Cancer Center Dashboard

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1 Cancer Center Dashboard Measure Definition Benchmark Endorsed By Screening Breast Cancer Screening Percentage of eligible women who received a mammogram within the past 24 months NCQA reported average: Commercial Health Plans: 68.9 % Medicare Health Plans: 67.2 % Medicaid Health Plans: 51.3 % 1 Ideal Benchmark: 100% NQF #0031 2, PQRS #112 3, ACO #20 4 Colorectal Cancer Screening Percentage of patients years of age who had appropriate screening for colorectal cancer. NCQA reported average performance: Commercial Health Plans: 55.1 % Medicare Health Plans: 49.3% 5 NQF #0034 6, PQRS #113 7, ACO #19 8 Appropriate Treatment Needle biopsy rate Percent of breast cancer patients receiving stereotactic or needle biopsy NCBC Average: 90% 9 ; NQF Recommendation: Needle biopsy should precede surgical excision/resection 10 NAPBC, NCBC 11, NQF # , PCHQR Core Set, ACoS 13 Cancer Stage Documented Percentage of patients, regardless of age, with a diagnosis of breast, colon, or rectal cancer who are seen in the ambulatory setting who have a baseline AJCC cancer stage or documentation that the cancer is metastatic in the medical record at least once during the 12 month reporting period Reported Averages: 38% 14-87% 15 Ideal Benchmark: 100% NQF # , AMA-PCPI, PQRS #194 17, ASCO- QOPI 18 Pathology report completeness Percent of pathology reports containing all data elements specified in College of American Pathologists (CAP) Cancer Protocols ACoS/CoC Requirement: >90% of pathology reports include required data elements as per CAP protocol 19 ACoS-CoC 20, ASCO- QOPI 21, CAP 22 Chemotherapy Intent Documented Percent of patients with with Chemotherapy intent (curative vs palliative) documented Ideal benchmark: 100% QOPI Endorsed Core measure 10 23, ASCO 24 Post breast conserving surgery radiation Post-operative radiation therapy in patients with rectal cancer Lymph node sampling for resected colon cancer Percent of patients <70 years of age who underwent breast conserving surgery and received radiation therapy within 1 year (365 days) of date of diagnosis Percent of patients, <80 years of age, with clinical or pathologic AJCC T4N0M0 or Stage III rectal cancer receiving surgical resection for whom radiation therapy is considered or administered within six months (180 days) of diagnosis Percent of surgical patients for which least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer National Cancer Database Average: 72% 25 ; ACoS/CoC CP3R Required Performance Rate: >90% to meet CoC Standard ACoS/CoC CP3R Required Performance Rate: >90% to meet CoC Standard National Average: 12 or more lymph nodes sampled in 41% 35-44% 36 of cases, Best Observed: 85% 37 ; ACoS/CoC CP3R Required Performance Rate: >80% to meet CoC Standard , Ideal Benckmark: >90% 39 ACoS-CoC 27, ASCO/NCCN 28, NAPBC, NQF # RQRS 31, CoC CP3R, ACoS/RQRS 32, ASCO 33, NCCN 34 ACoS/RQRS 40, AMA- PCPI, ASCO/QOPI 41, NCCN 42, NQF # , PCHQR, PQRS, CoC CP3R Timeliness of Adjuvant chemotherapy for Colon Cancer Percent of patients with stage III lymph node positive colon cancer, <80 years of age, for whom adjuvant chemotherapy was considered or administered within 4 months (120 days) of surgery National Average: 59% 44, Performance of over 90% required to meet CoC Standard ACoS/RQRS 46, AMA- PCPI, ASCO/QOPI 47, NCCN 48, NQF # , PCHQR, PQRS, CoC CP3R 2013 The Advisory Board Company advisory.com

