Form CMS-10621 Data Template for Candidate Measures

Centers for Medicare & Medicaid Services
Row
1
2

Field Label
Auto Date (no user
input required)
Issue Type

FINAL 1/31/2017

Measures under Consideration 2017

Req'd

Screen Guidance

Data Form

Yes

Select Measure Submission
to nominate a measure for
MUC list. Select Modify
Measure to change a
measure already submitted
for 2017. Select Question to
ask a question on the MUC
process. Select Feedback to
leave feedback about the
2017 MUC process.

Select one

Data Template for Candidate Measures

Possible Values

Add Your Content Here

Measure Submission
Question
Modify Candidate Measure
Feedback

1

Row
3

Field Label
Component/s

Req'd
Yes

Screen Guidance
Start typing to get a list of
possible matches or press
down to select. Enter CMS
program(s) for which the
measure is being submitted.
These should not be current
use programs. Please note if
a user selects programs MIPS
or HIQR and if approved for
the MUC List and rulemaking
the measure has the
potential to be “borrowed”
for use in Hospital and
Physician Compare.
If you select MIPS, please
navigate to the Additional
Resources list at this web
site:
https://www.cms.gov/Medic
are/Quality-InitiativesPatient-AssessmentInstruments/QualityMeasure
s/Pre-Rule-Making.html,
download the “MIPS PeerReview Template and a
Completed Sample,” and
attach the completed form
to your JIRA submission
using the “Attachments”
field at the bottom of this
web page.

Data Form
Multiselect

Possible Values
Ambulatory Surgical Center Quality
Reporting Program

Add Your Content Here

End-Stage Renal Disease Quality Incentive
Program
Home Health Quality Reporting Program
Hospice Quality Reporting Program
Hospital-Acquired Condition Reduction
Program
Hospital Inpatient Quality Reporting
Program
Hospital Outpatient Quality Reporting
Program
Hospital Readmissions Reduction Program
Hospital Value-Based Purchasing Program
Inpatient Psychiatric Facility Quality
Reporting Program
Inpatient Rehabilitation Facility Quality
Reporting Program
Long-Term Care Hospital Quality Reporting
Program
Medicaid and Medicare EHR Incentive
Program for Eligible Hospitals and Critical
Access Hospitals
Medicare Shared Savings Program
Merit-based Incentive Payment System
Prospective Payment System-Exempt
Cancer Hospital Quality Reporting Program
Skilled Nursing Facility Quality Reporting
Program
Skilled Nursing Facility Value-Based
Purchasing Program

FINAL 1/31/2017

2

Row
4

Field Label
What is the history or
background for
including this measure
on the new MUC list?

Req'd
Yes

Screen Guidance
Select only one reason

Data Form
Select one

None

Possible Values

Add Your Content Here

New measure never used in a program
Measure currently used in a CMS program
being proposed as-is for a new or different
program
Measure currently used in a CMS program,
but the measure is undergoing substantial
change

5
6

If currently used:
Range of year(s) this
measure has been used
by CMS Program(s).

FINAL 1/31/2017

No

For example: Hospice Quality
Reporting (2012-2017)

Free text

3

Row
7

Field Label
What other programs
are currently using this
measure?

Req'd
No

Screen Guidance
Select as many as apply.
These should be current use
programs only, not proposed
programs.

Data Form
Multiselect

Possible Values
Ambulatory Surgical Center Quality
Reporting Program

Add Your Content Here

End-Stage Renal Disease Quality Incentive
Program
Home Health Quality Reporting Program
Hospice Quality Reporting Program
Hospital-Acquired Condition Reduction
Program
Hospital Inpatient Quality Reporting
Program
Hospital Outpatient Quality Reporting
Program
Hospital Readmissions Reduction Program
Hospital Value-Based Purchasing Program
Inpatient Psychiatric Facility Quality
Reporting Program
Inpatient Rehabilitation Facility Quality
Reporting Program
Long-Term Care Hospital Quality Reporting
Program
Medicaid and Medicare EHR Incentive
Program for Eligible Hospitals and Critical
Access Hospitals
Medicare Shared Savings Program
Merit-based Incentive Payment System
Prospective Payment System-Exempt
Cancer Hospital Quality Reporting Program
Skilled Nursing Facility Quality Reporting
Program
Skilled Nursing Facility Value-Based
Purchasing Program

