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The clinical impact is high as pain is highly prevalent among ambulatory palliative care patients and is one of the most common reasons for referral to palliative care. This performance measure focuses on patient-reported experience in the context of end-of-life care. The PMC was concerned with the CPT codes needed to define the denominator accurately. Codes are available for palliative care visits but may not always used appropriately. The committee believes there is a need to clarify the purpose of the visit, whether the patient saw a palliative care physician or is in palliative care. Additionally, physicians automatically fail the measure if the patient responds “no” to the question, “Did you receive the help you wanted for your pain?”. There is a distinction between what a patient expects for pain and what a physician can provide for the patient, which the measure specifications do not account for. The developer should remove the exclusion for patients who do not respond to the survey. This exclusion could contribute to inaccurate performance rates. Collecting the patient-reported data through the survey instrument, completed via web survey, on paper or over the telephone, is burdensome. The exact routing and structure of the survey elements have not yet been used among ambulatory care populations. While this performance measure has been tested and used for research in group practice settings for palliative and non-palliative care patient populations, it is not currently used in an accountability program. It is unclear if performance rates would be similar in ambulatory settings.