OCM Quality Measures

The Oncology Care Model (OCM) is an episode-based payment model designed to provide high quality, highly coordinated oncology care at low cost. In order to assess and verify clinical outcomes, patient outcomes, and coordination of care, as well as ensure continued quality of care, CMS measures OCM participants’ performance using quality measures from four of the National Quality Strategy Domains, including:

  • Communication and Care Coordination
  • Person and Caregiver-Centered Experience and Outcomes
  • Clinical Quality of Care
  • Patient Safety

OCM Quality Measures and Performance-Based Payments

12 of the OCM quality measures selected from the above domains are used in the calculation of participants’ performance-based payments. These measures include:

Measure NameOCM Measure NumberMeasure Source
Communication and Care Coordination
Risk-adjusted proportion of patients with all-cause hospital admissions within the 6-month episodeOCM-1Claims
Risk-adjusted proportion of patients with all-cause emergency department visits or observation stays that did not result in a hospital admission within the 6-month episodeOCM-2Claims
Proportion of patients who died who were admitted to hospice for 3 days or moreOCM-3Claims
Person- and Caregiver-Centered Experience and Outcomes 
Pain Assessment and Management Composite1OCM-4Registry (practice-reported)
Preventive Care and Screening: Screening for Depression and Follow-Up Plan (CMS 2v6.3, NQF 0418)OCM-5Registry (practice-reported)
Patient-Reported Experience of CareOCM-6Survey
Clinical Quality of Care
Prostate Cancer: Adjuvant Hormonal Therapy for High or Very High-Risk Prostate Cancer (PQRS 104, NQF 0390)2OCM-7Registry (practice-reported)
Adjuvant chemotherapy is recommended or administered within 4 months (120 days) of diagnosis to patients under the age of 80 with AJCC III (lymph node positive) colon cancer (NQF 0223)3OCM-8Registry (practice-reported)
Combination chemotherapy is recommended or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0M0, or Stage IB – III hormone receptor negative breast cancer (NQF 0559)3OCM-9Registry (practice-reported)
Trastuzumab administered to patients with AJCC stage I (T1c) – III and human epidermal growth factor receptor 2 (HER2) positive breast cancer who receive adjuvant chemotherapy (NQF 1858)3OCM-10Registry (practice-reported)
Breast Cancer: Hormonal Therapy for Stage I (T1b)-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer (CMS 140v5.0, NQF 0387)3OCM-11Registry (practice-reported)
Patient Safety
Documentation of Current Medications in the Medical Record (CMS 68v6.1, NQF 0419)OCM-12Registry (practice-reported)

1The composite measure, OCM-4, is comprised of two measures: OCM-4a, Oncology: Medical and Radiation – Pain Intensity Quantified (PQRS 143, NQF 0384), and OCM-4b, Oncology: Medical and Radiation – Plan of Care for Pain (PQRS 144, NQF 0383).
2OCM-7 was retired effective with the March 2018 reporting period.
3OCM-8 – OCM-11 were retired effective with the March 2019 reporting period.

Source: https://innovation.cms.gov/Files/x/ocm-cancercodelists.pdf

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