CMS-10621 Measures under Consideration 2019, Data Template for Can

Quality Payment Program/Merit-Based Incentive Payment System (MIPS) (CMS-10621)

Appendix G1 2020 MUC Data Template

2023 > (Quality Performance Category) Call for Quality Measures (see SS-A Table 18)

OMB: 0938-1314

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Centers for Medicare & Medicaid Services

Measures under Consideration 2020

Data Template for Candidate Measures

Instructions:
1. Complete the measure template below by entering your candidate measure information in the column titled “Add Your Content Here.”
2. All rows that have an asterisk symbol * in the Field Label require a response. These rows also appear unshaded.
3. All rows shaded in gray are optional. You are encouraged to complete all rows that are applicable to your measure.
4. For each row, the “Guidance” column provides details about how to complete the form and what kind of data to include in your response.
5. For check boxes, note whether the field is “select one” or “select all that apply.” You can click on the box to place or remove the “X.”
6. If you have lengthy text to insert, place the text at the bottom of the form, clearly indicating your intended row number or field label.
7. Send completed templates and any accompanying files (e.g., MIPS Peer Review Journal Article attachment, testing data, MAT information) by
June 30, 2020 to [email protected]
8. If you need to submit a measure change, please use the “Review” tab in Word and select “Track Changes” or highlight any updates you made to
the measure, then by September 4, 2020, send the revised template to [email protected]
Row
1
2

Field Label

*Date

MM/DD/YYYY

*Issue Type

4/10/2020

Guidance
Enter the current date of submission or revision
Select Measure Submission to nominate a measure
for the 2020 MUC list. Select Modify Candidate
Measure to change a measure already submitted
for 2020. Select only one.

ADD YOUR CONTENT HERE

☐ Measure Submission
☐ Modify Candidate Measure

1

Row
3

Field Label

*CMS Program(s)

Guidance
Select the CMS program(s) for which the measure is
being submitted. Select all that apply.
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 enter both MIPS-Quality and MIPS-Cost
for the same measure.
If you enter MIPS (either Quality or Cost), please
navigate to the Additional Resources list at this web
site: https://www.cms.gov/Medicare/QualityInitiatives-Patient-AssessmentInstruments/QualityMeasures/Pre-RuleMaking.html, download the “MIPS Peer Review
Template and a Completed Sample,” and send the
completed form with your template by email to
[email protected].

4

5
6

*What is the

history or
background for
including this
measure on the
2020 MUC list?
If currently used:
Range of year(s) this
measure has been
used by CMS
Program(s).

4/10/2020

Select only one description

ADD YOUR CONTENT HERE
☐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
☐ Part C and D Star Ratings
☐ Prospective Payment System-Exempt Cancer Hospital Quality Reporting Program
☐ Skilled Nursing Facility Quality Reporting Program
☐ Skilled Nursing Facility Value-Based Purchasing Program
☐ 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

For example: Hospice Quality Reporting (20122018)

2

Row
7

Field Label
What other federal
programs are
currently using this
measure?

4/10/2020

Guidance
Select all that apply. These should be current use
programs only, not programs for the 2020
submittal.

ADD YOUR CONTENT HERE
☐ 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
☐ 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

3

Row
8

*Measure Title

9

Measure ID

10
11

Field Label

*Measure

description

*Numerator

Guidance
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 other fields below). The CMS
program name should not ordinarily be part of the
measure title, because each measure record already
has a required field that specifies the CMS program.
An exception would be if there are several
measures with otherwise identical titles that apply
to different programs. In this case, including or
imbedding a program identifier in the title (to
prevent there being any otherwise duplicate titles)
is helpful.
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.

ADD YOUR CONTENT HERE

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).
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.
For all free-text fields: Be sure to spell out all
abbreviations and define special terms at their first
occurrence. This will save time and revision/editing
cycles during clearance.

4/10/2020

4

Row
12

*Denominator

Field Label

13

*Exclusions/
Exceptions

Guidance
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.
If applicable, specify Numerator Exclusion,
Denominator Exclusion, or Denominator Exception.

*Measure Type

Select only one type of measure. For definitions,
visit this web site:
https://www.cms.gov/Medicare/Quality-InitiativesPatient-AssessmentInstruments/QualityMeasures/Pre-RuleMaking.html .

