Oncology: Medical and Radiation - Pain Intensity Quantified

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Measure Information	2023 Performance Period	2024 Performance Period	2025 Performance Period
Title	Oncology: Medical and Radiation - Pain Intensity Quantified	Oncology: Medical and Radiation - Pain Intensity Quantified	Oncology: Medical and Radiation - Pain Intensity Quantified
CMS eCQM ID	CMS157v11	CMS157v12	CMS157v13
CBE ID*	0384e	0384e	0384e
MIPS Quality ID	143	143	143
Measure Steward	American Society of Clinical Oncology	American Society of Clinical Oncology	American Society of Clinical Oncology
Description	Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified	Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified	Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified
Measure Scoring	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process	Process	Process
Stratification	*See CMS157v11.html	None	None
Risk Adjustment	*See CMS157v11.html	None	None
Rationale	*See CMS157v11.html	An estimated 1,806,590 new cases of cancer were projected to be diagnosed in the US in 2020 (NIH, 2020). Pain is a commonly occurring symptom for cancer patients as 30% to 50% (510,000 to 850,000 each year based on current statistics) will experience moderate to severe pain (Wiffen, Wee,... Derry, Bell, & Moore, 2017). Initial and ongoing pain assessments are essential to determine the pathophysiology of pain and ensure proper pain management. According to the National Comprehensive Cancer Network (NCCN, 2022), undertreatment of pain remains a problem among a significant subset of cancer patients, survival is linked with symptom control and pain management, and pain management contributes to broad quality of life improvement. Furthermore, NCCN notes that formal pain reevaluation is required at each contact to ensure fulfilment of patient goals around comfort, function, and safety. Cancer patients have reported that pain interferes with their mood, work, relationships with other people, sleep and overall enjoyment of life (Moryl et al., 2018). To maximize patient outcomes, pain management is an essential part of oncologic management (NCCN, 2022). A recent analysis of registry data for chronic pain cancer patients found average pain intensity reported as mild (24.6% of patients), moderate (41.5%), and severe (33.9%). The study also indicated that patient report of pain relief is inversely related to the average pain intensity reported (Moryl et al., 2018). These data suggest that assessing and managing a cancer patient’s pain is critical and there remains significant room for improvement in assessing and mitigating cancer-related pain. A prospective study of changes in pain severity of cancer patients found that, at initial assessment, 47% of patients reported pain. At follow-up, the patients with pain at initial assessment reported reduced pain (32.2%), stable pain (48.2%) and worse pain (19.6%). Of the 53% of patients reporting no pain at initial assessment, 82.6% reported stable pain and 17.4% reported worse pain at follow-up assessment (Zhao et al., 2014). This study highlights the importance of initial and ongoing assessments of pain to identify gaps and ensure proper pain management. Show more > An estimated 1,806,590 new cases of cancer were projected to be diagnosed in the US in 2020 (NIH, 2020). Pain is a commonly occurring symptom for cancer patients as 30% to 50% (510,000 to 850,000 each year based on current statistics) will experience moderate to severe pain (Wiffen, Wee, Derry, Bell, & Moore, 2017). Initial and ongoing pain assessments are essential to determine the pathophysiology of pain and ensure proper pain management. According to the National Comprehensive Cancer Network (NCCN, 2022), undertreatment of pain remains a problem among a significant subset of cancer patients, survival is linked with symptom control and pain management, and pain management contributes to broad quality of life improvement. Furthermore, NCCN notes that formal pain reevaluation is required at each contact to ensure fulfilment of patient goals around comfort, function, and safety. Cancer patients have reported that pain interferes with their mood, work, relationships with other people, sleep and overall enjoyment of life (Moryl et al., 2018). To maximize patient outcomes, pain management is an essential part of oncologic management (NCCN, 2022). A recent analysis of registry data for chronic pain cancer patients found average pain intensity reported as mild (24.6% of patients), moderate (41.5%), and severe (33.9%). The study also indicated that patient report of pain relief is inversely related to the average pain intensity reported (Moryl et al., 2018). These data suggest that assessing and managing a cancer patient’s pain is critical and there remains significant room for improvement in assessing and mitigating cancer-related pain. A prospective study of changes in pain severity of cancer patients found that, at initial assessment, 47% of patients reported pain. At follow-up, the patients with pain at initial assessment reported reduced pain (32.2%), stable pain (48.2%) and worse pain (19.6%). Of the 53% of patients reporting no pain at initial assessment, 82.6% reported stable pain and 17.4% reported worse pain at follow-up assessment (Zhao et al., 2014). This study highlights the importance of initial and ongoing assessments of pain to identify gaps and ensure proper pain management. Show less	Pain is a commonly occurring symptom for cancer patients as 30% to 50% (510,000 to 850,000 each year based on current statistics) will experience moderate to severe pain (Wiffen, Wee, Derry, Bell, & Moore, 