Form CMS-10621 Data Template for Candidate Measures

Centers for Medicare & Medicaid Services Measures under Consideration 2019 Data Template for Candidate Measures

Row	Field Label	Req'd	Screen Guidance	Data Form	Possible Values	Add Your Content Here
1	Auto Date (no user input required)
2	Issue Type	Yes	Select Measure Submission to nominate a measure for the 2019 MUC list. Select Question to ask a question on the MUC process. Select Modify Candidate Measure to change a measure already submitted for 2019. Select Feedback to leave feedback about the 2019 MUC process.	Select one	Measure Submission Question Modify Candidate Measure Feedback
3	Component/s	Yes	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. If you are submitting for MIPS, there are two choices of program. Choose MIPS-Quality for measures that pertain to quality and/or efficiency. Choose MIPS-Cost only for measures that pertain to cost. Do not select both MIPS-Quality and MIPS-Cost for the same measure. If you select MIPS (either Quality or Cost), please navigate to the Additional Resources list at this web site: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Pre-Rule-Making.html, download the “MIPS Peer Review 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.	Multi-select	Ambulatory Surgical Center Quality Reporting Program 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 Medicare and Medicaid Promoting Interoperability Program for Eligible Hospitals and Critical Access Hospitals (CAHs) Medicare Shared Savings Program Merit-based Incentive Payment System-Cost Merit-based Incentive Payment System-Quality Prospective Payment System-Exempt Cancer Hospital Quality Reporting Program Skilled Nursing Facility Quality Reporting Program Skilled Nursing Facility Value-Based Purchasing Program
4	What is the history or background for including this measure on the 2019 MUC list?	Yes	Select only one reason	Select one	None New measure never reviewed by MAP Workgroup or used in a CMS program Measure previously submitted to MAP, refined and resubmitted per MAP recommendation Measure currently used in a CMS program being submitted as-is for a new or different program Measure currently used in a CMS program, but the measure is undergoing substantial change
5	If currently used:
6	Range of year(s) this measure has been used by CMS Program(s).	No	For example: Hospice Quality Reporting (2012-2018)	Free text
7	What other federal programs are currently using this measure?	No	Select as many as apply. These should be current use programs only, not programs for the 2019 submittal.	Multi-select	Ambulatory Surgical Center Quality Reporting Program End-Stage Renal Disease Quality Incentive Program Comprehensive Primary Care Plus (CPC+) Health Homes Core Set 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 Adult Core Set Medicaid and CHIP Child Core Set Medicare and Medicaid Promoting Interoperability Program for Eligible Hospitals and Critical Access Hospitals Medicare and Medicaid Promoting Interoperability Program for Eligible Professionals Medicare Part C Medicare Part D Medicare Shared Savings Program Merit-based Incentive Payment System
7	What other federal programs are currently using this measure? (continued)				Prospective Payment System-Exempt Cancer Hospital Quality Reporting Program Quality Health Plan Quality Rating System Skilled Nursing Facility Quality Reporting Program Skilled Nursing Facility Value-Based Purchasing Program
8	Summary	Yes	Provide the measure title only (255 characters or less). Put program-specific ID number in the next field, not in the title. Note: Do not enter the NQF ID, former JIRA MUC ID number, or any other ID numbers here (see below).	Free text 255 characters max
9	Measure ID	No	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.	Free text 20 characters max
10	Measure description	Yes	Provide a brief description of the measure (700 characters or less). When you paste text, any content over the limit will be truncated.	Free text 700 characters or less)
11	Numerator	Yes	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.	Free text
12	Denominator	Yes	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.	Free text
13	Exclusions/Exceptions	Yes	If applicable, specify Numerator Exclusion, Denominator Exclusion, or Denominator Exception.	Free text
14	Measure Type	Yes	Select only one type of measure. For definitions, visit this web site: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Pre-Rule-Making.html and link to the user guide under The JIRA System.	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)
15	Which clinical guideline(s)?	No	The measure should improve compliance with standard clinical guidelines. Provide a detailed description of which guideline supports the measure and how the measure will enhance compliance with the clinical guidelines. Indicate whether the guideline is evidence-based or consensus-based.	Free text