15

Which clinical
guideline(s)?

16

*Is this measure
similar to and/or
competing with
measure(s) already
in a program?
If Yes:
Which measure(s)
already in a
program is your
measure similar to
and/or competing
with?

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.
Select either Yes or No. Consider other measures
with similar purposes.

14

17
18

4/10/2020

ADD YOUR CONTENT HERE

☐ Composite
☐ Cost/Resource Use
☐ Efficiency
☐ Intermediate Outcome
☐ Outcome
☐ Patient Reported Outcome
☐ Process
☐ Structure
☐ Other (enter here):

☐ Yes
☐ No

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

5

Row
19

20

21

22

23

24

Field Label
How will this
measure add value
to the CMS
program?
How will this
measure be
distinguished from
other similar and/or
competing
measures?
MIPS Quality:
Identify any links
with related Cost
measures and
Improvement
Activities

Guidance
Describe benefits of this measure, in comparison to
measure(s) already in a program.

ADD YOUR CONTENT HERE

Describe key differences that set this measure apart
from others.

For MIPS Quality measures only: Where available,
provide description of linkages and a rationale that
correlates this MIPS quality measure to other
performance category measures and activities.

*What is the target

What populations are included in this measure?
e.g., Medicare Fee for Service, Medicare Advantage,
Medicaid, CHIP, All Payer, etc.

*What one area of

Select the one most applicable area of specialty.

See Appendix A.23 for list choices. Copy/paste or enter your choice here:

*What one primary
healthcare priority
applies to this
measure?

Healthcare priorities (also known as domains).
Select the best 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

population of the
measure?

specialty is the
measure aimed to,
or which specialty is
most likely to report
this measure?

4/10/2020

6

Row
25

Field Label

*What one primary

meaningful measure
area applies to this
measure?

26

What secondary
healthcare priority
applies to this
measure?

4/10/2020

Guidance
Select the best one. The meaningful measure area
choices depend on your selection of primary
healthcare priority above.

Healthcare priorities (also known as domains).
Select one alternate or secondary priority only if
applicable.

ADD YOUR CONTENT HERE
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
☐ 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

7

Row
27

Field Label
What secondary
meaningful measure
area applies to this
measure?

Guidance
Select one alternate or secondary area only if
applicable. The meaningful measure area choices
depend on your selection of secondary healthcare
priority above.

28

*Briefly describe
the peer reviewed
evidence justifying
this measure

Add description of evidence. If you have lengthy
text to insert, place the text at the bottom of this
form, clearly indicating row number 28.

29

30

*What is the NQF
status of the
measure?

Select only one. Refer to
http://www.qualityforum.org/QPS/ for information
on NQF endorsement, measure ID, and other
information.

*NQF ID

Four- or five-digit identifier with leading zeros and
following letter if needed. If no NQF ID number is
known, enter numerals 0000. Place zeros ahead of
ID if necessary (e.g., 0064). Add a letter after the ID
if necessary (e.g., 0064e).

4/10/2020

ADD YOUR CONTENT HERE
If #26 is Make care safer…, then choices are:
☐ Healthcare-associated infections
☐ Preventable healthcare harm
If #26 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 #26 is Promote effective communication…, then choices are:
☐ Medication management
☐ Admissions and readmissions to hospitals
☐ Transfer of health information and interoperability
If #26 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 #26 is Work with communities…, then choices are:
☐ Equity of care
☐ Community engagement
If #26 is Make care affordable, then choices are:
☐ Appropriate use of healthcare
☐ Patient-focused episode of care
☐ Risk adjusted total cost of care

☐
☐
☐
☐
☐

Endorsed
Endorsement Removed
Submitted
Failed endorsement
Never submitted

8

Row
31

Field Label
Evidence that the
measure can be
operationalized

32
33

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

34

35

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

4/10/2020

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 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. If
you have lengthy text to insert, place the text at the
bottom of this form, clearly indicating row number
31.

ADD YOUR CONTENT HERE

Select Yes or No

☐ Yes
☐ No

Which specification fields are different? Select all
that apply.

☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐

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

Briefly describe the differences

9

Row
36

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

37

Year of next
anticipated NQF
CDP endorsement
review

Select one

38

*In what state of
development is the
measure?

Select all that apply.