2 Cancer Center Dashboard Measure Definition Benchmark Endorsed By Timeliness of combination chemotherapy for hormone receptor negative breast cancer Percent of women <70 years of age with AJCC T1c or Stage II or III hormone receptor (ER/PgR) negative breast cancer where combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis. ACoS/CoC CP3R Required Performance Rate: >90% to meet CoC Standard ASCO/QOPI 51, ACoS/RQRS, AMA-PCPI, NAPBC, NQF # , PCHQR, PQRS, CoC CP3R Use of tamoxifen or third generation aromotase for hormone receptor positive breast cancer Percent of women over 18 with AJCC T1cN0M0, or Stage II or III hormone receptor (ER/PgR) positive breast cancer where adjuvant hormonal therapy (Tamoxifen or third generation aromatase inhibitor) is considered or administered within 1 year (365 days) of diagnosis. ACoS/CoC CP3R Required Performance Rate: >90% to meet CoC Standard ASCO/QOPI 54, ACoS/CoC/RQRS, AMA- PCPI 55, NAPBC, NQF # , # , PCHQR, PQRS, CoC CP3R Clinical Pathway Compliance Percentage of patients treated in compliance with vender-defined clinical pathways Physician practices utilizing vendordefined clinical pathways average between 65-80% compliance 58. Limited Inpatient, ED Utilization Cancer Patient Readmission Percent of cancer patients readmitted within 30 days of discharge Reported average: 32.5% total, Preventable, unexpected, and unplanned: 3.6% 59 Chemotherapy Patient Inpatient Admissions Number of inpatient hospital admissions per 1000 chemotherapy patients National average: 378 admissions per 1000 chemotherapy patients, Lowest utilizing regions: 233 admissions 60 Chemotherapy Patient Emergency Department Admissions Number of ED admissions per 1000 chemotherapy patients National average: 929 ED visits per 1000 chemotherapy patients, Lowest utilizing regions: 465 ED visits 61 Survivorship Treatment Summary Communication Radiation Oncology Percentage of patients, 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 one month of completing treatment Results of the National Initiative for Cancer Care Quality indicated that across five metropolitan statistical areas, only 50% of radiation therapy medical records for patients with breast cancer included information regarding the total dose of radiation, dose per fraction, number of fractions, and the site treated 62 ; Among physicians participating in ASTRO s Performance Assessment for the Advancement of Radiation Oncology Treatment (PAAROT) program, an average performance rate of 92% was reported 63. NQF # , AMA-PCPI 2013 The Advisory Board Company advisory.com

3 Cancer Center Dashboard Measure Definition Benchmark Endorsed By Chemotherapy Treatment Summary Percentage of patients with chemotherapy treatment summary process completed within 3 months of chemotherapy end. Chemotherapy treatment summary includes: Chemotherapy treatment delivered, including number of cycles administered, duration, and extent of dose reduction; Reason treatment was stopped; Major toxicities and/or hospitalizations; Treatment response; Follow up care and relevant providers. QOPI Endorsed Core measure 17 65, ASCO 66 Follow-up visits with treating physician Percentage of patients with at least 2 follow-up visits with treating physician during the first year post-treatment Ideal Benchmark: 100% of eligible patients RAND Quality of Care measure P26 67 Communication with PCP on Survivorship Patient Experience Percentage of patients with documentation or evidence of communication with patient s primary care physician on provision of continuing care Ideal Benchmark: 100% of eligible patients RAND Quality of Care measure P27 68 Shared Decision Making Percentage of patients satisfied that they were sufficiently involved in decisions about cancer treatment See Cancer CAHPS for additional information 69 Cancer CAHPS, Advisory Board interviews and analysis Palliative Care and EOL Proportion receiving chemotherapy in the last 14 days of life Percentage of patients who died from cancer receiving chemotherapy in the last 14 days of life National average: 5.6%-6.4% 70 NQF # , ASCO- QOPI 72 Proportion not admitted to hospice Percentage of patients who died from cancer and were not admitted to hospice Average: 65-85% 73 Best observed: <55% 74 NQF # , ASCO- QOPI Endorsed EOL measure 42, 43, 46, Proportion with more than one emergency room visit in the last days of life Percentage of patients who died from cancer with more than one emergency room visit in the last 30 days of life Average: 8-10% 77 Best Observed: 2% 78 NQF # , ASCO, NCI 80 Proportion admitted to the ICU in the last 30 days of life Percentage of patients who died from cancer and were admitted to the ICU in the last 30 days of life Average: 8-12% 81 Best observed: <4% 82 NQF # , ASCO Proportion admitted to hospice for less than 3 days Percentage of patients who died from cancer, and were admitted to hospice and spent less than 3 days there Average: 27-35% 84 Best Observed: 8% 85 NQF # , ASCO- QOPI Endorsed EOL measure 44, 44a, 45, 45a 87 Plan of Care for Pain Medical Oncology and Radiation Oncology Percentage of patients, regardless of age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy who report having pain with a documented plan of care to address pain ASTRO's PAAROT reported average: 61% 88 ; CMS PQRS reported average: 91.24% 89 NQF # , AMA-PCPI, PQRS #144 91, ASCO- QOPI #38 92 Pain Intensity Quantified Medical Oncology and Radiation Oncology Percentage of visits for patients, regardless of age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified by second office visit QOPI National Aggregate: 70.21% 93 NQF # , AMA-PCPI, PQRS #143 95, ASCO- QOPI endorsed Core measure 3, 4a The Advisory Board Company advisory.com

