AQUA Registry 2019 Non-QPP Measure Specifications. Denominator Exceptions. IPSS<8 None None Yes Patient Reported Outcome (PRO)

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1 AQUA12 Benign Prostate Hyperplasia: IPSS improvement after diagnosis with NEW diagnosis of clinically significant BPH who had IPSS (international prostate symptoms score) or AUASS (American urological association symptom score) improvement by 20%. patients with a new diagnosis of benign prostatic hyperplasia(bph) and baseline IPSS / AUASS 8 patients with a new diagnosis of benign prostatic hyperplasia(bph) with a baseline IPSS/AUASS 8 (defining at least "moderate" symptoms) who are documented to have an improvement (decrease) in IPSS/AUASS by at least 20% within 12 months of diagnosis IPSS<8 None None Yes Patient Outcome (PRO) NQS Domain Person and Caregiver Centered Experience and Area Patient Functional AQUA14 Stones: Repeat Shock Wave Lithotripsy (SWL) within 6 months of treatment who underwent endoscopic procedures following SWL Patients undergoing SWL followed by ipsilateral SWL, ureteroscopy, or percutaneous nephrolithotomy within 6 months Patients undergoing SWL twice on the ipsilateral side within 6 months (inverse measure) None None None Yes Outcome Effective Admissions and Readmissions to Hospitals Yes Yes 1 No AQUA15 Stones: Urinalysis documented 30 days before surgical stone procedures with a documented urinalysis 30 days before surgical stone procedures Patients undergoing surgical stone procedures (including cystoscopy stent placement, percutaneous nephrostomy tube placement, shock wave lithotripsy, percutaneous nephrolithotomy, and ureteroscopy) Patients with documented urinalysis within 30 days before surgery None None None Yes Process Patient Safety Preventable Healthcare Harm AQUA16 Non-Muscle Invasive Bladder Cancer: Repeat Transurethral Resection of Bladder Tumor (TURBT) for T1 disease with T1 disease, that had a second TURBT within 6 weeks of the initial TURBT Patients diagnosed with clinical stage T1 bladder cancer Patients with T1 disease, that had a second TURBT within 6 weeks of the initial TURBT None Onset of systemic chemotherapy or radical cystectomy within 3 months of diagnosis None No Process Effective 2019 American Urological Association All Rights Reserved 1

2 AQUA17 Non-Muscle Invasive Patients diagnosed Patients starting BCG within 3 months Non-urothelial histology Bladder Cancer: who initiate BCG with high-grade T1 of TURBT Initiation of BCG treatment within 3 bladder cancer and/or within 3 months of months of diagnosis of CIS diagnosis of highgrade high-grade T1 bladder T1 bladder cancer and/or CIS cancer and/or CIS Onset of systemic chemotherapy or radical cystectomy within 3 months of diagnosis; prior completion of at least 6 weeks BCG None No Process Effective NQS Domain Area AQUA18 Non-Muscle Invasive Bladder Cancer: Early surveillance cystoscopy within 4 months of initial diagnosis who receive surveillance cystoscopy within 4 months of TURBT for bladder cancer Patients undergoing TURBT for any bladder cancer Patients undergoing cystoscopy within 4 months of TURBT None Onset of systemic chemotherapy or radical cystectomy within 3 months of diagnosis None No Process Effective AQUA19 Diagnosis of of Azoospermia and Diagnostic Testing for Obstructive Azoospermia All patients with who had minimum azoospermia necessary concepts discussed as part of diagnosis of azoospermia alone, to determine possibility of obstructive versus nonobstructive azoospermia and underwent diagnostic testing for obstructive azoospermia Patients who had documentation of Patients with CF mutation and minimum necessary concepts an absent vas discussed as part of diagnosis of azoospermia alone, to determine possibility of obstructive vs non obstructive azoospermia and received proper diagnostic testing for obstructive azoospermia. Discussion must include: Normal testicular size, Normal FSH (<8), Normal semen volume and ph, AND Missing vas/beaded vas AND TESTING MUST INCLUDE: FSH AND Semen analysis volume and ph AND Genetic testing AND (one of the following): Open diagnostic testicular biopsies (unilateral) OR Open diagnostic testicular biopsy (bilateral) OR Needle diagnostic testicular aspiration (bilateral) OR Needle diagnostic testicular aspiration (unilateral) OR Biopsy gun diagnostic testicular biopsy (bilateral) OR Biopsy gun diagnostic testicular biopsy (unilateral) OR Epididymal aspiration (unilateral or bilateral) 2019 American Urological Association All Rights Reserved 2