16	Is this measure similar to and/or competing with measure(s) already in a program?	Yes	Consider other measures with similar purposes.	Select one	Yes No
17	If Yes:
18	Which measure(s) already in a program is your measure similar to and/or competing with?	No	Identify the other measure(s) including title and any other unique identifier	Free text
19	How will this measure add value to the CMS program?	No	Describe benefits of this measure, in comparison to measure(s) already in a program.	Free text
20	How will this measure be distinguished from other similar and/or competing measures?	No	Describe key differences that set this measure apart from others.	Free text
21	What is the target population of the measure?	Yes	What populations are included in this measure? e.g., Medicare Fee for Service, Medicare Advantage, Medicaid, CHIP, All Payer, etc.	Free text
22	What one area of specialty is the measure aimed to, or which specialty is most likely to report this measure?	Yes	Select the most applicable area of specialty. Use the scroll bar to view all available specialties.	Select one	See Appendix A.22 for list choices.
23	What one primary healthcare priority applies to this measure?	Yes	Healthcare priorities (also known as domains); select the best one.	Select one	Make care safer by reducing harm caused in the delivery of care Strengthen person and family engagement as partners in their care Promote effective communication and coordination of care Promote effective prevention and treatment of chronic disease Work with communities to promote best practices of healthy living Make care affordable
24	What one primary meaningful measure area applies to this measure?	Yes	Select the best one. The meaningful measure area choices depend on your selection of primary healthcare priority above.	Select one	If #23 is Make care safer…, then choices are: Healthcare-associated infections Preventable healthcare harm If #23 is Strengthen person…, then choices are: Care is personalized and aligned with patient’s goals End of life care according to preferences Patient’s experience of care Functional outcomes If #23 is Promote effective communication…, then choices are: Medication management Admissions and readmissions to hospitals Transfer of health information and interoperability If #23 is Promote effective prevention…, then choices are: Preventive care Management of chronic conditions Prevention, treatment, and management of mental health Prevention and treatment of opioid and substance use disorders Risk adjusted mortality If #23 is Work with communities…, then choices are: Equity of care Community engagement If #23 is Make care affordable, then choices are: Appropriate use of healthcare Patient-focused episode of care Risk adjusted total cost of care
25	What secondary healthcare priority applies to this measure?	No	Healthcare priorities (also known as domains); select one alternate or secondary priority only if applicable.	Select one	Make care safer by reducing harm caused in the delivery of care Strengthen person and family engagement as partners in their care Promote effective communication and coordination of care Promote effective prevention and treatment of chronic disease Work with communities to promote best practices of healthy living Make care affordable
26	What secondary meaningful measure area applies to this measure?	No	Select an alternate or secondary area only if applicable. The meaningful measure area choices depend on your selection of secondary healthcare priority above.	Select one	If #24 is Make care safer…, then choices are: Healthcare-associated infections Preventable healthcare harm If #24 is Strengthen person…, then choices are: Care is personalized and aligned with patient’s goals End of life care according to preferences Patient’s experience of care Functional outcomes If #24 is Promote effective communication…, then choices are: Medication management Admissions and readmissions to hospitals Transfer of health information and interoperability If #24 is Promote effective prevention…, then choices are: Preventive care Management of chronic conditions Prevention, treatment, and management of mental health Prevention and treatment of opioid and substance use disorders Risk adjusted mortality If #24 is Work with communities…, then choices are: Equity of care Community engagement If #24 is Make care affordable, then choices are: Appropriate use of healthcare Patient-focused episode of care Risk adjusted total cost of care
27	Briefly describe the peer reviewed evidence justifying this measure	Yes	Add description of evidence.	Free text
28	What is the NQF status of the measure?	Yes	Select only one. Refer to http://www.qualityforum.org/QPS/ for information on NQF endorsement, measure ID, and other information.	Select one	None Endorsed Endorsement Removed Submitted Failed endorsement Never submitted