2017). Initial and ongoing pain assessments are essential to determine the... pathophysiology of pain and ensure proper pain management. According to the National Comprehensive Cancer Network (NCCN, 2023), undertreatment of pain remains a problem among a significant subset of cancer patients, survival is linked with symptom control and pain management, and pain management contributes to broad quality of life improvement. Furthermore, NCCN notes that formal pain reevaluation is required at each contact to ensure fulfilment of patient goals around comfort, function, and safety. Cancer patients have reported that pain interferes with their mood, work, relationships with other people, sleep and overall enjoyment of life (Moryl et al., 2018). To maximize patient outcomes, pain management is an essential part of oncologic management (NCCN, 2023). A recent analysis of registry data for chronic pain cancer patients found average pain intensity reported as mild (24.6% of patients), moderate (41.5%), and severe (33.9%). The study also indicated that patient report of pain relief is inversely related to the average pain intensity reported (Moryl et al., 2018). These data suggest that assessing and managing a cancer patient’s pain is critical and there remains significant room for improvement in assessing and mitigating cancer-related pain. A prospective study of changes in pain severity of cancer patients found that, at initial assessment, 47% of patients reported pain. At follow-up, the patients with pain at initial assessment reported reduced pain (32.2%), stable pain (48.2%) and worse pain (19.6%). Of the 53% of patients reporting no pain at initial assessment, 82.6% reported stable pain and 17.4% reported worse pain at follow-up assessment (Zhao et al., 2014). This study highlights the importance of initial and ongoing assessments of pain to identify gaps and ensure proper pain management. Show more > Pain is a commonly occurring symptom for cancer patients as 30% to 50% (510,000 to 850,000 each year based on current statistics) will experience moderate to severe pain (Wiffen, Wee, Derry, Bell, & Moore, 2017). Initial and ongoing pain assessments are essential to determine the pathophysiology of pain and ensure proper pain management. According to the National Comprehensive Cancer Network (NCCN, 2023), undertreatment of pain remains a problem among a significant subset of cancer patients, survival is linked with symptom control and pain management, and pain management contributes to broad quality of life improvement. Furthermore, NCCN notes that formal pain reevaluation is required at each contact to ensure fulfilment of patient goals around comfort, function, and safety. Cancer patients have reported that pain interferes with their mood, work, relationships with other people, sleep and overall enjoyment of life (Moryl et al., 2018). To maximize patient outcomes, pain management is an essential part of oncologic management (NCCN, 2023). A recent analysis of registry data for chronic pain cancer patients found average pain intensity reported as mild (24.6% of patients), moderate (41.5%), and severe (33.9%). The study also indicated that patient report of pain relief is inversely related to the average pain intensity reported (Moryl et al., 2018). These data suggest that assessing and managing a cancer patient’s pain is critical and there remains significant room for improvement in assessing and mitigating cancer-related pain. A prospective study of changes in pain severity of cancer patients found that, at initial assessment, 47% of patients reported pain. At follow-up, the patients with pain at initial assessment reported reduced pain (32.2%), stable pain (48.2%) and worse pain (19.6%). Of the 53% of patients reporting no pain at initial assessment, 82.6% reported stable pain and 17.4% reported worse pain at follow-up assessment (Zhao et al., 2014). This study highlights the importance of initial and ongoing assessments of pain to identify gaps and ensure proper pain management. Show less
Clinical Recommendation Statement	*See CMS157v11.html	-Screen all patients for pain at each contact. -Routinely quantify and document pain intensity and quality as characterized by the patient (whenever possible). Include patient reporting of breakthrough pain, treatments used and their impact on pain, satisfaction with pain relief, pain... interference, provider assessment of impact on function, and any special issues for the patient relevant to pain treatment. If necessary, get additional information from caregiver regarding pain and impact on function. -Perform comprehensive pain assessment if new or worsening pain is present and regularly for persisting pain. Various methods and tools exist to assess pain severity. Intensity of pain should be quantified using a numerical rating scale (i.e., 0-10), visual analog scale, categorical scale, or pictorial scale (e.g., The Faces Pain Rating Scale) (Category 2A) (National Comprehensive Cancer Network, 2022). Show more > -Screen all patients for pain at each contact. -Routinely quantify and document pain intensity and quality as characterized by the patient (whenever possible). Include patient reporting of breakthrough pain, treatments used and their impact on pain, satisfaction with pain relief, pain interference, provider assessment of impact on function, and any special issues for the patient relevant to pain treatment. If necessary, get additional information from caregiver regarding pain and impact on function. -Perform comprehensive pain assessment if new or worsening pain is present and regularly for persisting pain. Various methods and tools