FINAL 1/31/2017

4

Row
8

Field Label
Summary

9

Measure ID

No

10

Measure description

Yes

FINAL 1/31/2017

Req'd
Yes

Screen Guidance
Provide the measure title
only (255 characters or less).
Put program-specific ID
number in the next field, not
in the title. Note: Enter the
NQF ID number and former
MUC ID number (if
applicable) in later fields.
Alphanumeric identifier (if
applicable), such as a
recognized program ID
number for this measure (20
characters or less).
Examples: 199 GPRO HF-5;
ACO 28; CTM-3; PQI #08.
Fields for the NQF ID number
and previous year(s) Jira
MUC ID number are
provided in other data fields
within this form.
Provide a brief description of
the measure (700 characters
or less). When you paste
text, any content over the
limit will be truncated.

Data Form
Free text
255
characters
max

Possible Values

Add Your Content Here

Free text
20
characters
max

Free text
700
characters
or less)

5

Row
11

Field Label
Numerator

12

Denominator

Yes

13

Exclusions

Yes

14

Measure Type*

Yes

FINAL 1/31/2017

Req'd
Yes

Screen Guidance
The upper portion of a
fraction used to calculate a
rate, proportion, or ratio. A
clinical action to be counted
as meeting a measure's
requirements. For all fields,
especially Numerator and
Denominator, use plain text
whenever possible. If
needed, convert any special
symbols, math expressions,
or equations to plain text
(keyboard alphanumeric,
such as + - * /). This will help
reduce errors and speed up
data conversion, team
evaluation, and MUC report
formatting.
The lower part of a fraction
used to calculate a rate,
proportion, or ratio. The
denominator is associated
with a given patient
population that may be
counted as eligible to meet a
measure’s inclusion
requirements.
Can apply to the Numerator
or the Denominator.
Select only one type of
measure.

Data Form
Free text

Possible Values

Add Your Content Here

Free text

Free text
Select one

None
Composite
Cost/Resource Use
Efficiency
Intermediate Outcome
Outcome
Patient Reported Outcome
Process
Structure
Other (enter in Comments at far bottom of
this form)

6

Row
15

Field Label
Which clinical
guideline(s)?

16

Is this measure similar
to and/or competing
with measure(s) already
in a program?
If Yes:
Which existing
measure(s) is your
measure similar to
and/or competing with?
Rationale for how this
measure will add to the
CMS program
How will this measure
be distinguished from
other similar and/or
competing measures?
What is the target
population of the
measure?

Yes

What area of specialty
best fits the measure?

Yes

17
18

19
20

21

22

FINAL 1/31/2017

Req'd
No

Screen Guidance
The measure should improve
compliance with standard
clinical guidelines. Provide a
detailed description of which
guideline the measure is
based on and how the
measure will enhance
compliance with the clinical
guidelines.
Consider other measures
with similar purposes.

Data Form
Free text

No

Identify the other measure(s)
including title and any other
unique identifier

Free text

No

Describe benefits of this
measure, in comparison to
existing measure(s).
Describe key differences that
set this measure apart from
others.

Free text

What populations are
included in this measure?
e.g., Medicare Fee for
Service, Medicare
Advantage, Medicaid, All
Payer, etc.
Select the most applicable
area of specialty. Use the
scroll bar to view all available
specialties.

Free text

No

Yes

Select one

Possible Values

Add Your Content Here

Yes
No

Free text

Select one
See Appendix A.22 for list choices.

7

Row
23

Field Label
What NQS priority
applies to this
measure?

Req'd
Yes

Screen Guidance
National Quality Strategy
priorities (also known as
domains); select as many as
apply. Hold down the Ctrl
button while choosing to
make multiple selections.

Data Form
Multiselect

Possible Values
Making care safer by reducing harm caused
in the delivery of care

Add Your Content Here

Ensuring that each person and family is
engaged as partners in their care
Promoting effective communication and
coordination of care
Promoting the most effective prevention
and treatment practices for the leading
causes of mortality, starting with
cardiovascular disease
Working with communities to promote
wide use of best practices to enable
healthy living
Making quality care more affordable for
individuals, families, employers, and
governments by developing and spreading
new health care delivery models
Measure not able to be categorized

24
25

26

Briefly describe the
peer reviewed evidence
justifying this measure
What is the NQF status
of the measure?