29	NQF ID	Yes	Four- or five-digit identifier with leading zeros and following letter if needed. If no NQF ID number is known, enter numerals 0000.	Can be four- or five-character alphanumeric ID value
30	Evidence that the measure can be operationalized	No	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 registry-based, the submitter must provide a plan for CMS to gain access to the registry data. For eCQMs, attach feasibility scorecard or other quantitative evidence indicating measure can be reported by the intended reporting entities.	Free text
31	If endorsed:
32	Is the measure being submitted exactly as endorsed by NQF?	No	Select only one	Radio button	Yes No
33	If not exactly as endorsed, specify the locations of the differences	No	Which specification fields are different? Select as many as apply.	Multi-select	Measure title Description Numerator Denominator Exclusions Target Population Setting (for testing) Level of analysis Data source eCQM status Other (see next field)
34	If not exactly as endorsed, describe the nature of the differences	No	Briefly describe the differences	Free text
35	Year of most recent NQF Consensus Development Process (CDP) endorsement	No	Select one	Select one	None 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
36	Year of next anticipated NQF CDP endorsement review	No	Select one	Select one	None 2019 2020 2021 2022 2023
37	In what state of development is the measure?	Yes	Select as many as apply. Hold down the Ctrl button while choosing to make multiple selections.	Multi-select	Early Development Field Testing Fully Developed
38	State of Development Details	No	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. 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 in which the measure will be tested. 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. Related to testing, summarize results from validity testing including number of reporting entities and patients measured, and how validity was assessed. Summarize results from reliability testing including number of reporting entities and patients measured, and how reliability was assessed.	Free text
39	In which setting was this measure tested?	Yes	Select as many as apply. Hold down the Ctrl button while choosing to make multiple selections.	Multi-select	None Ambulatory surgery center Ambulatory/office-based care Behavioral health clinic and treatment facility Community hospitals Dialysis facility Emergency department Federally qualified health center (FQHC) 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)
40	At what level of analysis was the measure tested?	Yes	Select as many as apply. Hold down the Ctrl button while choosing to make multiple selections.	Multi-select	None Clinician Group Facility Health plan Medicaid program (e.g., Health Home or 1115) State Not yet tested Other (enter in Comments at far bottom of this screen)
41	What data sources are used for the measure?	Yes	Select as many as apply. Hold down the Ctrl button while choosing to make multiple selections. If Claims, then enter relevant parts in the field below. If EHR, then enter relevant parts in the field below. If Registry, then enter which registry in the field below. Use the “Comments” field to specify or elaborate on the type of data source, if needed to define your measure.	Multi-select	Administrative clinical data Facility discharge data Chronic condition data warehouse (CCW) Claims CROWNWeb EHR 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 Survey State Vital Records Other (enter in Comments at far bottom of this screen) None
42	If Registry:
43	Specify the registry(ies)	No	Identify the registry using the submitted measure. Select as many as apply. Use the scroll bar to view all available registries.	Multi-select	See Appendix A.43 for list choices.
44	If EHR or Claims or Chart-Abstracted Data, description of parts related to these sources	No	Provide a brief, specific description of which parts of the measure are taken from EHR, claims-based, or chart-abstracted (i.e., paper medical records) data sources.	Free text
45	How is the measure expected to be reported to the program?	Yes	This differs from the data sources above. This is the anticipated data submission method. Select as many as apply. Hold down the Ctrl button while choosing to make multiple selections. Use the “Comments” field to specify or elaborate on the type of reporting data, if needed to define your measure.	Multi-select	eCQM CQM (Registry) Claims Web interface Other (enter in Comments at far bottom of this screen)
46	Is this measure an eCQM?	Yes	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.	Select one	Yes No
47	If eCQM = Yes