exist to assess pain severity. Intensity of pain should be quantified using a numerical rating scale (i.e., 0-10), visual analog scale, categorical scale, or pictorial scale (e.g., The Faces Pain Rating Scale) (Category 2A) (National Comprehensive Cancer Network, 2022). Show less	-Screen all patients for pain at each contact. -Routinely quantify and document pain intensity and quality as characterized by the patient (whenever possible). Include patient reporting of breakthrough pain, treatments used and their impact on pain, satisfaction with pain relief, pain... interference, provider assessment of impact on function, and any special issues for the patient relevant to pain treatment. If necessary, get additional information from caregiver regarding pain and impact on function. -Perform comprehensive pain assessment if new or worsening pain is present and regularly for persisting pain. Various methods and tools exist to assess pain severity. Intensity of pain should be quantified using a numerical rating scale (i.e., 0-10), visual analog scale, categorical scale, or pictorial scale (e.g., The Faces Pain Rating Scale) (Category 2A) (National Comprehensive Cancer Network, 2023). Show more > -Screen all patients for pain at each contact. -Routinely quantify and document pain intensity and quality as characterized by the patient (whenever possible). Include patient reporting of breakthrough pain, treatments used and their impact on pain, satisfaction with pain relief, pain interference, provider assessment of impact on function, and any special issues for the patient relevant to pain treatment. If necessary, get additional information from caregiver regarding pain and impact on function. -Perform comprehensive pain assessment if new or worsening pain is present and regularly for persisting pain. Various methods and tools exist to assess pain severity. Intensity of pain should be quantified using a numerical rating scale (i.e., 0-10), visual analog scale, categorical scale, or pictorial scale (e.g., The Faces Pain Rating Scale) (Category 2A) (National Comprehensive Cancer Network, 2023). Show less
Improvement Notation	Higher score indicates better quality	Higher score indicates better quality	Higher score indicates better quality
Definition	*See CMS157v11.html	None	None
Guidance	This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients with a diagnosis of cancer who are also currently receiving chemotherapy or radiation therapy during the measurement period. For patients receiving radiation therapy, pain intensity should... be quantified at each radiation treatment management encounter where the patient and physician have a face-to-face or telehealth interaction. Due to the nature of some applicable coding related to radiation therapy (e.g., delivered in multiple fractions), the billing date for certain codes may or may not be the same as the face-to-face or telehealth encounter date. In this instance, for the reporting purposes of this measure, the billing date should be used to pull the appropriate patients into the initial population. It is expected, though, that the numerator criteria would be performed at the time of the actual face-to-face or telehealth encounter during the series of treatments. A lookback (retrospective) period of 7 days, including the billing date, may be used to identify the actual face-to-face or telehealth encounter, which is required to assess the numerator. Therefore, pain intensity should be quantified during the face-to-face or telehealth encounter occurring on the actual billing date or within the 6 days prior to the billing date. For patients receiving chemotherapy, pain intensity should be quantified at each face-to-face or telehealth encounter with the physician while the patient is currently receiving chemotherapy. For purposes of identifying eligible encounters, patients "currently receiving chemotherapy" refers to patients administered chemotherapy on the same day as the encounter or during the 30 days before the date of the encounter AND during the 30 days after the date of the encounter. Pain intensity should be quantified using a standard instrument, such as a 0-10 numerical rating scale, visual analog scale, a categorical scale, or pictorial scale. Examples include the Faces Pain Rating Scale and the Brief Pain Inventory (BPI). This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show more > This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients with a diagnosis of cancer who are also currently receiving chemotherapy or radiation therapy during the measurement period. For patients receiving radiation therapy, pain intensity should be quantified at each radiation treatment management encounter where the patient and physician have a face-to-face or telehealth interaction. Due to the nature of some applicable coding related to radiation therapy (e.g., delivered in multiple fractions), the billing date for certain codes may or may not be the same as the face-to-face or telehealth encounter date. In this instance, for the reporting purposes of this measure, the billing date should be used to pull the appropriate patients into the initial population. It is expected, though, that the numerator criteria would be performed at the time of the actual face-to-face or telehealth encounter during the series of treatments. A lookback (retrospective) period of 7 days, including the billing date, may be used to identify the actual face-to-face or telehealth encounter, which is required to assess the numerator. Therefore, pain intensity should be quantified during the face-to-face or telehealth encounter occurring on the actual billing date or