Yes

Add description of evidence.

Free text

Yes

Select only one

Select one

NQF ID number

Yes

Four-digit number with
leading zeros if needed. If no
NQF ID number is known,
enter numerals 0000.

Four-digit
ID value

FINAL 1/31/2017

None
Endorsed
De-endorsed
Submitted
Failed endorsement
Never submitted

8

Row
27

Field Label
Evidence that the
measure can be
operationalized

28
29

If endorsed:
Is the measure being
proposed exactly as
endorsed by NQF?
If not exactly as
endorsed, specify the
locations of the
differences

30

31

If not exactly as
endorsed, describe the
nature of the
differences

FINAL 1/31/2017

Req'd
No

Screen Guidance
Provide evidence that the
data source used by the
measure is readily available
to CMS. Summarize how
CMS would operationalize
the measure. For example, if
the measure is based on
registry data, the submitter
must provide evidence that
the majority of the hospitals
in the program in which the
measure will be used
participate in the registry; if
the measure is registrybased, the submitter must
provide a plan for CMS to
gain access to the registry
data.

Data Form
Free text

Possible Values

No

Select only one

Radio
button

Yes
No

No

Which specification fields are
different? Select as many as
apply.

Multiselect

No

Briefly describe the
differences

Free text

Measure title
Description
Numerator
Denominator
Exclusions
Target Population
Area of specialty
Setting (for testing)
Level of analysis
Data source
eCQM status
Other (see next field)

Add Your Content Here

9

Row
32

Field Label
Year of NQF Consensus
Development Process
(CDP) endorsement

Req'd
No

33

Year of next scheduled
NQF CDP endorsement
review

34

In what state of
development is the
measure?

FINAL 1/31/2017

Screen Guidance
Select one

Data Form
Select one

No

Select one

Select one

Yes

Select as many as apply. Hold
down the Ctrl button while
choosing to make multiple
selections.

Multiselect

Possible Values
None
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
None
2016
2017
2018
2019
2020
Early Development
Field Testing
Fully Developed

Add Your Content Here

10

Row
35

Field Label
State of Development
Details

Req'd
No

Screen Guidance
Details are helpful to CMS in
understanding where the
measure is in the
developmental cycle and will
weigh heavily in determining
whether or not the measure
will be published on the
MUC List.

Data Form
Free text

Possible Values

Add Your Content Here

If you selected field testing
or fully developed above,
please describe what testing
(e.g., alpha, beta, etc.) has
taken place in addition to the
results of that testing.
If you selected early
development above,
meaning testing is not
currently underway, please
describe when testing is
planned (i.e., specific dates),
what type of testing is
planned (e.g., alpha, beta,
etc.) as well as the types of
facilities the measure will be
tested in.

FINAL 1/31/2017

11

Row
36

Field Label
In which setting was
this measure tested?

37

At what level of analysis
was the measure
tested?

FINAL 1/31/2017

Req'd
Yes

Screen Guidance
Select as many as apply. Hold
down the Ctrl button while
choosing to make multiple
selections.

Data Form
Multiselect

Yes

Select as many as apply. Hold
down the Ctrl button while
choosing to make multiple
selections.

Multiselect

Possible Values
None
Ambulatory surgery center
Ambulatory/office-based care
Community hospitals
Dialysis facility
Emergency department
Hospital outpatient department (HOD)
Home health
Hospital inpatient
Hospital/acute care facility
Inpatient psychiatric facility
Inpatient rehabilitation facility
IP units within acute care hospitals
Long-term care hospital
Nursing home
Post-acute care facility(s)
PPS-exempt cancer hospital
Psychiatric outpatient
Veterans Health Administration facilities
Other (enter in Comments at far bottom of
this screen)
None
Clinician
Group
Facility
Health plan
Not yet tested
Other (enter in Comments at far bottom of
this screen)

Add Your Content Here

12

Row
38

Field Label
What data sources are
used for the measure?