48	If eCQM, enter Measure Authoring Tool (MAT) number	Yes	In the Attachments field below, you must attach Bonnie test cases for this measure, with 100% logic coverage (test cases should be appended), attestation that value sets are published in Value Set Authority Center, and NQF feasibility scorecard. If not an eCQM, or if MAT number is not available, enter 0.	Free text
49	If eCQM, does the measure have a Health Quality Measures Format (HQMF) specification in alignment with the latest HQMF standards?	Yes	If not eCQM, select No	Select one	Yes No
50	Evidence of performance gap	Yes	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. If available, include percent average performance rate, minimum, and maximum. Include validity and reliability values in a standard format, and the population size used in determining these values.	Free text
51	Unintended consequences	No	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.	Free text
52	Was this measure published on a previous year's Measures under Consideration list?	Yes	If yes, you are submitting an 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: 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 recommendation each year?, and NQF MAP report page number being referenced for each year. If no, then skip these subset questions.	Select one	Yes No
53	In what prior year(s) was this measure published?	No	Select as many as apply. Hold down the Ctrl button while choosing to make multiple selections.	Multi-select	None 2011 2012 2013 2014 2015 2016 2017 2018 Other (enter in Comments at far bottom of this screen)
54	What were the MUC IDs for the measure in each year?	No	List both the year and the associated MUC ID number in each year. If unknown, enter N/A.	Free text
55	List the NQF MAP workgroup(s) 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"	Free text
56	What were the programs that NQF MAP reviewed the measure for in each year?	No	List both the year and the associated program name in each year.	Free text
57	What was the NQF MAP recommendation in each year?	No	List the year(s), the program(s), and the associated recommendation(s) in each year. Options: Support; Do Not Support; Conditionally Support; Refine and Resubmit	Free text
58	Why was the measure not recommended by the MAP workgroups in those year(s)?	No	Briefly describe the reason(s) if known.	Free text
59	NQF MAP report link for each year	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 pre-rulemaking report (2012 to 2019). 2019: Link currently unavailable 2016-18: 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_Pre-Rulemaking_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_Pre-Rulemaking_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
60	NQF MAP report page number being referenced for each year	No	List both the year and the associated MAP report page number for each year.	Free text
61	If this measure is being submitted to meet a statutory requirement, please list the corresponding statute	No	List title and other identifying citation information.	Free text
62	Measure steward	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.	Multi-select	See Appendix A.62-64 for list choices.
63	Measure Steward Contact Information	Yes	Last name, First name; Affiliation (if different); Telephone number; Email address	Free text
64	Long-Term Measure Steward (if different)	No	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.	Multi-select	See Appendix A.62-64 for list choices.
65	Long-Term Measure Steward Contact Information	No	If different from Steward above: Last name, First name; Affiliation; Telephone number; Email address	Free text
66	Primary Submitter Contact Information	Yes	If different from Steward above: Last name, First name; Affiliation; Telephone number; Email address	Free text
67	Secondary Submitter Contact Information	No	If different from name(s) above: Last name, First name; Affiliation; Telephone number; Email address	Free text
68	Comments	No	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.	Free text
69	Attachment(s)	No	The maximum file upload size is 10.00 MB. You are encouraged to 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, comprehensive measure methodology documents are encouraged. If you select MIPS, please navigate to the Additional Resources list at this web site: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Pre-Rule-Making.html, download the “MIPS Peer Review 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. If eCQM, you must attach Bonnie test cases for this measure, with 100% logic coverage (test cases should be appended), attestation that value sets are published in Value Set Authority Center, and NQF feasibility scorecard.	Browse for files
70	MIPS Journal Article Requirement	No	For those submitting measures to MIPS program, click “Yes” after you have attached your completed Peer Reviewed Journal Article Requirement form.	Radio button	Yes No