4 Cancer Center Dashboard Measure Definition Benchmark Endorsed By Advance Care Plan Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan Observed Average: 41% 97 NQF #032698, PQRS #47 99, AMA-PCPI Symptom management: pain Percent of patients with a cancer related outpatient visit who have been screened for the presence or absence, and intensity of pain using a numeric pain score Ideal benchmark: 100% Best observed: 79% 100 Symptom management: depression Percent of cancer patients who are diagnosed with depression who have a documented plan for depression Ideal benchmark: 100% Best observed : 69% 101 Symptom management: fatigue Percent of patients undergoing chemotherapy, who were assessed for the presence or absence of fatigue during a cancer related outpatient visit Ideal benchmark: 100% Best observed: 25% The Advisory Board Company advisory.com

5 Cancer Center Dashboard Sources National Committee for Quality Assurance, "Continuous improvement and the expansion of quality measurement: The state of health care quality 2011," available at: last accessed: January National Quality Forum, NQF Endorsed Measure #0031, Breast cancer screening, available at: last accessed: January American Medical Association, 2013 Physician Quality Reporting System: PQRS quality measures, available at: last accessed: January Center for Medicare and Medicaid Services, Accountable Care Organization 2012 program analysis: Quality performance standards narrative measure specifications, available at: last accessed: January National Committee for Quality Assurance, "Continuous improvement and the expansion of quality measurement: The state of health care quality 2011," available at: last accessed: January National Quality Forum, NQF Endorsed Measure #0034, Colorectal cancer screening, available at: last accessed: January American Medical Association, 2013 Physician Quality Reporting System: PQRS quality measures, available at: last accessed: January Center for Medicare and Medicaid Services, Accountable Care Organization 2012 program analysis: Quality performance standards narrative measure specifications, available at: last accessed: January Kaufman CS, et al., "National quality measures for breast centers (NQMBC): A robust quality tool: Breast center quality measures, Annals of Surgical Oncology, 2010, 17(2): National Quality Forum, NQF Endorsed Measure #0221, Needle biopsy to establish diagnosis of cancer precedes surgical excision/resection, available at: last accessed: June 11 Kaufman CS, et al., "National quality measures for breast centers (NQMBC): A robust quality tool: Breast center quality measures, Annals of Surgical Oncology, 2010, 17(2): National Quality Forum, NQF Endorsed Measure #0221, Needle biopsy to establish diagnosis of cancer precedes surgical excision/resection, available at: last accessed: June 13 American College of Surgeons, National Accreditation Program for Breast Centers: NAPBC Components, available at: last accessed: January 14 Abernethy AP, et al., "Poor documentation prevents adequate assessment of quality metrics in colorectal cancer," Journal of Oncology Practice, 2009, 5: American Society for Radiation Oncology, Performance Assessment for the Advancement of Radiation Oncology Treatment program (PAAROT), 2010, Unpublished data, as cited by: National Quality Forum, NQF Endorsed Measure #0386, Oncology: Cancer Stage Documented, available at: last accessed: January 2013 The Advisory Board Company advisory.com

