MIPS #PIMSH 20: Appropriate Antiemetic Therapy for High- and Moderate-Emetic-Risk Antineoplastic Agents

• Numerator Criteria 1: Patients who are administered prior to treatment a four-drug combination of a neurokinin 1 (NK1) receptor antagonist, a serotonin (5-HT3) receptor antagonist, dexamethasone, and olanzapine

• Numerator Criteria 2: Patients who are administered prior to treatment a two-drug combination of a 5-HT3 receptor antagonist, and 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.

Note: ASCO acknowledges that all practices may encounter a scenario in which an antineoplastic intended to be given on C1D1 is held. In this scenario, it is possible for prophylactic antiemetic treatment to be considered inappropriate if the intended antineoplastic is ultimately not administered. The technical expert panel expects these scenarios to be consistent across practice types and settings, and unlikely to substantially impact performance scores.

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 Criteria 1: Patients who receive their first ever high-emetic-risk intravenous or both intravenous and oral antineoplastic agents during cycle 1 of any chemotherapy regimen

• Denominator Criteria 2: Patients who receive their first ever moderate-emetic-risk intravenous or both intravenous and oral antineoplastic agents during cycle 1 of any 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 Exception Criteria 1:

• Patient allergy or intolerance to neurokinin 1 (NK1) receptor antagonist, serotonin (5-HT3) receptor antagonist, dexamethasone, or olanzapine.

• Patients whose antineoplastic regimen includes prednisone

Denominator Exception Criteria 2:

• Patient allergy or intolerance to 5-HT3 receptor antagonist, or dexamethasone.

• Patients whose antineoplastic regimen includes prednisone.

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 their first ever high-emetic-risk intravenous antineoplastic agents during cycle 1 of any chemotherapy regimen and are administered prior to treatment a four-drug combination of a neurokinin 1 (NK1) receptor antagonist, a serotonin (5-HT3) receptor antagonist, dexamethasone, and olanzapine

• Population 2: Patients who receive their first ever moderate-emetic-risk intravenous antineoplastic agents during cycle 1 of any chemotherapy regimen and are administered prior to treatment a two-drug combination of a 5-HT3 receptor antagonist, and 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 Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)]