3 AQUA21 Appropriate Percentage of All patients with Management of obstructive obstructive Obstructive azoospermia patients azoospermia Azoospermia managed appropriately Patients who were managed by one of the following: Diagnostic biopsy/aspiration alone (only) and refer to male reproductive specialist OR Diagnostic testicular or epididymal aspiration with cryopreservation for IVF use OR Diagnostic testicular biopsy (needle or open) with cryopreservation for IVF use OR Vasal or vaso-epididymal reconstruction when appropriate (i.e. not CBAVD) OR TURED OR Discuss reconstruction/corrective (i.e. 4 and 5) vs aspiration/biopsy and cryo for IVF (i.e. 2 and 3) None NQS Domain Area AQUA22 Bone imaging and soft tissue imaging within 30 days (before or after) of diagnosis of metastatic CRPC who receive bone imaging and soft tissue imaging within 30 days (before or after) of diagnosis of metastatic CRPC Patients with metastatic CRPC Patients receiving bone imaging and soft tissue imaging within 30 days (before or after) of diagnosis of metastatic CRPC None AQUA23 Blood work for patients receiving abiraterone Patients with receiving abiraterone advanced prostate who receive monthly cancer on abiraterone blood work and serum transaminases (ALT and AST) and bilirubin levels prior to starting treatment and every two weeks for the first three months of treatment and monthly thereafter A. patients getting blood work on a monthly basis. B. patients receiving abiraterone whose serum transaminases (ALT and AST) and bilirubin levels were measured prior to starting treatment. C. patients tested for serum transaminases and bilirubin levels every two weeks during the first 3 months of treatment. D. patients receiving abiraterone whose serum transaminases (ALT and AST) and bilirubin levels were measured monthly after month 3 of treatment. E. Overall Performance: patients receiving abiraterone who receive monthly blood work and serum transaminases (ALT and AST) and bilirubin levels prior to starting treatment and every two weeks for the first three months of treatment and monthly thereafter None Medication Management 2019 American Urological Association All Rights Reserved 3

4 AQUA24 Testosterone and PSA Patients who have their testosterone levels checked for and PSA levels checked before starting CRPC patients treatment for CRPC on hormonal therapy who have their testosterone and PSA levels checked before starting treatment for CRPC Patients with advanced prostate cancer on hormonal therapy None NQS Domain Area Medication Management AQUA25 Use of Prednisone for CRPC patients on abiraterone who are receiving abiraterone who are also receiving prednisone Patients with advanced prostate cancer on abiraterone Patients receiving prednisone None Management of Chronic Conditions AQUA26 Benign Prostate Hyperplasia Care: Benign Prostate Hyperplasia with new diagnosis of BPH who had a creatinine lab order placed or had a CT abdomen, MRI abdomen, ultrasound abdomen ordered or performed. patients with a new diagnosis of benign prostatic hyperplasia(bph) A. patients with new diagnosis of BPH who had a creatinine lab order placed B. patients with new diagnosis of BPH who had a CT abdomen, MRI abdomen, ultrasound abdomen ordered or performed C. Overall Average Performance - patients with new diagnosis of BPH who had either a creatinine lab order placed or had a CT abdomen, MRI abdomen, ultrasound abdomen ordered or performed None Patients with known renal insufficiency (Cr >1.5 or documented in past medical history) or with documented flank pain or hematuria None Yes Process Efficiency and Cost Reduction Yes Yes 1 No AQUA27 Appropriate Testing for Vasectomy Patients where a Post Vasectomy Semen Analysis (PVSA) was ordered and confirmed sterility within 6 months of undergoing a vasectomy All patients undergoing a vasectomy Patients with an order for a PVSA 6 months after a vasectomy and confirmed sterility (fresh uncentrifuged semen sample performed) None AQUA29 Patient Report of Urinary function after treatment who had a reported urinary function score at 12 months after treatment that is within 80% of the reported urinary function score at baseline (before treatment) All newly diagnosed prostate cancer patients Men completing EPIC-26 urinary function domain who had a reported urinary function score within 80% of the reported urinary function score at baseline (before treatment) None None None Yes Patient Outcome (PRO) Person and Caregiver Centered Experience and Patient Functional 2019 American Urological Association All Rights Reserved 4