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
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)

A.43 Choices for Specify the registry(ies)

None

CDC, NHSN (National Healthcare Safety Network)

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

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

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

E*HealthLine.com Inc

eClinicalWeb (eClinicalWorks) Registry

EVMS Academic Physicians and Surgeons Health Services Foundation

Falcon Registry

FORCE-TJR Registry QITM

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

myCatalyst

Net Health Specialty Care Registry

Net.Orange cOS Registry

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

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

TeamPraxis-Allscripts CQS

The Pain Center USA PLLC

Unlimited Systems Specialty Healthcare Registry

Venous Patient Outcome Registry

Vericle, Inc.

Webconsort LLC

WebOutcomes LLC

WebPT, Inc

Wellcentive, Inc

Wisconsin Collaborative for Health Care Quality Registry

AAAAI Allergy, Asthma & Immunology Quality Clinical Data Registry in collaboration with CECity

American College of Cardiology Foundation FOCUS Registry

American College of Cardiology Foundation PINNACLE Registry

American College of Physicians Genesis RegistryTM in collaboration with CECity

American College of Radiology National Radiology Data Registry

American College of 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

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

Michigan Bariatric Surgery Collaborative QCDR

Michigan Urological Surgery Improvement Collaborative QCDR

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

OBERD QCDR

Oncology Nursing Quality Improvement Registry in collaboration with CECity

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

Physician Health Partners QCDR

Premier Healthcare Alliance Physician RegistryTM

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)

A.62-64 Choices for Measure steward (62) and Long-Term Measure Steward (if different) (64)

None

Agency for Healthcare Research & Quality

Alliance of Dedicated Cancer Centers

Ambulatory Surgical Center (ASC) Quality Collaboration

American Academy of Allergy, Asthma & Immunology (AAAAI)

American Academy of Dermatology

American Academy of Neurology

American Academy of Ophthalmology

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

American College of Cardiology

American College of Emergency Physicians

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

American College of Obstetricians and Gynecologists (ACOG)

American College of Radiology

American College of Rheumatology

American College of Surgeons

American Gastroenterological Association

American Health Care 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

American Nurses Association

American Psychological Association

American Society for Gastrointestinal Endoscopy

American Society for Radiation Oncology

American Society of Addiction Medicine

American Society of Anesthesiologists

American Society of Clinical Oncology

American Society of Clinical Oncology

American Urogynecologic Society

American Urological Association (AUA)

AQC/ASHA

ASC Quality Collaboration

Audiology Quality Consortium/American Speech Language Hearing Association

Bridges to Excellence

Centers for Disease Control and Prevention

Centers for Medicare & Medicaid Services

Eugene Gastroenterology Consultants, PC Oregon Endoscopy Center, LLC

Health Resources and Services Administration (HRSA) - HIV/AIDS Bureau

Heart Rhythm Society (HRS)

IAC

Indian Health Service

Infectious Diseases Society of America (IDSA)

KCQA- Kidney Care Quality Alliance

MN Community Measurement

National Committee for Quality Assurance

National Minority Quality Forum

Office of the National Coordinator for Health Information Technology

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

Oregon Urology Institute

Oregon Urology Institute in collaboration with Large Urology Group Practice Association

Other (enter in Comments at far bottom of this screen)

Pharmacy Quality Alliance

Philip R. Lee Institute for Health Policy Studies

PPRNet 

RAND Corporation

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

Seattle Cancer Care Alliance

Society of Gynecologic Oncology

Society of Interventional Radiology

The Academy of Nutrition and Dietetics

The Joint Commission

The Society for Vascular Surgery

The University of Texas MD Anderson Cancer Center

University of Minnesota Rural Health Research Center

University of North Carolina- Chapel Hill

Wisconsin Collaborative for Healthcare Quality (WCHQ

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 1.5 hours per response, 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 QPP at [email protected].

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