CMS Quality Measures: Overview and FAQ

The Department of Health and Human Services is continually seeking ways to improve patient outcomes in the U.S. As part of this push, the Center 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. Additionally, reporting on quality measures encourages facilities to meet standards of equitable, patient-centered care.

What Are the Different Types of CMS Quality Measures?

There are specific types or categories of quality measures that are designed to assess different aspects of healthcare. These categories (and what they measure) include:

• Patient-reported outcomes — Outcomes directly reported by patients to assess their perception of care
• Health outcomes — Any changes in the health status of patients
• Intermediate outcomes — Changes resulting from a healthcare intervention leading to a longer term outcome
• Processes of care delivery — Steps taken to provide optimal care
• Organizational structures — Features of a facility that support care
• Costs/resources — Costs or resources used to deliver care

Quality Measures: Examples

There are dozens of quality measures that the CMS uses to collect data from facilities and providers. The CMS Quality Measures Inventory is an online repository that provides access to all of these measures and their descriptions.

Along with descriptions, there are two additional sections detailing a denominator and numerator for each measure. The numerator describes the final outcome expected for the targeted population. The denominator defines the population being measured. Below are two examples of how measures are listed and described in the inventory.

Measure: Child and Adolescent Well-Care Visits

• 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. The wellcare visit must occur with a PCP or an OB/GYN practitioner, but the practitioner does not have to be the practitioner assigned to the member.
• Denominator: Members 3-21 years as of December 31 of the measurement year.

Measure: Age Appropriate Screening Colonoscopy

• Description: The percentage of screening colonoscopies performed in patients greater than or equal to 86 years of age from January 1 to December 31
• Numerator: Screening colonoscopies performed in patients greater than or equal to 86 years of age
• Denominator: All screening colonoscopy examinations performed on patients greater than or equal to 45 years of age during the encounter period

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. They will then 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.

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 all about the CMS quality measures, you may be seeking ways to enhance care delivery at your own facility. If you’re not sure where to start, IntelyCare has got you covered. Sign up for our free newsletter to gain access to dozens of healthcare tips, strategies, and guides that are geared towards facility leaders.