5 AQUA30 All newly diagnosed Men completing EPIC-26 sexual Patient Report of prostate cancer function domain who had a reported Sexual function after patients sexual function score within 60% of treatment the reported sexual function score at baseline (before treatment) who had a reported sexual function score at 24 months after treatment that is within 60% of the reported sexual function score at baseline (before treatment) None None None Yes Patient Outcome (PRO) NQS Domain Person and Caregiver Centered Experience and Area Patient Functional AQUA31 Documentation of PSA, Gleason score and clinical stage for risk stratification newly diagnosed with Prostate Cancer with documentation of PSA, Gleason score and clinical stage in the MD notes before treatment. newly diagnosed Prostate Cancer patients ( FOR ALL ITEMS) A. patients newly diagnosed with prostate cancer with documentation of PSA level in the MD notes before treatment B. patients newly diagnosed with prostate cancer with documentation of Gleason score (primary and secondary) in the MD notes before treatment C. patients newly diagnosed with prostate cancer with documentation of clinical stage in the MD notes before treatment D. Overall total - patients newly diagnosed with prostate cancer with documentation of PSA level and Gleason score (primary and secondary pattern) and clinical stage in the MD notes before treatment None Transfer of Health Information and Interoperability 2019 American Urological Association All Rights Reserved 5

6 AQUA32 Hypogonadism: men who had a serum Laboratory evaluation luteinizing hormone (LH) level, conducted within 6 testosterone level, and hematocrit months of starting measured within six months of the testosterone initial testosterone level replacement measurement Percentage of men age 18 years and older with testosterone deficiency who have a serum luteinizing hormone (LH) level, testosterone level, and hematocrit measured within 6 months of the initial testosterone level measurement All men with a diagnosis of hypogonadism (testosterone deficiency less than 300 ng/dl) receiving testosterone replacement medication (any formulation of testosterone) or receiving a testosterone injection in clinic Documentation of clinical reason(s) for not performing the serum LH level: For select patients, serum LH level measurement is not likely to impact clinical management and may, therefore, be omitted. Such patients include those with a history of previously diagnosed pituitary macroadenoma, prior hypothalamic or pituitary extirpative surgery, prior hypothalamic or pituitary trauma, genetic conditions known to result in congenitally low serum LH levels (i.e. Kallmann syndrome), or previously diagnosed hypogonadotropic hypogonadism. Men with infertility. NQS Domain Area Management of Chronic Conditions AQUA32 Exclusion continued Men receiving prescriptions for HCG, SERMS, or aromatase inhibitors. Men with conditions resulting in hypogonadism regardless of laboratory testing: bilateral anorchic, pituitary insufficiency, Klinefelter syndrome 2.1% of all men (40->80 year of age) using low testosterone laboratory levels (<300 ng/dl) and symptoms of testosterone deficiency was the reported prevalence rate of testosterone deficiency syndrome. This rate increases for each decade of age in three epidemiological studies. Intra-individual variability (as much as 32%) is such that one blood sample is not sufficient to accurately access total Testosterone levels. If there is a major discrepancy in the two samples obtained then a third sample is recommended. For all ages of males there is a clear diurnal variation in levels of total T with highest levels occurring in the am so samples should be drawn before 11 a.m. to be valid. The magnitude of this variation is greater in young men compared to men over 60 years of age but the diurnal variation is still present. Making a diagnosis of testosterone deficiency in the absence of signs and or symptoms increases the likelihood of making a false diagnosis and reduces the potential benefit of testosterone therapy. Clinicians should refrain from measuring a testosterone level in patients who are asymptomatic, do not exhibit signs related to low testosterone, or do not have any co-morbid conditions associated with low testosterone. It is important to remember that signs and symptoms are often not specifically caused by testosterone deficiency American Urological Association All Rights Reserved 6