6 16 National Quality Forum, NQF Endorsed Measure #0386, Oncology: Cancer Stage Documented, available at: last accessed: January 17 American Medical Association, 2013 Physician Quality Reporting System: PQRS quality measures, available at: last accessed: January Cancer Center Dashboard Sources 18 American Society of Clinical Oncology, Quality Practice Initiative, Fall 2011, Unpublished Data as cited by: National Quality Forum, NQF Endorsed Measure #0386, Oncology: Cancer Stage Documented, available at: last accessed: January 19,20 American College of Surgeons, Cancer program standards 2012: Ensuring patient-centered care, 2011, available at: last accessed: August 21 American Society of Clinical Oncology, Quality oncology practice initiative: Summary of measures, Spring 2012, 22 Idowu MO, et al., "Adequacy of surgical pathology reporting of cancer: A college of American pathologists q-probes study of 86 institutions," Archives of Pathology and Laboratory Medicine, 2012, 134(7): American Society of Clinical Oncology, Quality oncology practice initiative: Summary of measures, Spring 2012, 24 American Society of Clinical Oncology, "Cancer treatment plan and summary," available at: motherapy+treatment+plan+and+summary/cancer+treatment+plan+and+summary+resources, last accessed: January 25 National Cancer Database (NCDB) Benchmark Reports, NCDB Analytic Cases: Diagnosis Year 2009, Partial mastectomy, Less Than Total Mastectomy, United States, available at: 26 American College of Surgeons, Implementation of Commission on Cancer standards 4.4 and 4.5, 2012, available at: last accessed: January 27 American College of Surgeons, Cancer program standards 2012: Ensuring patient-centered care, 2011, available at: last accessed: August 28 American Society of Clinical Oncology, National Comprehensive Cancer Network, Inc, Quality measures: Breast and colorectal cancers, 2007, available at: last accessed: January 29 National Quality Forum, NQF Endorsed Measure #0219, Post breast conserving surgery irradiation, available at: last accessed: June 30 American College of Surgeons, Implementation of Commission on Cancer Standards 4.4 and 4.5, 2012, available at: last accessed: January 31 American College of Surgeons & Commission on Cancer, Rapid Quality Reporting System (RQRS), available at: last accessed: February 32 American College of Surgeons, Cancer program standards 2012: Ensuring patient-centered care, 2011, available at: last accessed: August 2013 The Advisory Board Company advisory.com

7 33 American Society of Clinical Oncology, Quality oncology practice initiative: Summary of measures, Spring 2012, 34 National Comprehensive Cancer Network, National comprehensive cancer network clinical practice guidelines: Rectal cancer, 2010, available at: last accessed August, 35 Storli KE, et al., "Overall survival after resection for colon cancer in a national cohort study was adversely affected by TNM stage, lymph node ratio, gender, and old age, International Journal of Colorectal Disease, 2011, 26(10): Baxter NN, et al., "Lymph node evaluation in colorectal cancer patients: A population-based study," Journal of the National Cancer Institute, 2005, 97(3): Stocchi L, et al., Individual surgeon, pathologist, and other factors affecting lymph node harvest in stage II colon carcinoma. Is a minimum of 12 examined lymph nodes sufficient?" Annals of Surgical Oncology, 2011, 18(2): American College of Surgeons, Implementation of Commission on Cancer Standards 4.4 and 4.5, 2012, available at: last accessed: January 39 Vather R, et al., "Lymph node evaluation and long-term survival in stage II and stage III colon cancer: A national study, Annals of Surgical Oncology, 2009, 16(3): American College of Surgeons, Cancer program standards 2012: Ensuring patient-centered care, 2011, available at: last accessed: August 41 American Society of Clinical Oncology, Quality oncology practice initiative: Summary of measures, Spring 2012, 42 ASCO/NCCN Quality measures: Breast and colorectal cancers, Alexandria (VA): American Society of Clinical Oncology, National Comprehensive Cancer Network, Inc, National Quality Forum, NQF Endorsed Measure #0225, At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer, available at: last accessed: June 20, Rayson D., et al., Clinical practice guidelines (CPGs) for adjuvant chemotherapy (act) in colorectal cancer: A population-based analysis of adherence and non-receipt, Journal of Clinical Oncology, 2011, American College of Surgeons, Implementation of Commission on Cancer Standards 4.4 and 4.5, 2012, available at: last accessed: January 46 American College of Surgeons, Cancer program standards 2012: Ensuring patient-centered care, 2011, available at: last accessed: August 47 Benson AB 3rd, et al., "American society of clinical oncology recommendations on adjuvant chemotherapy for stage II colon cancer," Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 2004, 22(16): ASCO/NCCN Quality measures: Breast and colorectal cancers, Alexandria (VA): American Society of Clinical Oncology, National Comprehensive Cancer Network, Inc, National Quality Forum, NQF Endorsed Measure #0223 Adjuvant chemotherapy is considered or administered within 4 months (120 days) of surgery to patients under the age of 80 with AJCC III (lymph node positive) colon cancer, available at: last accessed: June 20, 50 American College of Surgeons, Implementation of Commission on Cancer Standards 4.4 and 4.5, 2012, available at: last accessed: January 2013 The Advisory Board Company advisory.com