Req'd
Yes

Screen Guidance
Select as many as apply.
Hold down the Ctrl button
while choosing to make
multiple selections.

Data Form
Multiselect

Possible Values
Administrative claims (non-Medicare; enter
relevant parts in the field below)

Add Your Content Here

Administrative clinical data
Facility discharge data
Chronic condition data warehouse (CCW)
Claims
CROWNWeb
EHR (enter relevant parts in the field
below)
Hybrid
IRF-PAI
LTCH CARE data set
National Healthcare Safety Network
OASIS-C1
Paper medical record
Prescription Drug Event Data Elements
PROMIS
Record review
Registry (enter which Registry in the field
below)
Survey
Other (enter in Comments at far bottom of
this screen)
None

39
40

If Registry:
Specify the registry(ies)

FINAL 1/31/2017

No

Identify the registry using
the proposed measure.
Select as many as apply. Use
the scroll bar to view all
available registries.

Multiselect

See Appendix A.40 for list choices.

13

Row
41

Field Label
If EHR or Administrative
Claims or ChartAbstracted Data,
description of parts
related to these sources

42

Is this measure an
eCQM?

Yes

43

If eCQM, enter Measure
Authoring Tool (MAT)
number
If eCQM, does the
measure have a Health
Quality Measures
Format (HQMF)
specification?

Yes

44

FINAL 1/31/2017

Req'd
No

Yes

Screen Guidance
Provide a brief, specific
description of which parts of
the measure are taken from
EHR, administrative claimsbased, or chart-abstracted
(i.e., paper medical records)
data sources.
Is this an electronic clinical
quality measure (eCQM)?
Select only one. If your
answer is yes, the Measure
Authoring Tool (MAT) ID
number must be provided
below.
If not an eCQM, or if MAT
number is not available,
enter 0.
If not eCQM, enter No

Data Form
Free text

Select one

Possible Values

Add Your Content Here

Yes
No

Free text
Select one

Yes
No

14

Row
45

Field Label
Evidence of
performance gap

46

Unintended
consequences

FINAL 1/31/2017

Req'd
Yes

No

Screen Guidance
Evidence of a performance
gap among the units of
analysis in which the
measure will be
implemented. Provide
analytic evidence that the
units of analysis have room
for improvement and
therefore that the
implementation of the
measure would be
meaningful. The distribution
of performance should be
wide. Measures must not
address “topped-out”
opportunities. Please provide
current rate of performance
and standard deviation from
that rate to demonstrate
variability. If available, please
provide information on the
testing data set.
Summary of potential
unintended consequences if
the measure is implemented.
Information can be taken
from NQF CDP manuscripts
or documents. If referencing
NQF documents, you must
submit the document or a
link to the document, and
the page being referenced.

Data Form
Free text

Possible Values

Add Your Content Here

Free text

15

Row
47

Field Label
Was this measure
published on a previous
year's Measures under
Consideration list?

48

In what prior year(s)
was this measure
published?

No

49

What were the MUC IDs
for the measure in each
year?

No

FINAL 1/31/2017

Req'd
Yes

Screen Guidance
If yes, you are proposing the
existing measure for
expansion into additional
CMS programs or the
measure has substantially
changed since originally
published, then proceed to
the following subset of data
fields including (i.e., In what
prior year(s) was this
measure published?, What
were the MUC IDs for the
measure in each year?, Why
was the measure not
recommended by the MAP
workgroups in those
year(s)?, What were the
programs that NQF MAP
reviewed the measure for in
each year?, List the NQF
MAP workgroup(s) in each
year, What was the NQF
MAP decision each year?,
and NQF MAP report page
number being referenced for
each year). If no, then skip
these subset questions.
Select as many as apply. Hold
down the Ctrl button while
choosing to make multiple
selections.

Data Form
Select one

List both the year and the
associated MUC ID number
in each year. If unknown,
enter N/A.

Free text

Multiselect

Yes
No

Possible Values

Add Your Content Here

None
2011
2012
2013
2014
2015
2016
Other (enter in Comments at far bottom of
this screen)

16

Row
50

51

52

53

Field Label
Why was the measure
not recommended by
the MAP workgroups in
those year(s)?
What were the
programs that NQF
MAP reviewed the
measure for in each
year?
List the NQF MAP
workgroup(s) in each
year

Req'd
No

Screen Guidance
Briefly describe the reason(s)
if known.

