions

Source of Change: Logic Review
Updated logic from 'starts on or before end' of prostate cancer prevalence period to 'during' prostate cancer prevalence period in the Androgen Deprivation Therapy Start Date definition as ADT must occur during the prostate cancer prevalence period, not before.

Measure Section: Definitions

Source of Change: Measure Lead
Updated the names of Clinical Quality Language (CQL) definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

Measure Section: Multiple Sections

Source of Change: Standards Update
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-6.2.000). Updated the 'Inpatient Encounter' definition to include a 'day of' timing clarification. Added the following timing functions: Normalize Interval, Has Start, Has End, Latest, Latest Of, Earliest, and Earliest Of. Please see individual measure details for application of specific timing functions.

Measure Section: Multiple Sections

Source of Change: Standards Update
Added new NormalizeInterval function to timing attributes to decrease implementation burden due to variable use of timing attributes for select QDM data types. The NormalizeInterval function was applied, where applicable, for the following data elements: Assessment, Performed; Device, Applied; Diagnostic Study, Performed; Intervention, Performed; Laboratory Test, Performed; Medication, Administered; Medication, Dispensed; Physical Exam, Performed; Procedure, Performed; Substance, Administered.

Measure Section: Multiple Sections

Source of Change: Standards Update

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

Value set Androgen deprivation therapy for Urology Care (2.16.840.1.113762.1.4.1151.48): Added 1 RxNorm code (314008) based on terminology update. Deleted 1 RxNorm code (571914) based on terminology update.

Measure Section: Terminology

Source of Change: Annual Update