CQMs are tools that measure and track the ability of providers to deliver safe, effective, efficient, patient-centered care that is equitable and timely. CQMs look to address health outcomes, clinical processes, patient safety, efficient use of healthcare resources, care coordination, patient engagement, population and public health and adherence to clinical guidelines.
In 2014, CMS replaced the core set requirement with recommended adult and pediatric core measures that are aligned with high priority healthcare improvement goals. However, you do not have to use the recommended measures. Just remember that the measures that you select must report 9 of the 64 measures and cover at least 3 of the 6 available National Quality Strategy domains.
CMS Recommended Core Measures for Adults
- Controlling High Blood Pressure
- Use of High-Risk Medications in the Elderly New
- Preventive Care and Screening: Tobacco Use Screening and Cessation Intervention
- Use of Imaging Studies for Low Back Pain
- Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan New
- Documentation of Current Medications in the Medical Record New
- Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up
- Closing the Referral Loop: Receipt of Specialist Report New
- Functional Status Assessment for Complex Chronic Conditions New
CMS Recommended Core Measures for Pediatrics
- Appropriate Testing for Children with Pharyngitis
- Weigh Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
- Chlamydia Screening for Women
- Use of Appropriate Medications for Asthma
- Childhood Immunization Status
- Appropriate Treatment for Children with Upper Respiratory Infection (URI) New
- Attention Deficit/Hyperactivity Disorder: Follow-up Care for Children Prescribed ADHD Medication New
- Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan New
- Children Who Have Dental Decay or Cavities New
All CQM Measures - You must select 9 measures that cover at least 3 of the domains
- Patient and Family Engagement
- Oncology: Medical and Radiation – Pain Intensity Quantified
- Functional Status Assessment for Knee Replacement
- Functional Status Assessment for Hip Replacement
- Functional Status Assessment for Complex Chronic Conditions New
- Patient Safety
- Use of High-Risk Medications in the Elderly
- Falls: Screening for Future Fall Risk
- Documentation of Current Medications in the Medical Record New
- Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures
- Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment
- ADE Prevention and Monitoring: Warfarin Time in Therapeutic Range
- Care Coordination
- Closing the Referral Loop: Receipt of Specialist Report New
- Population/Public Health
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
- Preventive Care and Screening: Tobacco Use Screening and Cessation Intervention
- Chlamydia Screening for Women
- Childhood Immunization Status
- Preventive Care Screening: Influenza Immunization
- Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan New
- Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up
- Maternal Depression Screening
- Preventive Care and Screening: Screening for High Blood Pressure and Follow-up Documented
- Efficient Use of Healthcare Resources
- Appropriate Testing for Children with Pharyngitis
- Use of Imaging Studies for Low Back Pain
- Appropriate Treatment for Children with Upper Respiratory Infection (URI) New
- Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
- Clinical Process/Effectiveness
- Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
- Controlling High Blood Pressure
- Breast Cancer Screening
- Cervical Cancer Screening
- Colorectal Cancer Screening
- Use of Appropriate Medications for Asthma
- Pneumonia Vaccination Status for Older Adults
- Diabetes: Eye Exam
- Diabetes: Foot Exam
- Diabetes: Hemoglobin A1c Poor Control
- Hemoglobin A1c Test for Pediatric Patients
- Diabetes: Urine Protein Screening
- Diabetes: Low Density Lipoprotein (LDL) Management
- Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
- Coronary Artery Disease (CAD): Beta-Blocker Therapy – Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%)
- Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control
- Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
- Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
- Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
- Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
- Diabetic Retinopathy: Communication with Physician Managing Ongoing Diabetes Care
- Adult Major Depressive Disorder (MDD): Suicide Risk Assessment
- Anti-Depressant Medication Management
- Attention Deficit/Hyperactivity Disorder: Follow-up Care for Children Prescribed ADHD Medication New
- Bipolar Disorder and Major Depression: Appraisal for Alcohol or Chemical Substance Use
- Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer Patients
- Breast Cancer Hormonal Therapy for Stage IC-III Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
- HIV/AIDS: Medical Visit
- HIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis
- HIV/AIDS: RNA Control for Patients with HIV
- Cataracts: 20/40 or Better Visual Acuity Within 90 Days Following Cataract Surgery
- Pregnant Women That Had HBsAg Testing
- Depression Remission at Twelve Months
- Depression Utilization of the PHQ-9 Tool
- Children Who Have Dental Decay or Cavities New
- Primary Caries Prevention Intervention as Offered by Primary Care Providers, Including Dentists
- Preventive Care and Screening: Cholesterol – Fasting Low Density Lipoprotein (LDL-C) Test Performed
- Preventive Care and Screening: Risk-Stratified Cholesterol – Fasting Low Density Lipoprotein (LDL-C) Test Performed
- Dementia: Cognitive Assessment
- Hypertension: Improvement in Blood Pressure
CQM Reporting Options:
- Option 1: Attest through the EHR Registration and Attestation System
- For Year 1 participation, submit 90 days of data
- For Year 2 and beyond, submit at least 1 quarter of data
- Option 2: eReporting of Data
- For Year 1 participation, submit 90 days
- For Year 2 and beyond participation, submit at least 1 quarter of data