Data Form
Free text

No

List both the year and the
associated program name in
each year.

Free text

No

Free text

What was the NQF MAP
decision in each year?

No

List both the year and the
associated workgroup name
in each year. Workgroup
options: Clinician; Hospital;
Post-Acute Care/Long-Term
Care; Coordinating
Committee. Example:
"Clinician, 2014"
List the year(s), the
program(s), and the
associated decision(s) in
each year. Decision options:
Support; Do Not Support;
Conditionally Support

FINAL 1/31/2017

Possible Values

Add Your Content Here

Free text

17

Row
54

Field Label
NQF MAP report link for
each year

Req'd
Screen Guidance
Data Form
Possible Values
Add Your Content Here
For your reference in completing this section, click on the links below or copy/paste the links into your browser to view each year's MAP prerulemaking report (2012 to 2017).
2017: Link currently unavailable
2016: http://www.qualityforum.org/map/
2015: http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=78711
2014: http://www.qualityforum.org/Publications/2014/01/MAP_PreRulemaking_Report__2014_Recommendations_on_Measures_for_More_than_20_Federal_Programs.aspx
2013: http://www.qualityforum.org/Publications/2013/02/MAP_Pre-Rulemaking_Report_-_February_2013.aspx
2012: http://www.qualityforum.org/Publications/2012/02/MAP_PreRulemaking_Report__Input_on_Measures_Under_Consideration_by_HHS_for_2012_Rulemaking.aspx
All major NQF reports going back to 2008 should be locatable here: http://www.qualityforum.org/Publications.aspx

55

56

57

58

NQF MAP report page
number being
referenced for each
year
If this measure is being
proposed to meet a
statutory requirement,
please list the
corresponding statute
Measure steward

Measure Steward
Contact Information

FINAL 1/31/2017

No

List both the year and the
associated MAP report page
number for each year.

Free text

No

List title and other
identifying citation
information.

Free text

Yes

Select the current Measure
Steward. Select as many as
apply. Use the scroll bar to
view all available stewards.
Hold down the Ctrl button
while choosing to make
multiple selections.
Last name, First name;
Affiliation (if different);
Telephone number; Email
address

Multiselect

Yes

See Appendix A.57-59 for list choices.

Free text

18

Row
59

Field Label
Long-Term Measure
Steward (if different)

Req'd
No

60

Long-Term Measure
Steward Contact
Information

No

61

Primary Submitter
Contact Information

Yes

62

Secondary Submitter
Contact Information

No

63

Comments

No

FINAL 1/31/2017

Screen Guidance
Entity or entities that will be
the permanent measure
steward(s), responsible for
maintaining the measure and
conducting NQF
maintenance review. Use the
scroll bar to view all available
stewards. Hold down the Ctrl
button while choosing to
make multiple selections.
If different from Steward
above: Last name, First
name; Affiliation; Telephone
number; Email address
If different from Steward
above: Last name, First
name; Affiliation; Telephone
number; Email address
If different from name(s)
above: Last name, First
name; Affiliation; Telephone
number; Email address
Any notes, qualifiers,
external references, or other
information not specified
above. For OTHER entries:
please indicate the type of
additional data you are
providing, such as Measure
Type, Setting, Level of
Analysis, or Measure
Steward.

Data Form
Multiselect

Possible Values

Add Your Content Here

See Appendix A.57-59 for list choices.

Free text

Free text

Free text

Free text

19

Row
64

65

Field Label
Attachment(s)

MIPS Journal Article
Requirement

FINAL 1/31/2017

Req'd
No

No

Screen Guidance
The maximum file upload
size is 10.00 MB. Attach
measure information form
(MIF) if available. This is a
detailed description of the
measure used by NQF during
endorsement proceedings. If
a MIF is not available, a
detailed Measure
Methodology form is
acceptable.
If you select MIPS, please
navigate to the Additional
Resources list at this web
site:
https://www.cms.gov/Medic
are/Quality-InitiativesPatient-AssessmentInstruments/QualityMeasure
s/Pre-Rule-Making.html,
download the “MIPS PeerReview Template and a
Completed Sample,” and
attach the completed form
to your JIRA submission
using the “Attachments”
field at the bottom of this
web page.
For those submitting
measures to MIPS program,
click “Yes” after you have
attached your completed
Peer-Reviewed Journal
Article Requirement form.

