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Clinical Quality Measures Basics

Beginning in 2019, all eligible professionals (EPs), eligible hospitals, dual-eligible hospitals, and critical access hospitals (CAHs) are required to use 2015 edition certified electronic health record technology (CEHRT) to meet the requirements of the Promoting Interoperability Program. Note that the requirements for eligible hospitals, dual-eligible hospitals, and CAHs that submit an attestation to CMS under the Medicare Promoting Interoperability Program were updated in the 2019 IPPS final rule.  

In 2019, all Medicaid eligible hospitals and EPs must adhere to the requirements of their state’s Medicaid Promoting Interoperability Program and attest directly to their state. Visit the 2019 Promoting Interoperability Medicaid page for more information.

Electronic clinical quality measures (CQMs) are tools that help measure and track the quality of health care services that EPs, eligible hospitals, and CAHs provide, as generated by a provider's EHR. Measuring and reporting eCQMs helps to ensure that our health care system is delivering effective, safe, efficient, patient-centered, equitable, and timely care. eCQMs 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

Health care providers are required to electronically report eCQMs, which use data from EHRs and/or health information technology systems to measure health care quality. 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 successfully participate in the Medicare and Medicaid Promoting Interoperability Programs, CMS requires EPs, eligible hospitals, CAHs, and dual-eligible hospitals to report on eCQMs. These eCQMs are determined by CMS and require the use of 2015 Edition of CEHRT. For more information on 2015 Edition CEHRT, review this fact sheet.

Medicare Promoting Interoperability Program Requirements for 2019

Reporting Electronically

For first-time and returning participants, the 2019 reporting period for eligible hospitals and CAHs who report electronically is one self-selected quarter of calendar year (CY) 2019 data. Additionally, eligible hospitals, CAHs, and dual-eligible hospitals are required to report on four self-selected eCQMs from the set of 16 available. The submission period will be the two months following the close of the 2019 CY, ending on February 29, 2020.

Reporting via Attestation

If electronic reporting is not feasible, an eligible hospital or CAH may report via attestation. This reporting period would require data from the full CY 2019 (consisting of four quarterly data reporting periods). If an eligible hospital, CAH, or dual-eligible hospital reports via attestation, they are required to report on all 16 eCQMs.

For more information on the 2019 Medicare Promoting Interoperability Program CQM requirements, please review this CQM fact sheet.

Medicaid Promoting Interoperability Program Requirements for 2019

For first-time EPs, the 2019 eCQM reporting period for those who report electronically or through attestation is the full 2019 CY data. For EPs attesting for the first time, the 2019 reporting period for those who report electronically or through attestation is any continuous 90-day period within CY 2019. All participating EPs are required to report on any 6 eCQMs relevant to their scope of practice from the set of 50 available. In addition, EPs must report on at least one outcome measure. If no outcome measure is relevant to his or her scope of practice, the EP must report on one high priority measure. If no high priority measures are relevant to their scope of practice, they may report on any six relevant measures. The list of available eCQMs can be found on the eCQI Resource Center.

For first-time hospitals who submit eCQMs electronically, the reporting period is any continuous 90-day period, these participants are required to report on four measures. For first-time hospitals who submit eCQMs via attestation, the reporting period is the full 2019 CY data. These participants are required to report on all 16 eCQMs. 

For returning hospitals who submit eCQMs via attestation, the reporting period is any continuous 90-day period and requires reporting on all 16 eCQMs is required. The reporting period is the same for those who submit electronically, but this form of submission only requires reporting on four eCQMs.

Note: Under the Medicaid Promoting Interoperability Program, states have the flexibility to determine the method of reporting eCQMs and submission period, subject to prior approval by CMS. States also have the flexibility to determine the specifications that may be used to electronically report eCQMs under the Medicaid PI Program.

eCQM Reporting Requirement Tables

Additional Resources

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