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PQRI - Summary of Upcoming Changes for 2009
Listed below are the changes to PQRI for 2009. There are a number of measures available for radiation oncologists. Those measures presented in bold are generally the most relevant to radiation oncologists. Unless otherwise indicated, all measures can be reported either via claims or through a CMS-approved registry. Regulations require that, beginning for 2009, CMS publish the names of physicians that satisfactorily submitted data on quality measures. The list will be published beginning in 2010. Please note that CMS has currently defined “satisfactorily submitted data” as those physicians that have submitted data and received a bonus. As it stands today, this definition omits those physicians that have attempted submission but have been unsuccessful either due to difficulties within the physicians practice or outside of the physician’s control. 2009 PQRI INDICATORS 1 (most relevant indicators are in bold) 2007 Measure 74: Invasive breast cancer patients who have
Deleted for 2009
undergone breast conserving surgery and who have received
recommendation for radiation therapy with 12 months of first
office visit
2007 Measure 71: ER or PR positive breast cancer patients with prescription for tamoxifen or aromatase inhibitor 2007 Measure 47: Advance Care Plan documented in medical record 2007 Measure 72: Stage III colon cancer patients receiving 2007 Measure 4: Patients aged 65 years or older with a history of fall risk that were screened for future fall risk 1 Indicator should be reviewed in-depth to be sure that CPT codes and ICD-9 code requirements have not changed. Detailed specifications for each measure can be found at cms.gov\PQRI 2007 Measure 46: Patients 65 years or older recently discharged from inpatient facility that had discharge medications reconciled with their outpatient medication list. Cannot report on this measure 2007 Measure 20*: Surgical patients with indications for prophylactic parenteral antibiotic who have an order for prophylactic antibiotic to be given prior to surgical incision 2007 Measure 21*: Surgical patients undergoing procedures with indications for first or second generation cephalosporin who have 2007 Measure 22*: Non-cardiac surgical patients undergoing procedure with indications for prophylactic antibiotics and who 2007 Measure 30: Surgical patient with an order for a parenteral antibiotic to be given within specified time frame and 2008 Measure 99: Breast cancer patients who have a pT and pN category and histologic grade for their cancer 2008 Measure 100: Colorectal cancer patients who have a pT and pN category and histologic grade for their cancer 2008 Measure 101: Appropriate initial evaluation of patients with 2008 Measure 102: Inappropriate use of bone scan for staging
Continued for
low risk prostate cancer patients
2008 Measure 103: Review of treatment options in patients with 2008 Measure 104: Adjuvant hormonal therapy for high-risk
Continued for
prostate cancer patients
* This indicator is part of a measures group. Detailed requirements of measure groups should be reviewed before selecting this indicator. 2008 Measure 105: Three dimensional radiotherapy or IMRT
for patients with prostate cancer
2008 Measure 124: Health information technology adoptions /
use of electronic health records
2008 Measure 125: Adoption / use of e-prescribing 2 2009 Measure 131: Pain Assessment Prior to Initiation of Patient 2009 Measure 143: Patient visits with a diagnosis of cancer
New for 2009
currently receiving chemotherapy or radiation therapy in which
pain intensity in quantified.
2009 Measure 144: Percentage of patient visits with a diagnosis
New for 2009
of cancer current receiving chemotherapy or radiation therapy
who report having pain with a documented plan of care to
address pain.
2009 Measure 154: Patients aged 65 or older with a history of falls New for 2009
who had a risk assessment for falls completed within 12 months 2009 Measure 155: Patients age 65 or older with a history of falls New for 2009
that had a plan of care for falls documented within 12 months. 2009 Measure 156: Patients with a diagnosis of pancreatic or
New for 2009
lung cancer receiving 3D conformal radiation therapy with
documentation in medical record that radiation dose limits to
normal tissues were established prior to initiation of a course of
3D conformal radiation for a minimum of two tissues 3
2 The eRX measure may be applicable to radiation oncologists practicing in a hospital setting or other entity that does not bill for radiation therapy treatment. For those physicians practicing in a freestanding center that also bills for radiation therapy, it is less likely that the physician will meet the CMS threshold of having 10% or more of their Medicare allowed charges consist of standard evaluation and management codes. For those physicians that believe this measure might be applicable to their practice the detailed measure specifications should be reviewed, including whether (a) more than 10% of Medicare allowable charges are for standard evaluation and management services; and (b) whether the eRX system used by the physician meets CMS standards. 3 This last measure was put forth by ACRO during its participation in The Oncology Work Group, sponsored by the PCPI. CMS has expanded its use of measure groups which now encompass care for patients in the following clinical areas: diabetes, chronic kidney disease, preventive care, CABG surgery, coronary artery disease, rheumatoid arthritis, HIV/AIDS, perioperative care and back pain. At this time, there are no measure groups that are directly related to radiation oncology. There are unique reporting options open to those using measure groups, including the option to report on the first 30 consecutive patients qualifying for a given measure group. If you believe one of the above measure groups may apply to your practice, further information can be obtained at cms.gov/PQRI.

Source: http://www.acro.org/washington/PQRIChanges.pdf