Data Form
Browse for
files

Radio
button

Possible Values

Add Your Content Here

Yes
No

20

Appendix: Lengthy Drop-Down List Choices
A.22 Choices for What area of specialty best fits the measure?
None
Addiction medicine
Allergy/immunology
Anesthesiology
Cardiac electrophysiology
Cardiac surgery
Cardiovascular disease (cardiology)
Chiropractic medicine
Colorectal surgery (proctology)
Critical care medicine (intensivists)
Dermatology
Diagnostic radiology
Electrophysiology
Emergency medicine
Endocrinology
Family practice
Gastroenterology
General practice
General surgery
Geriatric medicine
Gynecological oncology
Hand surgery
Hematology/oncology
Hospice and palliative care
Infectious disease
Internal medicine
Interventional pain management
Interventional radiology
Maxillofacial surgery
Medical oncology
Mental health professionals
Nephrology
Neurology
Neuropsychiatry
Neurosurgery
Nuclear medicine
Obstetrics/gynecology
Ophthalmology

FINAL 1/31/2017

Optometry
Oral surgery (dentists only)
Orthopedic surgery
Osteopathic manipulative medicine
Otolaryngology
Pain management
Palliative care
Pathology
Pediatric medicine
Peripheral vascular disease
Physical medicine and rehabilitation
Plastic and reconstructive surgery
Podiatry
Preventive medicine
Primary care
Psychiatry
Pulmonary disease
Pulmonology
Radiation oncology
Rheumatology
Sleep medicine
Sports medicine
Surgical oncology
Thoracic surgery
Urology
Vascular surgery
Other (enter in Comments at far bottom of this screen)

21

A.40 Choices for Specify the registry(ies)
None

E*HealthLine.com Inc

CDC, NHSN (National Healthcare Safety Network)

eClinicalWeb (eClinicalWorks) Registry

American Nursing Association’s National Database for Nursing Quality Indicators®
(NDNQI®)

EVMS Academic Physicians and Surgeons Health Services Foundation

American College of Surgeons National Surgical Quality Improvement Program ASC
NSQIP)

FORCE-TJR Registry QITM

American College of Surgeons National Cancer Data Base (ASC NCDB)
American Heart Association’s Get With the Guidelines Database
Alere Analytics Registry
American Board of Family Medicine Registry
American College of Surgeons (ACS) Surgeon Specific Registry (SSR)
American Health IT
American Osteopathic Association Clinical Assessment Program
American Society of Clinical Oncology’s Quality Oncology Practice Initiative (QOPI)
Anesthesia Quality Institute National Anesthesia Clinical Outcomes Registry (NACOR)
Bayview Physician Services Registry
BMC Clinical Data Warehouse Registry
Care Coordination Institute Registry
CECity Registry (“PQRSwizard”)
Cedaron Medical
Central Utah Informatics
CINA
Clinical Support Services
Clinicient
Clinigence
Conifer Value-Based Care
Corrona, LLC
Covisint Corporation Registry (formerly Docsite)
Crimson Care Registry
DC2 Healthcare (NOC2 Spine Registry and C3 Total Joint Registry)
Digital Medical Solutions Registry
DrexelMed Registry

FINAL 1/31/2017

Falcon Registry
FOTO PQRS Registry
Fresenium Medical Care CKD Data Registry
Geriatric Practice Management LTC Registry
Greenway Health PrimeDATACLOUD PQRS Registry
HCA Physician Services PQRS Registry
HCFS Health Care Financial Services LLC (HCFS)
Health Focus Registry
ICLOPS
Ingenious Med, Inc.
Intellicure, Inc
Intelligent Healthcare
iPatientCare Registry
IPC The Hospitalist Company Registry
IRISTM Registry
Johns Hopkins Disease Registry
Lumeris Registry
M2S Registry
Mankato Clinic Registry
Massachusetts General Physicians Organization Registry
McKesson Population Manager
MDinteractive
MDSync LLC
MedAmerica/CEP America Registry
Meditab Software, Inc
MedXpress Registry
MEGAS, LLC Alpha II Registry
Michigan Spine Surgery Improvement Collaborative

