The 2008 Physician Quality Reporting Initiative (PQRI) program implemented by CMS encourages quality improvement through the use of clinical performance measures on a variety of clinical conditions. Physicians who successfully report on a designated set of quality measures through claims submitted for services provided from Jan 1, 2008 to Dec 31, 2008, may earn a bonus payment, subject to a cap of 1.5% of total allowed charges for covered Medicare physician fee schedule services.

To assist physicians who may elect to participate in this program, the AMA , in collaboration with the CMS, Mathematica Policy Research, Inc., and the National Committee for Quality Assurance has developed and recently published participation tools. The tools are designed to:

• Aid physicians wishing to participate in the program to identify measures relevant to their practice
• Facilitate the data collection required to report clinical performance data

The tools include:

• Measure Description
• Data Collection Work Sheet
• Coding Specifications

There are seven (7) measures applicable to Radiation Oncologist for reporting in 2008. The description of each measure is summarized below:

1. Measure 71: Hormonal Therapy for Stage IC-III ER/PR Positive Breast Cancer

DESCRIPTION:

Percentage of female patients aged 18 years and older with Stage IC through IIIC, estrogen receptor (ER) or progesterone receptor (PR) positive breast cancer who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting period

This measure is to be reported for all female patients aged 18 years and older with breast cancer - a minimum of once per reporting period.

2. Measure 74: Radiation Therapy Recommended for Invasive Breast Cancer Patient Who Have Undergone Breast Conserving Surgery

DESCRIPTION:

Percentage of invasive female breast cancer patients aged 18 through 70 years old who have undergone breast conserving surgery and who have received recommendation for radiation therapy within 12 months of the first office visit

This measure is to be reported a minimum once per reporting period for female breast cancer patients at the time of the initial office visit.

3. Measure 101: Appropriate Initial Evaluation of Patients with Prostate Cancer

DESCRIPTION:

Percentage of patients, regardless of age, with prostate cancer receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy with documented evaluation of prostate-specific antigen (PSA), AND primary tumor (T) stage, AND Gleason score prior to initiation of treatment.

This measure is to be reported a minimum of once per reporting period for patients with prostate cancer seen during the reporting period.

4. Measure 102: Inappropriate Use of Bone Scan for Staging Low-Risk Prostate Cancer Patients

DESCRIPTION:

Percentage of patients, regardless of age, with a diagnosis of prostate cancer at 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

This measure is to be reported each time a patient with prostate cancer receives interstitial prostate brachytherapy, external beam radiotherapy to the prostate, radical prostatectomy, or cryotherapy procedure during the reporting period.

5. Measure 103: Review of Treatment Options in Patients with Clinically Localized Prostate Cancer

DESCRIPTION:

Percentage of patients, regardless of age, with clinically localized prostate cancer AND receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who received counseling prior to initiation of treatment on, at a minimum, the following treatment options for clinically localized disease: active surveillance, AND interstitial prostate brachytherapy, AND external beam radiotherapy, AND radical prostatectomy

This measure is to be reported a minimum of once per reporting period for patients with prostate cancer receiving interstitial prostate brachytherapy, external beam radiotherapy to the prostate, radical prostatectomy, or cryotherapy procedure during the reporting period.

6. Measure 104: Adjuvant Hormonal Therapy for High-Risk Prostate Cancer Patients

DESCRIPTION:

Percentage of patients, regardless of age, with a diagnosis of prostate cancer at high risk of recurrence receiving external beam radiotherapy to the prostate who were prescribed adjuvant hormonal therapy (GnRH agonist or antagonist)

This measure is to be reported once per episode of radiation therapy for all patients with prostate cancer who receive external beam radiotherapy to the prostate during the reporting period. Claims data will be analyzed to determine unique episodes of radiation therapy.

7. Measure 105: Three-dimensional Radiotherapy for Patients with Prostate Cancer

DESCRIPTION:

Percentage of patients, regardless of age, with prostate cancer receiving external beam radiotherapy to the prostate only (no metastases) who receive 3D-CRT or IMRT

This measure is to be reported each time an external beam radiotherapy to the prostate procedure is performed during the reporting period for prostate cancer patients.

To further assist in reporting the above listed measures please find attached the complete measure descriptions, data worksheets and coding specifications.

In closing, please advise if you will be participating in the 2008 PQRI and as always any questions or concerns please do not hesitate.

Sincerely,

Mitzi Wilson
Vice President
1817 West Braker Lane
Building F, Suite 200
Austin, TX 78758
tel: 512.583.3042
fax: 512.583.2001
Cell: 727-808-9835
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