within the 6 days prior to the billing date. For patients receiving chemotherapy, pain intensity should be quantified at each face-to-face or telehealth encounter with the physician while the patient is currently receiving chemotherapy. For purposes of identifying eligible encounters, patients "currently receiving chemotherapy" refers to patients administered chemotherapy on the same day as the encounter or during the 30 days before the date of the encounter AND during the 30 days after the date of the encounter. Pain intensity should be quantified using a standard instrument, such as a 0-10 numerical rating scale, visual analog scale, a categorical scale, or pictorial scale. Examples include the Faces Pain Rating Scale and the Brief Pain Inventory (BPI). This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less	This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients with a diagnosis of cancer who are also currently receiving chemotherapy or radiation therapy during the measurement period. For patients receiving radiation therapy, pain intensity should... be quantified at each radiation treatment management encounter where the patient and physician have a face-to-face or telehealth interaction. Due to the nature of some applicable coding related to radiation therapy (e.g., delivered in multiple fractions), the billing date for certain codes may or may not be the same as the face-to-face or telehealth encounter date. In this instance, for the reporting purposes of this measure, the billing date should be used to pull the appropriate patients into the initial population. It is expected, though, that the numerator criteria would be performed at the time of the actual face-to-face or telehealth encounter during the series of treatments. A lookback (retrospective) period of 7 days, including the billing date, may be used to identify the actual face-to-face or telehealth encounter, which is required to assess the numerator. Therefore, pain intensity should be quantified during the face-to-face or telehealth encounter occurring on the actual billing date or within the 6 days prior to the billing date. For patients receiving chemotherapy, pain intensity should be quantified at each face-to-face or telehealth encounter with the physician while the patient is currently receiving chemotherapy. For purposes of identifying eligible encounters, patients "currently receiving chemotherapy" refers to patients administered chemotherapy on the same day as the encounter or during the 30 days before the date of the encounter AND during the 30 days after the date of the encounter. Pain intensity should be quantified using a standard instrument, such as a 0-10 numerical rating scale, visual analog scale, a categorical scale, or pictorial scale. Examples include the Faces Pain Rating Scale and the Brief Pain Inventory (BPI). This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show more > This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients with a diagnosis of cancer who are also currently receiving chemotherapy or radiation therapy during the measurement period. For patients receiving radiation therapy, pain intensity should be quantified at each radiation treatment management encounter where the patient and physician have a face-to-face or telehealth interaction. Due to the nature of some applicable coding related to radiation therapy (e.g., delivered in multiple fractions), the billing date for certain codes may or may not be the same as the face-to-face or telehealth encounter date. In this instance, for the reporting purposes of this measure, the billing date should be used to pull the appropriate patients into the initial population. It is expected, though, that the numerator criteria would be performed at the time of the actual face-to-face or telehealth encounter during the series of treatments. A lookback (retrospective) period of 7 days, including the billing date, may be used to identify the actual face-to-face or telehealth encounter, which is required to assess the numerator. Therefore, pain intensity should be quantified during the face-to-face or telehealth encounter occurring on the actual billing date or within the 6 days prior to the billing date. For patients receiving chemotherapy, pain intensity should be quantified at each face-to-face or telehealth encounter with the physician while the patient is currently receiving chemotherapy. For purposes of identifying eligible encounters, patients "currently receiving chemotherapy" refers to patients administered chemotherapy on the same day as the encounter or during the 30 days before the date of the encounter AND during the 30 days after the date of the encounter. Pain intensity should be quantified using a standard instrument, such as a 0-10 numerical rating scale, visual analog scale, a categorical scale, or pictorial scale. Examples include the Faces Pain Rating Scale and the Brief Pain Inventory (BPI). This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less	This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients with a diagnosis of cancer who are also currently receiving chemotherapy or radiation therapy during the measurement period. For patients receiving radiation therapy, pain intensity should... be quantified at each radiation treatment management encounter where the patient and physician have a face-to-face or telehealth interaction. Due to the nature of some applicable coding related to radiation therapy (e.g., delivered in multiple fractions), the billing date for certain codes may or may not be the same as the face-to-face or telehealth encounter date. In this instance, for the reporting purposes