22

myCatalyst

American College of Cardiology Foundation FOCUS Registry

Net Health Specialty Care Registry

American College of Cardiology Foundation PINNACLE Registry

Net.Orange cOS Registry

American College of Physicians Genesis RegistryTM in collaboration with CECity

NeuroPoint Alliance (NPA)’s National Neurosurgery Quality & Outcomes Database
(N2QOD)

American College of Radiology National Radiology Data Registry

NextGen Healthcare Solutions
NJ-HITEC Clinical Reporting Registry
OmniMD
Patient360
PMI Registry
PQRS Solutions
PQRSPRO NetHealth LLC
Pulse PQRS Registry
Quintiles PQRS Registry
ReportingMD Registry
RexRegistry by Prometheus Research
Solutions for Quality Improvement (SQI) Registry
Specialty Benchmarks Registry
SunCoast RHIO
SupportMed Data Analytics & Registry
Surgical Care and Outcomes Assessment Program (SCOAP)
SwedishAmerican Medical Group

American College of Rheumatology Rheumatology Informatics System for Effectiveness
American Gastroenterological Association Colorectal Cancer Screening and Surveillance
Registry in collaboration with CECity
American Gastroenterological Association Digestive Recognition Program Registry in
collaboration with CECity
American Joint Replacement Registry
American Society of Breast Surgeons Mastery of Breast Surgery Program
American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI)R
Anesthesia Quality Institute National Anesthesia Clinical Outcomes Registry
Chronic Disease Registry, Inc
CUHSM.ORG
Faculty Practice Foundation, Inc. supported by BMC Clinical Data Warehouse Registry
Geriatric Practice Management LTC Qualified Clinical Data Registry
GI Quality Improvement Consortium’s GIQuIC Registry
Louisiana State University Health Care Quality Improvement Collaborative [Louisiana
State University, Quality in Health Care Advisory Group, LLC (QHC Advisory Group),
CECity]
Massachusetts eHealth Collaborative Quality Data Center QCDR

TeamPraxis-Allscripts CQS

Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program
(MBSAQIP) QCDR

The Pain Center USA PLLC

Michigan Bariatric Surgery Collaborative QCDR

Unlimited Systems Specialty Healthcare Registry

Michigan Urological Surgery Improvement Collaborative QCDR

Venous Patient Outcome Registry
Vericle, Inc.

National Osteoporosis Foundation and National Bone Health Alliance Quality
Improvement Registry in collaboration with CECity

Webconsort LLC

OBERD QCDR

WebOutcomes LLC

Oncology Nursing Quality Improvement Registry in collaboration with CECity

WebPT, Inc

Oncology Quality Improvement Collaborative (The US Oncology Network, McKesson
Specialty Health, Quality in Health Care Advisory Group, LLC (QHC Advisory Group),
CECity)

Wellcentive, Inc
Wisconsin Collaborative for Health Care Quality Registry
AAAAI Allergy, Asthma & Immunology Quality Clinical Data Registry in collaboration with
CECity

FINAL 1/31/2017

Physician Health Partners QCDR
Premier Healthcare Alliance Physician RegistryTM

23

Renal Physicians Association Quality Improvement Registry in collaboration with CECity
Society of Thoracic Surgeons National Database
The Guideline AdvantageTM (American Cancer Society, American Diabetes Association,
American Heart Association) supported by Forward Health Group's PopulationManagerR
Vancouver Clinic
Wisconsin Collaborative for Healthcare Quality
Wound Care Quality Improvement Collaborative (Paradigm Medical Management,
Patient Safety Education Network (PSEN), Net Health Systems, Inc., CECity)

FINAL 1/31/2017

24

A.57-59 Choices for Measure steward (57) and Long-Term Measure Steward (if different) (59)
None

Heart Rhythm Society (HRS)

Agency for Healthcare Research & Quality

Indian Health Service

Alliance of Dedicated Cancer Centers

Infectious Diseases Society of America (IDSA)

