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Clinical Quality Measures Basics

The Centers for Medicare & Medicaid Services (CMS) is renaming the EHR Incentive Programs to the Promoting Interoperability (PI) Programs to continue the agency’s focus on improving patients’ access to health information and reducing the time and cost required of providers to comply with the programs’ requirements. CMS is also in the process of finalizing updates to the programs through rulemaking. For more information, visit the landing page where CMS will publish updates and additional resources as soon as they are available.

Clinical quality measures (CQMs) are tools that help measure and track the quality of health care services that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) provide. Measuring and reporting CQMs helps to ensure that our health care system is delivering effective, safe, efficient, patient-centered, equitable, and timely care. CQMs measure many aspects of patient care, including:

  • Patient and Family Engagement
  • Patient Safety
  • Care Coordination
  • Population/Public Health
  • Efficient Use of Healthcare Resources
  • Clinical Process/Effectiveness

To participate in the PI Programs (formerly named the EHR Incentive Programs), health care providers are required to submit CQM data from certified electronic health record (EHR) technology. CQM data may be reported manually via attestation until CY 2018 (except in certain circumstances where electronic reporting is not feasible). Review this table to learn more about CQM requirements for Medicare and Medicaid hospitals and Medicaid EPs from 2017 - 2018.

Health care providers are required to electronically reporting clinical quality measures (eCQMs), which use data from EHRs and/or health information technology systems to measure health care quality, is required beginning in January 2018. To report eCQMs successfully, health care providers must adhere to the requirements identified by the CMS quality program in which they intend to participate.

Each year, CMS makes updates to the eCQMs approved for CMS programs to reflect changes in:

  • Evidence-based Medicine
  • Code Sets
  • Measure Logic

To learn more about eCQMs, visit the eCQI Resource Center.

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