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Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

Last updated: November 15, 2018

CMS Measure ID: CMS129v8
Version: 8
NQF Number: 0389
Measure Description:

Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancer

Initial Patient Population:

All patients, regardless of age, with a diagnosis of prostate cancer

Denominator Statement:

Equals Initial Populationinfo-icon at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy

Denominator Exclusions:

None

Numerator Statement:

Patients who did not have a bone scan performed at any time since diagnosis of prostate cancer

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Documentation of reason(s) for performing a bone scan (including documented pain, salvage therapy, other medical reasons, bone scan ordered by someone other than reporting physician)

Measure Steward: PCPI(R) Foundation (PCPI[R])
Domain: Efficiency and Cost Reduction
Previous Version:
Improvement Notation:

Higher score indicates better quality

Guidance:

A higher score indicates appropriate treatment of patients with prostate cancer at low (or very low) risk of recurrence. Only patients with prostate cancer with low (or very low) risk of recurrence will be counted in the performance denominatorinfo-icon of this measure.

Quality ID: 102
Meaningful Measure: Appropriate Use of Healthcare

Specifications

Release Notes

Header

  • Updated Version Number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Added definition for bone scan to further clarify the intent of the data element per clinical experts' recommendation.

    Measure Section: Definition

    Source of Change: Expert Work Group Review

  • Updated risk strata definitions to align with guidelines.

    Measure Section: Definition

    Source of Change: Expert Work Group Review

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated Disclaimer.

    Measure Section: Disclaimer

    Source of Change: Measure Lead

  • Updated Clinical Recommendation Statement.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated Reference.

    Measure Section: Reference

    Source of Change: Measure Lead

Logic

  • Replaced LOINC single code value setsinfo-icon with direct reference codes. A direct reference code is a single concept code that is used to describe a clinical element directly within the logic. The use of direct reference codes replaces the need for single code value sets. Measures using other code systems in single value sets may optionally transition to direct reference codes.

    Measure Section: Denominatorinfo-icon

    Source of Change: Standards Update

  • Replaced SNOMEDCT single code value sets with direct reference codes. A direct reference code is a single concept code that is used to describe a clinical element directly within the logic. The use of direct reference codes replaces the need for single code value sets. Measures using other code systems in single value sets may optionally transition to direct reference codes.

    Measure Section: Denominator

    Source of Change: Standards Update

  • Added supplemental timing attributes to most datatypes in QDMinfo-icon 5.3 to facilitate accurate retrieval of time related information within CQLinfo-icon logic. Timing attributes now include a time interval, such as prevalence period or relevant period, and/or actual time of documentation with Author Datetime. Relevant period is the general method to describe start and stop times for datatypes. Prevalence period is used for some datatypes to more accurately define onset and abatement times.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Assigned cardinality to each attribute to be more explicit in guiding specificationinfo-icon and implementation of QDM data elements. Cardinality refers to the number of instances of the attribute that can be included in the measure description. Cardinality for most attributes is 0.. 1 (i.e., can occur up to 1 time), but some attributes have a cardinality of 0.. * (i.e., can occur multiple times).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • CQL libraries contain sets of CQL definitions, or CQL expression statements. A context statement, patient or population, can now be used in a CQL library to clearly establish how the subsequent list of CQL expressions will be interpreted. A 'Population' context will interpret the CQL expression with reference to the entire population of the item being counted, patients or encounters. A 'Patient' context will interpret the CQL expression with reference to a single patient. Context statements are not required, but one or more context statements may be used within a library to help clarify how the CQL expressions will be interpreted. Patient context is the default if none is specified.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated measure logic from Quality Data Model (QDM)-based logic to Clinical Quality Language (CQL)-based logic. Information on CQL can be found at the eCQI Resource centerinfo-icon (https://ecqi.healthit.gov/cql). Information about specific versions of the new standards in use for CMS reporting periods can be found at the eCQI Resource Center (https://ecqi.healthit.gov/ecqm-tools-key-resources). Switching from QDM to CQL brings with it many changes, as well as enhanced expression capability, but only those changes with significant impact will be outlined in technical release notes. For example, in the case of timing operators, changes may only be summarized if those changes impact the measure calculation.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Setinfo-icon

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

  • Value set Bone Scan (2.16.840.1.113883.3.526.3.320): Added 2 LOINC codes (81551-4, 81552-2).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 11 SOP codes (299, 32127, 32128, 391, 517, 524, 614, 621, 622, 623, 629) and deleted 3 SOP codes (63, 64, 69).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Replaced LOINC single code value sets with direct referenced codes. A direct referenced code is a single concept code that is used to describe a clinical element directly within the logic. The use of direct referenced codes replaces the need for single code value sets. Measures using other code systems in single value sets may optionally transition to direct referenced codes.

    Measure Section: QDM Data Elements

    Source of Change: Standards Update

  • Removed following single code value sets: Gleason Score (2.16.840.1.113883.3.526.3.397), Prostate Cancer Primary Tumor Size T1a (2.16.840.1.113883.3.526.3.1534), Prostate Cancer Primary Tumor Size T1b (2.16.840.1.113883.3.526.3.1535), Prostate Cancer Primary Tumor Size T1c (2.16.840.1.113883.3.526.3.1325), Prostate Cancer Primary Tumor Size T2a (2.16.840.1.113883.3.526.3.1326), Reason Documented (2.16.840.1.113883.3.526.3.1494).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Replaced SNOMEDCT single code value sets with direct referenced codes. A direct referenced code is a single concept code that is used to describe a clinical element directly within the logic. The use of direct referenced codes replaces the need for single code value sets. Measures using other code systems in single value sets may optionally transition to direct referenced codes.

    Measure Section: QDM Data Elements

    Source of Change: Standards Update

  • Value set Bone Scan (2.16.840.1.113883.3.526.3.320): Deleted 4 LOINC codes (39814-9, 39815-6, 39817-2, 39903-0).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Payer (2.16.840.1.114222.4.11.3591): Deleted 1 SOP code (24).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

External Resources