Oncology: Medical and Radiation – Pain Intensity Quantified

Measure Specification

Pain is a commonly occurring symptom for cancer patients as 30% to 50% (510,000 to 850,000 each year based on current statistics) will experience moderate to severe pain. Initial and ongoing pain assessments are essential to determine the pathophysiology of pain and ensure proper pain management. According to the National Comprehensive Cancer Network (National Comprehensive Cancer Network (NCCN), 2024), undertreatment of pain remains a problem among a significant subset of cancer patients, survival is linked with symptom control and pain management, and pain management contributes to broad quality of life improvement.

Furthermore, NCCN notes that formal pain reevaluation is required at each contact to ensure that pain management therapies are successfully meeting patient-specific goals for comfort, function, and safety. Cancer patients have reported that pain interferes with their mood, work, relationships with other people, sleep and overall enjoyment of life. Pain management is an essential part of oncologic management and contributes to a patient’s overall function and quality of life (National Comprehensive Cancer Network (NCCN), 2024).

A recent analysis of registry data for chronic pain cancer patients found average pain intensity reported as mild (24.6% of patients), moderate (41.5%), and severe (33.9%). The study also indicated that patient report of pain relief is inversely related to the average pain intensity reported. These data suggest that assessing and managing a cancer patient’s pain is critical and there remains significant room for improvement in assessing and mitigating cancer-related pain.

A prospective study of changes in pain severity of cancer patients found that, at initial assessment, 47% of patients reported pain. At follow-up, the patients with pain at initial assessment reported reduced pain (32.2%), stable pain (48.2%) and worse pain (19.6%). Of the 53% of patients reporting no pain at initial assessment, 82.6% reported stable pain and 17.

4% reported worse pain at follow-up assessment. This study highlights the importance of initial and ongoing assessments of pain to identify gaps and ensure proper pain management.

Screen all patients for pain at each contact. Routinely quantify and document pain intensity and quality as characterized by the patient (whenever possible). Include patient reporting of breakthrough pain, treatments used and their impact on pain, satisfaction with pain relief, pain interference, provider assessment of impact on function, and any special issues for the patient relevant to pain treatment and access to care.

If necessary, get additional information from caregiver regarding pain and impact on function. Perform comprehensive pain assessment if new or worsening pain is present and regularly for persisting pain. Various methods and tools exist to assess pain severity. Intensity of pain should be quantified using a numerical rating scale (i.e., 0-10), visual analog scale, categorical scale, or pictorial scale (e.

g., The Faces Pain Rating Scale) (Category 2A) (National Comprehensive Cancer Network (NCCN), 2024).

This measure contains two strata defined by two submission criteria. This measure produces a single performance rate using a weighted average. There are 2 Submission Criteria for this measure: 1) All patient visits for patients with a diagnosis of cancer currently receiving chemotherapy OR 2) All patient visits for patients with a diagnosis of cancer currently receiving radiation therapy This measure produces a single performance rate.

For the purposes of MIPS implementation, this visit measure is submitted each time a patient has a denominator eligible encounter during the performance period. For patients receiving radiation therapy, pain intensity should be quantified at each radiation treatment management encounter, where the patient and physician have a face-to-face interaction.

Due to the nature of some applicable coding related to the radiation therapy (e.g., delivered in multiple fractions), the billing date for certain codes may or may not be the same as the face-to-face encounter date. In this instance, for the reporting purposes of this measure, the billing date should be used to pull the appropriate patients into the initial population.

It is expected, though, that the numerator criteria would be performed at the time of the actual face-to-face encounter during the series of treatments. A lookback (retrospective) period of 7 days, including the billing date, may be used to identify the actual face-to-face encounter, which is required to assess the numerator. Therefore, pain intensity should be quantified during the face-to- face encounter occurring on the actual billing date or within the 6 days prior to the billing date.

For patients receiving chemotherapy, pain intensity should be quantified at each face-to-face or telehealth encounter with the physician while the patient is currently receiving chemotherapy. For purposes of identifying eligible encounters, patients “currently receiving chemotherapy” refers to patients administered chemotherapy on the same day as the encounter or during the 30 days before the date of the encounter AND during the 30 days after the date of the encounter.