7 AQUA33 Intracavernosal Men who received ICI in-office testing Men counterindicated to the Injection Therapy In- use of ICI therapy Office Test Percentage of men who are prescribed intracavernosal injection therapy and received in-office testing All men diagnosed with erectile dysfunction who are prescribed intracavernosal injection (ICI) therapy NQS Domain Area AQUA34 Genetic Testing and Patient Counseling of the Azoospermic Male with non-obstructive azoospermia due to primary testis failure who were offered genetic testing and patient counseling All patients with nonobstructive azoospermia due to testis failure Patients who were offered genetic testing (karyotype AND Y- chromosome microdeletion) and patient counseling Documentation of medical reason(s) for not offering genetic testing. Documentation of patient reason(s) for not offering genetic testing MUSIC4 Active Surveillance/Watchful Waiting for Low Risk Prostate Cancer Patients Proportion of patients with low-risk prostate cancer receiving active surveillance or watchful waiting # of low-risk prostate cancer patients 30 or older # of low-risk prostate cancer patients on active surveillance or watchful waiting Prostate cancer patients < 30 years of age; patients that have had prior treatment for prostate cancer MUSIC10 Confirmation Testing in low risk AS eligible patients Percentage of low risk # of patients aged 30 patients that are or older with new eligible for active diagnosis of low and surveillance who low-intermediate receive confirmation prostate cancer testing within 6 months (Gleason 6 or low of diagnosis volume Gleason 3+4) # of patients that underwent a second biopsy, MRI, or genomics test within 6 months after date of diagnosis (positive biopsy date) Prostate cancer patients < 30 years of age; Patients that have had prior treatment for prostate cancer; Patients on watchful waiting MUSIC11 Follow-Up Testing for patients on active surveillance for at least 30 months on active surveillance that have 2 tumor burden reassessments and 3 PSA tests in first 30 months since diagnosis # of patients aged 30 or older with new diagnosis of low and low-intermediate prostate cancer (Gleason 6 or low volume Gleason 3+4) # of patients on active surveillance that have 2 tumor burden reassessments and 3 PSA tests in first 30 months since diagnosis Prostate cancer patients < 30 years of age; Patients that have had prior treatment for prostate cancer 2019 American Urological Association All Rights Reserved 7

8 QOPI21 Oncology: Treatment Summary Communication Radiation Oncology, regardless of age, with a diagnosis of cancer who have undergone brachytherapy or external beam radiation therapy who have a treatment summary report in the chart that was communicated to the physician(s) providing continuing care and to the patient within two weeks of completing treatment All patients, regardless of age, with a diagnosis of cancer who have undergone brachytherapy or external beam radiation therapy Patients who have a treatment summary report in the chart that was communicated to the physician(s) providing continuing care and to the patient within two weeks of completing treatment Documentation of a patient reason(s) for not communicating the treatment summary report to the physician(s) providing continuing care (eg, patient requests that report not be sent) and to the patient within two weeks of completing treatment Documentation of a system reason(s) for not communicating the treatment summary report to the physician(s) providing continuing care (eg, patient does not have any physician responsible for providing continuing care) and to the patient within two weeks of completing treatment None None Yes Process Communicati on and Care Coordination NQS Domain Area Transfer of Health Information and Interoperability QOPI22 External Beam Radiotherapy for Bone Metastases, regardless of age, with a diagnosis of painful bone metastases and no history of previous radiation who receive external beam radiation therapy (EBRT) with an acceptable fractionation scheme as defined by the guideline. All patients with painful bone metastases and no previous radiation to the same anatomic site who receive EBRT All patients, regardless of age, with painful bone metastases, and no previous radiation to the same anatomic site who receive EBRT with any of the following recommended fractionation schemes: 30Gy/10fxns, 24Gy/6fxns, 20Gy/5fxns, 8Gy/1fxn. The medical reasons for denominator exclusions are: 1) Previous radiation treatment to the same anatomic site; 2) Patients with femoral axis cortical involvement greater than 3 cm in length; 3) Patients who have undergone a surgical stabilization procedure; and 4) Patients with spinal cord compression, cauda equina compression or radicular pain None None Yes Process Communicati on and Care Coordination 2019 American Urological Association All Rights Reserved 8