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

Compare Versions of: "Bone density evaluation for patients with prostate cancer and receiving androgen deprivation therapy"

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Measure Information 2022 Performance Period 2023 Performance Period 2024 Performance Period
Title Bone density evaluation for patients with prostate cancer and receiving androgen deprivation therapy Bone density evaluation for patients with prostate cancer and receiving androgen deprivation therapy Bone density evaluation for patients with prostate cancer and receiving androgen deprivation therapy
CMS eCQM ID CMS645v5 CMS645v6 CMS645v7
CBE ID Not Applicable Not Applicable Not Applicable
MIPS Quality ID 462 462 462
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.

Percentage of 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.

Definition *See CMS645v5.html *See CMS645v6.html

DEXA - Dual Energy X-ray Absorptiometry - A scan that measures the bone of the spine, hip or total body and measures bone mineral density. It is considered one of the most accurate measurements.

PDXA - Peripheral Dual Energy X-ray Absorptiometry - Bone mineral density measurement of the wrist, heel or finger.

First Androgen Deprivation Therapy - The first Androgen Deprivation Therapy (ADT) is measured as the first order or administration of ADT for an anticipated period of 12 months or greater to a patient with prostate cancer.

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

Numerator

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

Equals Initial Population

Equals Initial Population

Equals Initial Population

Denominator Exclusions

None

None

None

Denominator Exceptions

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

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
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 5.6. Please refer to the QDM page 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.

Telehealth Eligible Yes Yes Yes
Rationale *See CMS645v5.html *See CMS645v6.html

Androgen suppression as a treatment for prostate cancer can cause osteoporosis (Qaseem, 2008). Men undergoing prolonged androgen deprivation therapy (ADT) incur bone loss at a rate higher than menopausal women (Guise, 2007). In preserving bone health, the goal is to prevent or treat osteopenia/osteoporosis for the patient on ADT and to prevent or delay skeletal related events. The National Osteoporosis Foundation recommendations including a baseline assessment of bone density with a dual energy X-ray absorptiometry (DEXA) scan and daily calcium and Vitamin D supplementation (Watts, 2012). The DEXA scan is the gold standard for bone density screening. Men at risk for adverse bone consequences from chronic ADT do not always receive care according to evidence-based guidelines. These findings call for improved processes that standardize evidence-based practice including baseline and follow up bone density assessment (Watts, 2012).

Stratification *See CMS645v5.html *See CMS645v6.html

None

Risk Adjustment *See CMS645v5.html *See CMS645v6.html

None

Clinical Recommendation Statement *See CMS645v5.html *See CMS645v6.html

Bone density screening should be performed at the start of Androgen Deprivation Therapy (ADT) for prostate cancer. It should also be performed every 2 years for the patient with continued ADT or for patients with known osteoporosis. Current insurance practice is to possibly cover the cost of bone density screening if osteoporosis is known or if there is a high-risk drug. Some patients choose to delay bone density screening until after ADT is started and they therefore have insurance authorization due to the administration of a high-risk drug.

Next Version No Version Available
Previous Version No Version Available

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

Last Updated: Feb 13, 2024