8 51 American Society of Clinical Oncology, Quality oncology practice initiative: Summary of measures, Spring 2012, 52 National Quality Forum, NQF Endorsed Measure #0559, Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1c, or Stage II or III hormone receptor negative breast cancer, available at: last accessed: June 53 American College of Surgeons, Implementation of Commission on Cancer Standards 4.4 and 4.5, 2012, available at: last accessed: January 54 American Society of Clinical Oncology, Quality oncology practice initiative: Summary of measures, Spring 2012, 2012; Winer EP, et al., "American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer: Status report 2004," Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 2005, 23(3): American Society for Therapeutic Radiology and Oncology, American Society of Clinical Oncology, Physician consortium for performance improvement: Oncology physician performance measurement set, Chicago, IL, American Medical Association, National Quality Forum, NQF Endorsed Measure #0220, Adjuvant hormonal therapy, available at: last accessed: June 57 National Quality Forum, NQF Endorsed Measure #0387, Oncology: Hormonal therapy for stage IC through IIIC, ER/PR positive breast cancer, available at: last accessed: August 58 Oncology Roundtable interviews and analysis. 59 Walters RS, et al., Thirty-day all-case readmission rate at a cancer center as a quality of care measure, 2012 ASCO s Quality Care Symposium, available at: last accessed: February 60 Cancer Patients receiving Chemotherapy: Opportunities for Better Management. Milliman Client Report, available at: last accessed: February 61 Cancer Patients receiving Chemotherapy: Opportunities for Better Management. Milliman Client Report, available at: last accessed: February 62 National Initiative for Cancer Care Quality: Malin JL, et al., Results of the National Initiative for Cancer Care Quality: How can we improve the quality of cancer care in the United States? Journal of Clinical Oncology, 2006, 24: , as cited by National Quality Forum, NQF Endorsed Measure #0381, Oncology: Treatment Summary Communication - Radiation Oncology, available at: last accessed: January 63 ASTRO's PAAROT program: American Society for Radiation Oncology, Performance Assessment for the Advancement of Radiation Oncology Treatment program (PAAROT). Unpublished data, 2010, as cited by National Quality Forum, NQF Endorsed Measure #0381, Oncology: Treatment Summary Communication - Radiation Oncology, available at: last accessed: January 64 National Quality Forum, NQF Endorsed Measure #0381, Oncology: Treatment Summary Communication - Radiation Oncology, available at: last accessed: January 65 American Society of Clinical Oncology, Quality oncology practice initiative: Summary of measures, Spring 2012, 2013 The Advisory Board Company advisory.com

9 66 ASCO, "Chemotherapy Treatment Pland and Summary Definitions," available at: motherapy+treatment+plan+and+summary/chemotherapy+treatment+plan+and+summary+definitions, last accessed: January 67 RAND, Prostate cancer patient outcomes and choice of providers: Development of an infrastructure for quality assessment, available at: last accessed February 68 RAND, Prostate cancer patient outcomes and choice of providers: Development of an infrastructure for quality assessment, available at: last accessed February 69 American Institutes for Research (AIR) & Mayo Clinic, CAHPS Cancer Care Survey draft, available at: last accessed: February 70 Goodman DC, et al., Quality of end-of-life cancer care for Medicare beneficiaries regional and hospital specific analyses, Dartmouth Atlas Project, 2010, available at: last accessed: February 71 National Quality Forum, NQF Endorsed Measure #0210, Proportion receiving chemotherapy in the last 14 days of life, available at: last accessed: January 72 American Society of Clinical Oncology, Quality Oncology Practice Initiative: Summary Measures Spring 2012, available at: last accessed: January 73 Setoguchi S, et al., Effective Health Care Program Research Reports: Testing cancer quality measures for end-of-life care, Agency for Healthcare Research and Quality, 2010, report number 21, available at: last accessed: February 74 Earle CC, et al., Evaluating claims-based indicators of the intensity of end-of-life cancer care, International Journal for Quality in Health Care, 2005, 17(6): National Quality Forum, NQF Endorsed Measure #0215, Proportion not admitted to hospice, available at: last accessed: January 76 American Society of Clinical Oncology, Quality Oncology Practice Initiative: Summary Measures Spring 2012, available at: last accessed: January 77 Setoguchi S, et al., Effective Health Care Program Research Reports: Testing cancer quality measures for end-of-life care, Agency for Healthcare Research and Quality, 2010, report number 21, available at: last accessed: February 78 Earle CC,et al., Evaluating claims-based indicators of the intensity of end-of-life cancer care, International Journal for Quality in Health Care, 2005, 17(6): National Quality Forum, NQF Endorsed Measure #0211, Proportion with more than one emergency room visit in the last days of life, available at: last accessed: January 80 National Cancer Institute, Cancer Quality of Care Measures Project, available at: last accessed: February 2013 The Advisory Board Company advisory.com

