MIPS #PIMSH 19: Antiemetic Therapy for Low- and Minimal-Emetic-Risk Antineoplastic Agents

• Numerator 1: Patients who are administered prior to treatment an NK1 receptor antagonist or olanzapine

• Numerator 2: Patients who are administered prior to treatment an NK1 receptor antagonist, 5-HT3 receptor antagonist, olanzapine, or dexamethasone

Numerator Guidance: For the purposes of the measure, the following antiemetics would meet the measure:

• Antiemetics administered on the same day as cycle 1 day 1 of the therapy OR

• Any new or refill prescription order of antiemetics on the same day as cycle 1 day 1 of the therapy or within 89 days prior to cycle 1 day 1 of the therapy OR

• Any record of antiemetics as active on the medication list within 90 days prior to cycle 1 day 1 of the therapy

Oral/IV combination regimen is when oral antineoplastic therapy is ordered as a component of a treatment regimen. Both oral and IV antineoplastic agents are ordered on the same day, and the IV agent determines the emetic risk of the oral/IV combination regimen.

Performance on this measure is intended to be attributed to the prescribing or attending provider and is not meant to reflect incident-to billing under non-physician providers (NPPs) who may be practicing in the infusion center during the patient's antineoplastic therapy.

• Denominator 1: Patients who receive low-emetic-risk intravenous or both intravenous and oral antineoplastic agents during cycle 1 of the patient's first chemotherapy regimen

•  Denominator 2: Patients who receive minimal-emetic risk intravenous or both intravenous and oral antineoplastic agents during cycle 1 of the patient's first chemotherapy regimen

Denominator Guidance: For multi-drug regimens, select antiemetic therapy based on the drug with the highest emetic risk. For guidance on determining emetic risk, please refer to the 2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting. Herrstedt, J. et al. ESMO Open, Volume 9, Issue 2, 102195.

 Denominator 1 Exceptions:

• Patients prescribed olanzapine as a PRN order

• Patients prescribed olanzapine for other indications

Denominator 2 Exceptions:

• Patients prescribed a 5-HT3 RA, dexamethasone, or olanzapine as a PRN order

• Patients prescribed olanzapine or dexamethasone for other indications

• Patients whose antineoplastic regimen includes dexamethasone

This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes:

• Population 1: Patients who receive low-emetic-risk intravenous antineoplastic agents during cycle 1 of the patient's first chemotherapy regimen and are administered prior to treatment an NK1 receptor antagonist or olanzapine

• Population 2: Patients who receive minimal-emetic-risk intravenous antineoplastic agents during cycle 1 of the patient's first chemotherapy regimen and are administered prior to treatment an NK1 receptor antagonist, 5-HT3 receptor antagonist, olanzapine, or dexamethasone

For the purposes of this measure, a single performance rate can be calculated as follows:

Performance Rate = (Numerator 1 + Numerator 2)/ (Denominator 1 + Denominator 2)