of this measure, the billing date should be used to pull the appropriate patients into the initial population. It is expected, though, that the numerator criteria would be performed at the time of the actual face-to-face or telehealth encounter during the series of treatments. A lookback (retrospective) period of 7 days, including the billing date, may be used to identify the actual face-to-face or telehealth encounter, which is required to assess the numerator. Therefore, pain intensity should be quantified during the face-to-face or telehealth encounter occurring on the actual billing date or within the 6 days prior to the billing date. For patients receiving chemotherapy, pain intensity should be quantified at each face-to-face or telehealth encounter with the physician while the patient is currently receiving chemotherapy. For purposes of identifying eligible encounters, patients "currently receiving chemotherapy" refers to patients administered chemotherapy on the same day as the encounter or during the 30 days before the date of the encounter AND during the 30 days after the date of the encounter. Pain intensity should be quantified using a standard instrument, such as a 0-10 numerical rating scale, visual analog scale, a categorical scale, or pictorial scale. Examples include the Faces Pain Rating Scale and the Brief Pain Inventory (BPI). This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show more > This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients with a diagnosis of cancer who are also currently receiving chemotherapy or radiation therapy during the measurement period. For patients receiving radiation therapy, pain intensity should be quantified at each radiation treatment management encounter where the patient and physician have a face-to-face or telehealth interaction. Due to the nature of some applicable coding related to radiation therapy (e.g., delivered in multiple fractions), the billing date for certain codes may or may not be the same as the face-to-face or telehealth encounter date. In this instance, for the reporting purposes of this measure, the billing date should be used to pull the appropriate patients into the initial population. It is expected, though, that the numerator criteria would be performed at the time of the actual face-to-face or telehealth encounter during the series of treatments. A lookback (retrospective) period of 7 days, including the billing date, may be used to identify the actual face-to-face or telehealth encounter, which is required to assess the numerator. Therefore, pain intensity should be quantified during the face-to-face or telehealth encounter occurring on the actual billing date or within the 6 days prior to the billing date. For patients receiving chemotherapy, pain intensity should be quantified at each face-to-face or telehealth encounter with the physician while the patient is currently receiving chemotherapy. For purposes of identifying eligible encounters, patients "currently receiving chemotherapy" refers to patients administered chemotherapy on the same day as the encounter or during the 30 days before the date of the encounter AND during the 30 days after the date of the encounter. Pain intensity should be quantified using a standard instrument, such as a 0-10 numerical rating scale, visual analog scale, a categorical scale, or pictorial scale. Examples include the Faces Pain Rating Scale and the Brief Pain Inventory (BPI). This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less
Initial Population	All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy	All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy	Population 1: All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy Population 2: All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving radiation therapy
Denominator	Equals Initial Population	Equals Initial Population	Equals Initial Population
Denominator Exclusions	None	None	None
Numerator	Patient visits in which pain intensity is quantified	Patient visits in which pain intensity is quantified	Patient visits in which pain intensity is quantified
Numerator Exclusions	Not Applicable	Not Applicable	Not Applicable
Denominator Exceptions	None	None	None
Telehealth Eligible	Yes	Yes	Yes
Next Version	CMS157v12	CMS157v13	No Version Available
Previous Version	No Version Available	CMS157v11	CMS157v12

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CMS157v12-TRN.xlsx

Header

Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
Updated disclaimer.
Measure Section: Disclaimer
Source of Change: Annual Update
Updated the rationale to align with current evidence.
Measure Section: Rationale
Source of Change: Measure Lead
Updated the clinical recommendation statement to align with current evidence.
Measure Section: Clinical Recommendation Statement
Source of Change: Measure Lead
Updated references.
Measure Section: Reference
Source of Change: Measure Lead

Logic

Updated the timing precision in numerator 2 definition by adding 'day of' to align with measure intent.
Measure Section: Numerator
Source of Change: Measure Lead

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 Cancer (2.16.840.1.113883.3.526.3.1010): Added 4 SNOMED CT codes (1217301006, 1179762006, 827186009, 871843002) based on review by technical experts, SMEs, and/or public feedback. Deleted 11 SNOMED CT codes (399994005, 400055004, 238864005, 238865006, 254146000, 400129003, 400153009, 403409009, 403410004, 403411000, 725049005) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Payer (2.16.840.1.114222.4.11.3591): Added 5 SOP codes (1111, 1112, 142, 344, 141) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead