Clinical Quality Measures Basics comprises public domain material from the Centers for Medicare & Medicaid
Clinical Quality Measures Basics
Clinical quality measures, or CQMs, are tools that help measure and track the quality of health care
services provided by eligible professionals, eligible hospitals and critical access hospitals (CAHs) within
our health care system. These measures use data associated with providers’ ability to deliver highquality care or relate to long term goals for quality health care. CQMs measure many aspects of patient
efficient use of health care resources
population and public health
adherence to clinical guidelines
Measuring and reporting CQMs helps to ensure that our health care system is delivering effective, safe,
efficient, patient-centered, equitable, and timely care.
To participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and
receive an incentive payment, providers are required to submit CQM data from certified EHR
To participate in the Medicare and Medicaid EHR Incentive Programs and receive an incentive payment,
providers are required to submit CQM data from certified EHR technology.
2014 Clinical Quality Measure Options
In August May 2014, CMS released a final rule that grants flexibility to providers who are unable to fully
implement 2014 Edition CEHRT for an EHR reporting period in 2014 due to delays in 2014 CEHRT
availability. The different 2014 CQM submission options are outlined below.
Providers scheduled to demonstrate Stage 1 or Stage 2 who are still using 2011 Edition CEHRT use 2013
2011 & 2014 CEHRT
Providers scheduled to demonstrate Stage 1 who are using a combination of 2011 and 2014 Editions
submit 2013 CQMs or 2014 CQMs, depending on whether they report 2013 Stage 1 or 2014 Stage 1
Providers scheduled to demonstrate Stage 2 using a combination of 2011 and 2014 Editions submit 2013
CQMs if they report 2013 Stage 1 objectives, or submit 2014 CQMs if they report 2014 Stage 1
objectives or Stage 2 objectives.
Providers scheduled to demonstrate Stage 1 or Stage 2 in 2014 who have fully implemented 2014 CEHRT
use 2014 CQMs.
Recommended Core Measures comprises public domain material from the Centers for Medicare & Medicaid
Recommended Core Measures
For 2014, CMS is not requiring the submission of a core set of CQMs. Instead we identify two
recommended core sets of CQMs, one for adults and one for children. We encourage eligible
professionals to report from the recommended core set to the extent those CQMs are applicable to your
scope of practice and patient population.
Measure Selection Process
CMS selected the recommended core set of CQMs for EPs based on analysis of several factors:
Conditions that contribute to the morbidity and mortality of the most Medicare and Medicaid
Conditions that represent national public health priorities
Conditions that are common to health disparities
Conditions that disproportionately drive healthcare costs and could improve with better quality
Measures that would enable CMS, States, and the provider community to measure quality of
care in new dimensions, with a stronger focus on parsimonious measurement
Measures that include patient and/or caregiver engagement
Adult Recommended Core Measures
Controlling High Blood Pressure
Use of High-Risk Medications in the Elderly
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Use of Imaging Studies for Low Back Pain
Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
Documentation of Current Medications in the Medical Record
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up
Closing the referral loop: receipt of specialist report
Functional status assessment for complex chronic conditions
Pediatric Recommended Core Measures
Appropriate Testing for Children with Pharyngitis
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and
Chlamydia Screening for Women
Use of Appropriate Medications for Asthma
Childhood Immunization Status
Appropriate Treatment for Children with Upper Respiratory Infection (URI)
ADHD: Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD)
Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
Children who have dental decay or cavities
Principles for the National Quality Strategy (NQS) comprises public domain material from Working for Quality, Agency
for Healthcare Research and Quality, U.S. Department of Health & Human Services.
Principles for the National Quality Strategy (NQS)
The National Quality Strategy—and all our efforts to improve health and health care delivery—should be
anchored in a core set of principles shared by stakeholders, including Federal and State agencies, local
communities, provider organizations, consumers, clinicians, businesses, employers, and payers. These
principles will provide a practical roadmap for achieving the Strategy's three aims of better care, healthy
people/healthy communities, and care that is affordable.
As part of soliciting public input on the Strategy, the Secretary proposed a set of four core principles.
After receiving a wide range of public comments, six additional principles were added. In 2011 and in
future years, the Federal government will report on how its policies support these 10 principles, as well
as the Strategy's key aims and priorities. It is hoped that other public and private groups seeking to
promote better health and health care delivery will also use these principles to hold themselves
The following section describes the 10 principles in further detail. (Over time, a resource guide of
examples of private and public sector efforts that embody these principles will be developed.)
1. Person-centeredness and family engagement, including understanding and valuing patient
preferences, will guide all strategies, goals, and improvement efforts.
The most successful health care experiences are often those in which clinicians, patients, and their
families work together to make decisions. When patients' needs, experiences, perspectives, and
preferences are taken into account—and when they get the clear and understandable information and
support they need to actively participate in their own care—outcomes and patient satisfaction can
improve. How patients rate their experience is now widely used as a measure of high quality care, but
more can be done to empower individuals and make sure their needs and preferences are taken into
2. Specific health considerations will be addressed for patients of all ages, backgrounds, health needs,
care locations, and sources of coverage.
Patients' health needs and care requirements vary substantially depending on their age, location,
condition, whether they live in an urban or rural location, and what type of coverage they have. In order
to provide high quality care for all Americans, we need to address these special needs.
3. Eliminating disparities in care—including but not limited to those based on race, color, national
origin, gender, age, disability, language, health literacy, sexual orientation and gender identity, source
of payment, socioeconomic status, and geography—will be an integral part of all strategies, goals, and
health care improvement efforts.
Health disparities continue to exist, largely due to gaps in access to care, provider biases, poor patientprovider communication, poor health literacy, and other factors. Despite significant advances in the
quality of certain kinds of care, some populations remain at higher risk of receiving poor care.
Collaborative efforts between clinicians and provider organizations; community, faith-based, and
nonprofit organizations; academic institutions; foundations; and Federal, State, and local agencies have
begun and must continue to address these disparities so that all populations, regardless of race, gender,
socioeconomic status, or other factors, get high-quality care and have equal access to timely, effective,
and safe health care services.
4. Attention will be paid to aligning the efforts of the public and private sectors.
Many organizations are already committed to the goal of providing consistent, high-quality, safe, and
affordable care. But these well-intentioned efforts often have the unintended result of putting
competing demands on clinicians and health care organizations that can stand in the way of
improvement. To raise the quality of health care across the country, both the public and private sectors
will need to maintain a strong commitment to aligning their efforts.
5. Quality improvement will be driven by supporting innovation, evaluating efforts around the
country, rapid-cycle learning, and disseminating evidence about what works.
The best way to improve health care quality is to help health professionals evaluate their own
performance and their colleagues' performance, quickly learn how interventions fare in the "real world,"
and see the benefits of innovation firsthand—and then widely share the lessons they learn. For this to
happen, health professionals must have rapid access to information about what works in their own care
and in care around the country.
The National Quality Strategy also recognizes that quality improvement is an iterative process.
Seemingly simple interventions can have powerful, positive impacts on patient outcomes. But clinicians
need the flexibility to update and apply these interventions based on their own experience and the
specific patient receiving care. In other words, quality improvement efforts can succeed best when they
are tailored to local needs and resources. To that end, the National Quality Strategy will provide a
shared set of priorities, while also continuing to support local approaches to achieving the aims of better
care, healthier individuals and communities, and lowered health care costs.
6. Consistent national standards will be promoted, while maintaining support for local, community,
and State-level activities that are responsive to local circumstances.
National standards for health care quality and consistent approaches to measuring quality are essential
components of the National Quality Strategy. At the same time, the old maxim that "all health care is
local" still holds true. For that reason, the National Quality Strategy will promote national standards
while supporting local, community, and State-level activities that respond to local circumstances.
7. Primary care will become a bigger focus, with special attention toward the challenges faced by
vulnerable populations, including children, older adults, and those with multiple health conditions.
Many Americans receive care from multiple providers at multiple locations, with little coordination
between them. Primary care can help fill this gap, especially for vulnerable populations such as children,
older adults, and those with multiple health conditions. The National Quality Strategy will build on the
efforts of multiple stakeholders who are working to strengthen primary care using models such as the
patient-centered medical home, which organizes care around the individual to help each person stay as
healthy as possible at all stages of life.
8. Coordination among primary care, behavioral health, other specialty clinicians, and health systems
will be enhanced to ensure that these systems treat the "whole person."
When health care services are fragmented, necessary care is often delayed. Other times, patients fail to
get the care they need altogether. Often, this occurs when a patient needs behavioral health or other
specialty services that fall outside the traditional scope of primary care services. To address this gap, the
National Quality Strategy will enhance the coordination between primary care, behavioral health, and
other specialty services to ensure that health systems treat the "whole person" and all of his or her
9. Integration of care delivery with community and public health planning will be promoted.
One of the biggest opportunities for improving health care and overall health is improving the way we
treat and try to prevent chronic illness. Clinicians can offer evidence-based recommendations about
how to stay healthy to individuals and families, but making changes in diet, exercise, and other health
behaviors is often difficult without community support and resources. For that reason, the Strategy
supports close collaboration between health professionals who deliver care and individuals and
organizations working to improve community and public health.
10. Providing patients, providers, and payers with the clear information they need to make choices
that are right for them will be encouraged.
Patients who want to partner with their health care providers in making decisions about their care too
often lack the necessary understandable information. The National Quality Strategy will foster
transparency so that patients have the information to make choices that are right for them, clinicians
have the information they need to improve, and payers have the information to move to value-based
Quality Initiatives-General Information comprises public domain material from Centers for Medicare & Medicaid
Quality Initiatives - General Information
About CMS' Center for Clinical Standards & Quality
CMS' Center for Clinical Standards & Quality (CCSQ), led by the CMS Chief Medical Officer and the CCSQ
Leadership Team, is a cadre of professionals with diverse backgrounds in clinical, scientific, public health,
legal, IT, project management, academic, and business management fields. We serve CMS, HHS, and the
public as a trusted partner with a steadfast focus on improving outcomes, beneficiaries' experience of
care, and population health, while also aiming to reduce healthcare costs through improvement.
About CMS' Quality Initiatives
Quality health care for people with Medicare is a high priority for the President, the Department of
Health and Human Services (HHS), and the Centers for Medicare & Medicaid Services (CMS). HHS and
CMS began launching Quality Initiatives in 2001 to assure quality health care for all Americans through
accountability and public disclosure.
The various Quality Initiatives touch every aspect of the healthcare system. Some initiatives focus on
publicly reporting quality measures for nursing homes, home health agencies, hospitals, and kidney
dialysis facilities. Consumers can use the quality measures information that is available
on www.medicare.gov for these healthcare settings to assist them in making healthcare choices or
Request for Information: Transforming Clinical Practices
The Center for Medicare & Medicaid Services (CMS) seeks information about large scale transformation
of clinician practices to accomplish our aims of better care and better health at lower costs. Practice
Transformation is a process that results in observable and measureable changes to practice behavior.
These behaviors include core competencies: Engaged leadership and quality improvement;
Empanelment and improved patient health outcomes; Business and Financial acumen ;Continuous
and team-based healing relationships that incorporate culture, values, and beliefs; Organized, evidencebased care; patient-centered interactions; Enhanced access; progression toward population based care
management; State-of-the-art, results-linked, care; Intentional approach of practices to maximize the
systematic engagement of patients and families; and Systematic efforts to reduce un-necessary
diagnostic testing and procedures with little or no benefit.
CMS seeks responses to questions listed in Request for Information (RFI) which can be accessed through
the download below. CMS may use this information collected through this RFI notice to test new
payment and service delivery models. Please take the opportunity to respond to the questions most
appropriate for your organization. All comments are requested in the described format to the
designated CMS representative noted in the RFI by 11:59 pm Eastern on April 8, 2014.
CMS Quality Strategy
We are pleased to announce the CMS Quality Strategy, which is built on the foundation of the CMS
Strategy and the HHS National Quality Strategy (NQS). The CMS Quality Strategy pursues and aligns with
the three broad aims of the National Quality Strategy and its six priorities. Each of these priorities has
become a goal in the CMS Quality Strategy. To learn more about the CMS Quality Strategy, and to
provide feedback and public comment, please visit: http://www.cms.gov/Medicare/Quality-InitiativesPatient-Assessment-Instruments/QualityInitiativesGenInfo/CMS-Quality-Strategy.html.
Physician Quality Reporting System
Physicians and other eligible professionals can participate in the Physician Quality Reporting System by
reporting quality measures information to CMS about specific services provided frequently to their
Medicare patients with certain medical conditions. This information helps doctors measure the quality
of care provided to Medicare beneficiaries. More information about it can be found
Quality Improvement Organizations
Successful quality initiatives rely on partnerships and support from many sources that encompass the
healthcare community such as federal and State agencies, researchers and academic experts,
stakeholder and consumer organizations, providers and advocates, and federal contractors such as
Quality Improvement Organizations (QIOs). QIOs can assist Medicare beneficiaries and their caregivers
understand and use quality measures information in their healthcare decision making process.
CMS has developed a standardized approach for the development of quality measures that it uses in its
quality initiatives. Known as the Measures Management System (MMS), this system is composed of a set
of business processes and decision criteria that CMS funded measure developers follow in the
development, implementation, and maintenance of quality measures.
Post Acute Care Reform Plan
CMS funded a project to review assessment approaches that could be used across post-acute settings to
reduce care fragmentation and unsafe transitions, and to compare outcomes and costs for patients
discharged to post acute care. It should be noted that the content of this report does not necessarily
reflect the views or policies of the Department of Health and Human Services nor does mention of any
trade names, commercial products, or organizations imply endorsement by the U.S. Government. CMS
has developed a plan to improve Medicare's payment for post-acute care services and the coordination
of these services. Post-acute care is care that is provided to individuals who need additional help
recuperating from an acute illness or serious medical procedure.
Development of Quality Indicators for Inpatient Rehabilitation Facilities (IRFs)
The overall goal of this project was to assist CMS in developing appropriate measures to monitor and
evaluate the quality of rehabilitation services provided to Medicare beneficiaries in IRFs. The key
questions addressed by this report include: What are the expected outcomes of an inpatient
rehabilitation stay? What factors affect those outcomes? Do we have appropriate measures of those
relationships? And if not, what measures do we need? Funded by CMS, in considering these key
questions, Research Tria ...
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