4/10/2020

Select one

Guidance
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐

None
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
None
2020
2021
2022
2023
2024
Early Development
Field Testing
Fully Developed

ADD YOUR CONTENT HERE

10

Row
39

Field Label
State of
Development
Details

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.

ADD YOUR CONTENT HERE

If you entered 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 entered 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.

4/10/2020

11

Row
40

Field Label

*In which setting

Select all that apply.

*At what level of

Select all that apply

was this measure
tested?

41

analysis was the
measure tested?

4/10/2020

Guidance

ADD YOUR CONTENT HERE
☐ Ambulatory surgery center
☐ Ambulatory/office-based care
☐ Behavioral health clinic or inpatient psychiatric facility
☐ Community hospitals
☐ Dialysis facility
☐ Emergency department
☐ Federally qualified health center (FQHC)
☐ Hospital outpatient department (HOD)
☐ Home health
☐ Hospice
☐ Hospital inpatient acute care facility
☐ Inpatient rehabilitation facility
☐ Long-term care hospital
☐ Nursing home
☐ PPS-exempt cancer hospital
☐ Skilled nursing facility
☐ Veterans Health Administration facilities
☐ Other (enter here):
☐ Clinician
☐ Group
☐ Facility
☐ Health plan
☐ Medicaid program (e.g., Health Home or 1115)
☐ State
☐ Not yet tested
☐ Other (enter here):

12

Row
42

Field Label

*What data sources

are used for the
measure?

Select all that apply.

Guidance

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 at Row 69 to specify or
elaborate on the type of data source, if needed to
define your measure.

43
44

If Registry:
Specify the
registry(ies)
If EHR or Claims or
Chart-Abstracted
Data, description of
parts related to
these sources

ADD YOUR CONTENT HERE
☐ 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 here):

Identify the registry using the submitted measure.
Select all that apply.
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.

See Appendix A.44 for list choices. Copy/paste or enter your choices here:

*How is the

This differs from the data sources above. This is the
anticipated data submission method. Select all that
apply. Use the “Comments” field at Row 69 to
specify or elaborate on the type of reporting data, if
needed to define your measure.

☐ eCQM
☐ CQM (Registry)
☐ Claims
☐ Web interface
☐ Other (enter here):

47

*Is this measure an
eCQM?

☐ Yes
☐ No

48

If eCQM = Yes

Is this an electronic clinical quality measure
(eCQM)? Select Yes or No. If your answer is yes, the
Measure Authoring Tool (MAT) ID number must be
provided below.

45

46

measure expected
to be reported to
the program?

4/10/2020

13

Row
49

Field Label

*If eCQM, enter

Measure Authoring
Tool (MAT) number

50

51

*If eCQM, does the

measure have a
Health Quality
Measures Format
(HQMF)
specification in
alignment with the
latest HQMF
standards?

*Evidence of

performance gap

52

Unintended
consequences

4/10/2020

Guidance
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.
Select Yes or No. If not eCQM, enter No

ADD YOUR CONTENT HERE

☐ Yes
☐ No

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. If
you have lengthy text to insert, place the text at the
bottom of this form, clearly indicating row number
51.
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.

14

Row
53

Field Label

*Was this measure

published on a
previous year's
Measures under
Consideration list?
54

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

55

What were the MUC
IDs for the measure
in each year?
List the NQF MAP
workgroup(s) in
each year

56

57

58

59

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

4/10/2020

Guidance
Select Yes or No. If yes, you are submitting an
existing measure for expansion into additional CMS
programs or the measure has substantially changed
since originally published, then answer the
following questions: 54 through 59 and 61. If no,
then skip these subset questions.
Select all that apply.

☐ Yes
☐ No

☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐

ADD YOUR CONTENT HERE

None
2011
2012
2013
2014
2015
2016
2017
2018
2019
Other (enter here):

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

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
Briefly describe the reason(s) if known.

15

Row
60

Field Label
NQF MAP report
link for each year

Guidance
See reference link information at right.