American Academy of Allergy, Asthma & Immunology (AAAAI)

MN Community Measurement

American Academy of Dermatology

National Committee for Quality Assurance

American Academy of Neurology

Office of the National Coordinator for Health Information Technology

American Academy of Otolaryngology – Head and Neck Surgery (AAOHN)

Office of the National Coordinator for Health Information Technology/Centers for
Medicare & Medicaid Services

American College of Cardiology
American College of Emergency Physicians

Pharmacy Quality Alliance

American College of Emergency Physicians (previous steward Partners-Brigham &
Women's)

Philip R. Lee Institute for Health Policy Studies
RAND Corporation

American College of Obstetricians and Gynecologists (ACOG)

Renal Physicians Association; joint copyright with American Medical Association Physician Consortium for Performance Improvement

American College of Radiology
American College of Rheumatology
American College of Surgeons
American Gastroenterological Association
American Medical Association
American Medical Association - Physician Consortium for Performance Improvement
American Medical Association - Physician Consortium for Performance
Improvement/American College of Cardiology/American Heart Association

Society of Interventional Radiology
The Joint Commission
The Society for Vascular Surgery
University of Minnesota Rural Health Research Center
University of North Carolina- Chapel Hill
Other (enter in Comments at far bottom of this screen)

American Nurses Association
American Society for Gastrointestinal Endoscopy
American Society for Radiation Oncology
American Society of Addiction Medicine
American Society of Anesthesiologists
American Urogynecologic Society
American Urological Association (AUA)
ASC Quality Collaboration
Bridges to Excellence
Centers for Disease Control and Prevention
Centers for Medicare & Medicaid Services
Health Resources and Services Administration (HRSA) - HIV/AIDS Bureau

FINAL 1/31/2017

25

Template
Peer Reviewed Journal Article Requirement

Section 101(c)(1) of the MACRA requires submission of new measures for publication in applicable specialtyappropriate, peer-reviewed journals prior to implementing in MIPS. These measures will be submitted to a
journal(s) before including any new measure in the final list of annual clinical quality measures (CQM) under
MIPS. The measure owner shall provide the required information for article submission under the MACRA per
CMS “Call for Measures” submission process.
Measure owners submitting measures into JIRA must complete the required information by the MUC deadline.
Some of the information requested below may be listed in specific fields in the JIRA tool, however to ensure
that CMS has all of the necessary information, please submit the information as an attached word document in
JIRA. This includes, but is not limited to:
[Measure Title]
[Domain]

Measure Owner: [Name]
Measure Developer: [Name]
Description:

I.

Statement
• Background (Why is this measure important?)
• Environmental Scan (Are there existing measures in this area?)

II.

Gap Analysis
• Evidence for Measure (What are the gaps and opportunities to improve care?)
• Expected Outcome (Patient care/patient health improvements, cost savings)
• Recommendation for Measure (Is it based on a study, consensus opinion, USPSTF
recommendation etc.?)

III.

Reliability/Validity (If applicable)
• Has it been tested? Please provide testing results.
• Is there a minimum sample size for reliability results?
a. Other Information
• Is it risk adjusted?
• Are there benchmarks?

IV.

Endorsement
• NQF or other endorsing body (If measure is only endorsed for paper records, please note
endorsement for only the data source being submitted)

V.

Summary
• Alignment with CMS Quality Strategy or MACRA (If applicable)
• Importance to MIPS or other CMS programs
• Rationale: Use of measure for inclusion in program (specialty society, regional collaborative,
other)
• Public reporting (if applicable)
• Preferable relevant Peer-Review Journal for publication

PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1314 (Expiration date:
XX/XX/XXXX). The time required to complete this information collection is estimated to average 0.5 hours per organization to
submit a measure to us, including the time to review instructions, search existing data resources, gather the data needed, and
complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop
C4-26-05, Baltimore, Maryland 21244-1850. ****CMS Disclosure**** Please do not send applications, claims, payments, medical
records or any documents containing sensitive information to the PRA Reports Clearance Office. Please note that any
correspondence not pertaining to the information collection burden approved under the associated OMB control number listed on
this form will not be reviewed, forwarded, or retained. If you have questions or concerns regarding where to submit your
documents, please contact [email protected]