CMS Quality Measures: Overview and FAQ
The Department of Health and Human Services (HHS) is continually seeking ways to improve patient outcomes in the U.S. As part of this push, the Centers for Medicare and Medicaid services (CMS) oversees a number of initiatives to enhance quality of care delivery. The CMS quality measures were created as a way to quantify efforts to meet these initiatives.
It’s important for healthcare leaders and providers to stay aware of these measures as a way to work toward improving care for their own patients. This guide provides a detailed description of what quality measures are, why they’re used, and how they relate to your facility.
What Are the CMS Quality Measures?
Quality measures are a set of tools created by CMS to help quantify improvements in the quality of care delivered in facilities throughout the U.S. These measures are calculated using data gathered from a variety of sources, including:
- Patient/provider surveys
- Electronic health records (EHR)
- Standardized assessments
- Medical claims
By piecing this data together, CMS administrators are able to better assess whether national healthcare goals around safety, efficiency, and effectiveness are being met. Reporting on quality measures also encourages facilities to meet standards of equitable, patient-centered care.
What Are the Different Types of Quality Measures?
There are specific types or categories of CMS quality measures that are designed to assess different aspects of healthcare. These categories, and what they measure, include (but aren’t limited to) the following:
- Patient-reported outcome-based performance measure (PRO-PM): Outcomes directly reported by patients to assess their perception of care
- Outcome: Changes in the health status of an individual as a result of healthcare
- Process: Steps taken to provide optimal care
- Costs/resource use: Costs or resources used to deliver care
- Efficiency: Cost of care associated with a specified health outcome
Quality Measures in Healthcare: Examples
There are dozens of quality measures that the CMS uses to collect data from facilities and providers. The CMS Measures Inventory Tool (CMIT) is an online repository that provides access to all of these measures and their descriptions.
Along with descriptions, CMS provides a numerator and denominator for each measure. The numerator describes the final outcome expected for the targeted population. The denominator defines the population being measured. An additional section defines the program that the measure is part of, such as the Merit-Based Incentive Payment System Program (MIPS).
Quality measures can be filtered, compared, and exported with CMIT’s functions. The following two examples of quality measures (for child and adolescent well-care visits and colorectal cancer screening) in healthcare illustrate how items are listed and described in the inventory.
|
|
|
|---|---|
| Description | Percentage of children ages 3 to 21 who had at least one comprehensive well-care visit with a primary care practitioner (PCP) or an obstetrician/gynecologist (OB/GYN) during the measurement year |
| Numerator | One or more well-care visits during the measurement year |
| Denominator | Members 3-21 years as of December 31 of the measurement year |
| Program | Marketplace Quality Rating System |
|
|
|
|---|---|
| Description | The percentage of patients ages 45 to 74 who had appropriate screening for colorectal cancer |
| Numerator | Patients with one more more screenings for colorectal cancer |
| Denominator | Patients between the ages of 45 and 74 who had a visit with the care provider during the measurement period |
| Program | Merit-Based Incentive Payment System Program |
In addition to accessing information on CMIT, a provider may also download a comprehensive list of CMS quality measures related to a certain program, such as the 2025 Quality Measures: MIPS List.
How Are CMS Quality Measures Developed?
Quality measures are developed using a continuous and rigorous feedback loop. Prior to creating new measures, a team of quality developers will identify areas or topics that are important to healthcare stakeholders. Then, they’ll test out data collection corresponding to these areas and assess whether the data is:
- Important and meaningful to individuals.
- Offering benefits that outweigh the burden of collection.
- Reliably and consistently measuring what they’re supposed to.
- Usable by stakeholders to improve care delivery.
- Unique from other data already being collected.
Throughout this process, CMS will hold regular panels soliciting input from various healthcare stakeholders, patients, and families to assess what information is most useful to collect. This allows for diverse perspectives to guide the development process.
How Are CMS Quality Measures Used?
Beyond tracking and informing improvements in healthcare, quality measures are also used for CMS payment programs that incentivize participating healthcare providers to optimize their care delivery.
For example, the Merit-based Incentive Payment (MIPS) Program allows Medicaid- and Medicare-eligible healthcare providers to collect and submit quality measures to CMS. If the collected data shows that healthcare providers are delivering quality, cost-effective care, they receive higher reimbursement rates.
Another area of healthcare where quality measures are used frequently is long-term care of the elderly. Facilities that provide this type of care may be considered measured entities because of their reliance on CMS reimbursement. In addition to informing reimbursement decisions, CMS quality measures for nursing homes provide the framework for the Five Star Rating Program that helps patients and their families easily compare nursing home options.
What Are Electronic Clinical Quality Measures (eCQMs)?
Electronic clinical quality measures, or eCQMs, are quality measures that are designed to be pulled directly from electronic health record (EHR) systems. They serve the same function as other quality measures but eliminate the need for manual data collection. Healthcare facilities can learn more about updating their hospital systems to utilize eCQMs through the official eCQI resource center.
Want to Learn More About Improving Care Quality?
Now that you’ve learned more about the CMS quality measures, you may be seeking more ways to enhance care delivery at your own facility. IntelyCare’s team of clinical experts has you covered, with up-to-date healthcare tips, strategies, and guides to help your facility optimize patient care.