The Admission and Emergency Department (ED) Visits for Patients Receiving Outpatient Chemotherapy Measure, hereafter referred to as the chemotherapy measure, estimates hospital-level, risk-adjusted rates of inpatient admissions or ED visits for cancer patients =18 years of age for at least one of the following diagnoses—anemia, dehydration, diarrhea, emesis, fever, nausea, neutropenia, pain, pneumonia, or sepsis—within 30 days of hospital-based outpatient chemotherapy treatment. Rates of admission and ED visits are calculated and reported separately.
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1.5 Measure Type1.7 Electronic Clinical Quality Measure (eCQM)1.8 Level Of Analysis1.20 Testing Data Sources
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1.14 Numerator
This measure involves calculating two mutually exclusive outcomes among cancer patients receiving chemotherapy treatment in a hospital outpatient setting: (1) one or more inpatient admissions for any of the following 10 diagnoses—anemia, dehydration, diarrhea, emesis, fever, nausea, neutropenia, pain, pneumonia, or sepsis—within 30 days of chemotherapy treatment or (2) one or more ED visits for any of the following 10 diagnoses—anemia, dehydration, diarrhea, emesis, fever, nausea, neutropenia, pain, pneumonia, or sepsis—within 30 days of chemotherapy treatment. These 10 conditions are potentially preventable through appropriately managed outpatient care. To be counted as an outcome, the qualifying diagnosis on the admission or ED visit claim must be (1) the principal diagnosis or (2) a secondary diagnosis accompanied by a principal diagnosis of cancer.
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1.15 Denominator
The measure cohort includes Medicare Fee-for-Service (FFS) patients, aged 18 years and older at the start of the performance period, with a diagnosis of any cancer (except leukemia), who received at least one outpatient chemotherapy treatment at the reporting hospital during the performance period.
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Exclusions
The measure excludes the following patients from the cohort:
1) Patients with a diagnosis of leukemia at any time during the performance period.
2) Patients who were not enrolled in Medicare FFS Parts A and B in the year prior to the any outpatient chemotherapy treatment during the performance period.
3) Patients who were not enrolled in Medicare FFS Parts A and B for the 30 days following any chemotherapy treatment.
4) Cases in which patients receive chemotherapy to treat conditions other than cancer. Note that this is a case-level exclusion; as long as the patient has additional cases that meet inclusion criteria, they will remain in the cohort.
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OLD 1.12 MAT output not attachedAttached1.13a Data dictionary not attachedNo
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Most Recent Endorsement ActivityAll-Cause Admissions and Readmissions Fall 2022Initial EndorsementLast Updated
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StewardCenters for Medicare & Medicaid ServicesSteward Organization POC EmailSteward Organization Copyright
Not applicable.
Measure Developer Secondary Point Of Contact Email
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Risk AdjustmentRisk adjustment approachOffRisk adjustment approachOffConceptual model for risk adjustmentOffConceptual model for risk adjustmentOff
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6.1.2 Current or Planned Use(s)6.1.3 Current Use(s)
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Effective March 27, 2023, the National Quality Forum (NQF) is no longer the consensus-based entity (CBE) funded through the Centers for Medicare & Medicaid Services (CMS) National Consensus Development and Strategic Planning for Health Care Quality Measurement Contract. Battelle has been selected to oversee the endorsement & maintenance (E&M) of clinical quality and cost/resource use measures. Since the Fall 2022 cycle launched at NQF, measures submitted to this E&M cycle continued along the prior E&M protocols that were in place at time of the Fall 2022 “Intent to Submit.” Battelle took over the E&M work for the Fall 2022 cycle after developers and/or stewards submitted their full measure information to NQF, which for CBE #3490, the most recent measure specifications can be found here: https://p4qm.org/sites/default/files/2024-02/3490.zip
Battelle took over the E&M work beginning with the public comment period to close the E&M committees for the post-comment meeting, convening the CSAC to render a final endorsement decision, and executing the appeals period.