10 81 Setoguchi S, et al., Effective Health Care Program Research Reports: Testing cancer quality measures for end-of-life care, Agency for Healthcare Research and Quality, 2010, report number 21, available at: last accessed: February 82 Earle CC,et al., Evaluating claims-based indicators of the intensity of end-of-life cancer care, International Journal for Quality in Health Care, 2005, 17(6): National Quality Forum, NQF Endorsed Measure #0213, Proportion admitted to the ICU in the last 30 days of life, available at: last accessed: January 84 Setoguchi S, et al., Effective Health Care Program Research Reports: Testing cancer quality measures for end-of-life care, Agency for Healthcare Research and Quality, 2010, report number 21, available at: last accessed: February 85 Earle CC,et al., Evaluating claims-based indicators of the intensity of end-of-life cancer care, International Journal for Quality in Health Care, 2005, 17(6): National Quality Forum, NQF Endorsed Measure #0216, Proportion admitted to hospitce for less than 3 days, available at: last accessed: January 87 American Society of Clinical Oncology, Quality Oncology Practice Initiative: Summary Measures Spring 2012, available at: last accessed: January 88 American Society for Radiation Oncology, Performance Assessment for the Advancement of Radiation Oncology Treatment program (PAAROT), unpublished data, 2010 as cited by National Quality Forum, NQF Endorsed Measure #0383, Oncology: Plan of Care for Pain Medical Oncology and Radiation Oncology (paired with 0384), available at: last accessed: January 89 Centers for Medicare & Medicaid Services (CMS), 2009 Reporting Experience Including Trends ( ): Physician Quality Reporting System and Electronic Prescribing (erx) Incentive Program, 2011, available at: last accessed: January 2012, as cited by National Quality Forum, NQF Endorsed Measure #0383, Oncology: Plan of Care for Pain Medical Oncology and Radiation Oncology (paired with 0384), available at: last accessed: January 90 National Quality Forum, NQF Endorsed Measure #0383, Oncology: Plan of Care for Pain Medical Oncology and Radiation Oncology (paired with 0384), available at: last accessed: January 91 Centers for Medicare & Medicaid Services (CMS), 2012 Physician Quality Reporting System (Physician Quality Reporting) Measures List, 2011, available at: Instruments/PQRS/How_To_Get_Started.html, last accessed: February 92 American Society of Clinical Oncology, Quality Oncology Practice Initiative: Summary Measures Spring 2012, available at: last accessed: January 93 Blue Cross Blue Shield of Michigan Physician Group Incentive Program, 2012 Program Year, "Improve Oncology Practice Care Quality through Participation in the American Society of Clinical Oncology, Quality Oncology Practice Initiative," available at: last accessed January 94 National Quality Forum, NQF Endorsed Measure #0384, Oncology: Pain Intensity Quantified Medical Oncology and Radiation Oncology (paired with 0383), available at: last accessed: January 95 Centers for Medicare & Medicaid Services (CMS), 2012 Physician Quality Reporting System (Physician Quality Reporting) Measures List, 2011, available at: Instruments/PQRS/How_To_Get_Started.html, last accessed: February 2013 The Advisory Board Company advisory.com

11 96 American Society of Clinical Oncology, Quality Oncology Practice Initiative: Summary Measures Spring 2012, available at: last accessed: January 97 Dow LA, et al., "Paradoxes in advance care planning: The complex relationship of oncology patients, their physicians, and advance medical directives," Journal of Clinical Oncology, 2010, 28(2): National Quality Forum, NQF Endorsed Measure #0326, Advance Care Plan, available at: last accessed: January 99 Centers for Medicare & Medicaid Services (CMS), 2012 Physician Quality Reporting System (Physician Quality Reporting) Measures List, 2011, available at: Instruments/PQRS/How_To_Get_Started.html, last accessed: February 100 Dy SM, et al., Quality of end-of-life care for patients with advanced cancer in an academic medical center, Journal of Palliative Medicine, 2011, 14: Dy SM, et al., Quality of end-of-life care for patients with advanced cancer in an academic medical center, Journal of Palliative Medicine, 2011, 14: Dy SM, et al., Quality of end-of-life care for patients with advanced cancer in an academic medical center, Journal of Palliative Medicine, 2011, 14: The Advisory Board Company advisory.com