Streamlining High Priority Quality Measures for a Healthy America

The Universal Foundation is a set of high-priority quality measures streamlined across CMS programs. Supporting CMS’s vision to shift the paradigm for health care away from a system that focuses on sick care, the Universal Foundation directs provider attention to key clinical areas, including prevention, wellness, and chronic disease management.

Use of the Universal Foundation promotes the highest quality and safest care for adults and children as we work together to improve care quality. By allowing providers to focus on their patients’ health outcomes, the Universal Foundation also reduces unnecessary paperwork and administrative burden.

CMS will continue to streamline measures across quality programs in other settings and for other populations to support further efficiency in quality measurement.

Selection Criteria for the Universal Foundation:

• The measure has a high national impact
• The measure can be benchmarked
• The measure is applicable to multiple populations and settings
• The measure has scientific acceptability
• The measure is feasible and computable (or capable of becoming digital)
• The measure has no unintended consequences

The Universal Foundation measures are used across CMS quality programs and prioritized for digitization. The CMS Center for Medicare & Medicaid Innovation (CMMI) continues to test new and innovative measures.

These measures will be used across CMS quality programs and prioritized for digitization. The CMS Center for Medicare & Medicaid Innovation (CMMI) retains the role to test new and innovative measures.

Universal Foundation Measures:

Adult

Domain	Measure Identification Number and Name
Wellness and prevention	139: Colorectal cancer screening 93: Breast cancer screening 26: Adult immunization status
Chronic conditions	167: Controlling high blood pressure 204: Hemoglobin A1c poor control (>9%)
Behavioral health	672: Screening for depression and follow-up plan 394: Initiation and engagement of substance use disorder treatment
Seamless care coordination	561 or 44: Plan all-cause readmissions or all-cause hospital readmissions
Person-centered care	158 (varies by program): Consumer Assessment of Healthcare Providers and Systems overall rating measures (CAHPS)

Child

Domain	Measure Identification Number and Name
Wellness and prevention	761 and 123: Well-child visits (well-child visits in the first 30 months of life; child and adolescent well-care visits) 124 and 363: Immunization (childhood immunization status; immunizations for adolescents) 760: Weight assessment and counseling for nutrition and physical activity for children and adolescents 897: Oral evaluation, dental services
Chronic conditions	80: Asthma medication ratio (reflects appropriate medication management of asthma)
Behavioral health	672: Screening for depression and follow-up plan 268: Follow-up after hospitalization for mental illness 264: Follow-up after emergency department visit for substance use 743: Use of first-line psychosocial care for children and adolescents on antipsychotics  271: Follow-up care for children prescribed attention deficit-hyperactivity disorder medicine
Person-centered care	158 (varies by program): Consumer Assessment of Healthcare Providers and Systems overall rating measures (CAHPS)

The following additional Universal Foundation measures assess the quality of care a patient receives across the continuum of care. 

Hospital

Domain	Measure Identification Number and Name
Chronic Conditions	696: Hybrid Hospital-Wide (All-Condition, All-Procedure) Risk-Standardized Mortality Measure
Person-Centered Care	338: Hospital Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey 162: Outpatient and Ambulatory Surgery CAHPS Survey
Safety	460: National Healthcare Safety Network (NHSN) Central Line Associated Bloodstream Infection (CLABSI) Outcome Measure 459: NHSN Catheter-Associated Urinary Tract Infection (CAUTI) Outcome Measure 463: NHSN Facility-Wide Inpatient Hospital-onset Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia Outcome Measure 1: NHSN Surgical Site Infection (SSI) 462: NHSN Facility-wide Inpatient Hospital-onset Clostridium difficile Infection (CDI) Outcome Measure 135: Patient Safety Indicators (PSI) 90 678: Severe Sepsis and Septic Shock Management Bundle 1633: Severe Obstetric Complications
Seamless care coordination	356: Hybrid Hospital-Wide All-Cause Readmission  427: Median Time from ED Arrival to ED Departure for Discharged ED Patients

Post-acute Care

Domain	Measure Identification Number and Name
Behavioral Health	522: Percent of Residents Who Have Symptoms of Depression (Long Stay)
Person-Centered Care	1698: Discharge Function Score 154: Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey
Safety	225: Drug Regimen Review Conducted with Follow-Up for Identified Issues-PAC  520: Percent of Residents Experiencing One or More Falls with Major Injury (Long-Stay) 680: Skilled Nursing Facility Healthcare-Associated Infections (SNF HAI) Requiring Hospitalization  121: Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury 471: Number of Hospitalizations per 1,000 Long Stay Resident Day
Seamless care coordination	575: Potentially Preventable 30-Day Post-Discharge Readmission Measure 210: Discharge to Community-Post Acute Care (PAC) 728: Transfer of Health Information to the Provider Post-Acute Care (PAC) 727: Transfer of Health Information to the Patient Post-Acute Care (PAC)

Maternity Care

Domain	Measure Identification Number and Name
Safety	418: Maternal Morbidity Structural Measure 1633: Severe Obstetric Complications (eCQM) 508: Cesarean Birth (LRCD-CH/ eCQM)
Wellness and Prevention	581: Prenatal and Postpartum Care: Postpartum Care (PPC-AD) 582: Prenatal and Postpartum Care: Timeliness of Prenatal Care (PPC-CH)

Future of the Universal Foundation

CMS reviews the Universal Foundation measures annually to ensure they continue to meet selection criteria, identify and fill measure gaps, and reflect a patient’s health care journey. CMS welcomes feedback on the Universal Foundation, which may result in: 

• Replacing or removing measures when goals are met
• Adding measures to assess quality across a patient’s care journey
• Continuing to test new and innovative measures in CMMI

History of the Universal Foundation

• “Aligning Quality Measures across CMS — The Universal Foundation” in The New England Journal of Medicine
• The Universal Foundation at the 2023 CMS Quality Conference (video)
• The Universal Foundation at the 2024 CMS Quality Conference (slide deck)

Send feedback to QualityStrategy@cms.hhs.gov.