Thank you for your question regarding CMS506v7 Safe Use of Opioids - Concurrent Prescribing. This measure excludes patients with cancer pain that begins prior to or during the encounter using value set "Cancer Related Pain" (2.16.840.1.113762.1.4.1111.180). The measure team aligned the denominator exclusion, “Inpatient hospitalizations where patients have cancer pain that begins prior to or during the encounter” with the clinical guidelines, CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022, that states that “recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.”

Cancer pain has very unique evidence-based management practices. I have one patient in particular with very aggressive cancer that has metastasized, and the multiple admissions are directly linked to the cancer diagnosis and subsequent treatments. This patient requires multiple pain medications to adequately address the ongoing pain. If a cancer diagnosis is a primary reason for admission and/or final coded upon discharge, why are these patients not excluded from the metric?