ADD YOUR CONTENT HERE
For your reference in completing this section, follow the links below or copy/paste the links
into your browser to view each year's MAP pre-rulemaking report (2012 to 2019). This is not a
data entry field.
2016-19: 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_Pr
ograms.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_Rulemaki
ng.aspx

61

62

63
64
65

66

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

*Measure steward

*Measure Steward

Contact Information
Long-Term Measure
Steward (if
different)
Long-Term Measure
Steward Contact
Information

4/10/2020

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

All major NQF reports going back to 2008 should be locatable here:
http://www.qualityforum.org/Publications.aspx

List title and other identifying citation information.

Enter the current Measure Steward. Select all that
apply.
Last name, First name; Affiliation (if different);
Telephone number; Email address

See Appendix A.63-65 for list choices. Copy/paste or enter your choices here:

Entity or entities that will be the permanent
measure steward(s), responsible for maintaining the
measure and conducting NQF maintenance review.
Select all that apply.
If different from Steward above: Last name, First
name; Affiliation; Telephone number; Email address

See Appendix A.63-65 for list choices. Copy/paste or enter your choices here:

16

Row
67

Field Label

*Primary Submitter

69

Contact Information
Secondary
Submitter Contact
Information
Comments

70

Attachment(s)

68

Guidance
If different from Steward above: Last name, First
name; Affiliation; Telephone number; Email address

ADD YOUR CONTENT HERE

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.
You are encouraged to attach the 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.

Please enter all attachment filename(s) here for completeness and cross-check purposes:

If you enter MIPS, please navigate to the Additional
Resources list at this web site:
https://www.cms.gov/Medicare/Quality-InitiativesPatient-AssessmentInstruments/QualityMeasures/Pre-RuleMaking.html, download the “MIPS Peer Review
Template and a Completed Sample,” and send the
completed form with your measure submission by
email to [email protected]

71

MIPS Journal Article
Requirement

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.
Select Yes or No. For those submitting measures to
MIPS program, enter “Yes.” Send your completed
Peer Reviewed Journal Article Requirement form
with your measure submission by email to
[email protected].

☐ Yes
☐ No

Send any questions or your completed form and any accompanying files to [email protected]

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17

Appendix: Lengthy Drop-Down List Choices
A.23 Choices for What area of specialty best fits the measure?
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
Nursing
Obstetrics/gynecology

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Occupational therapy
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
Physical therapy
Plastic and reconstructive surgery
Podiatry
Preventive medicine
Primary care
Psychiatry
Pulmonary disease
Pulmonology
Radiation oncology
Rheumatology
Sleep medicine
Speech therapy
Sports medicine
Surgical oncology
Thoracic surgery
Urology
Vascular surgery
Other (enter in Row 23)

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A.44 Choices for Specify the registry(ies)
AAAAI Allergy, Asthma & Immunology Quality Clinical Data Registry in collaboration with
CECity
Alere Analytics Registry
American Board of Family Medicine Registry
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 College of Surgeons (ACS) Surgeon Specific Registry (SSR)
American College of Surgeons National Cancer Data Base (ASC NCDB)
American College of Surgeons National Surgical Quality Improvement Program ASC
NSQIP)
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 Health IT
American Heart Association’s Get With the Guidelines Database
American Joint Replacement Registry
American Nursing Association’s National Database for Nursing Quality Indicators®
(NDNQI®)
American Osteopathic Association Clinical Assessment Program
American Society of Breast Surgeons Mastery of Breast Surgery Program
American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI)R
American Society of Clinical Oncology’s Quality Oncology Practice Initiative (QOPI)
Anesthesia Quality Institute National Anesthesia Clinical Outcomes Registry (NACOR)
Anesthesia Quality Institute National Anesthesia Clinical Outcomes Registry
Bayview Physician Services Registry
BMC Clinical Data Warehouse Registry
Care Coordination Institute Registry
CDC, NHSN (National Healthcare Safety Network)
CECity Registry (“PQRSwizard”)
Cedaron Medical
Central Utah Informatics
Chronic Disease Registry, Inc.
CINA
Clinical Support Services
Clinicient
Clinigence

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Conifer Value-Based Care
Corrona, LLC
Covisint Corporation Registry (formerly Docsite)
Crimson Care Registry
CUHSM.ORG
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
Faculty Practice Foundation, Inc. supported by BMC Clinical Data Warehouse Registry
Falcon Registry
FORCE-TJR Registry QITM
FOTO PQRS Registry
Fresenium Medical Care CKD Data Registry
Geriatric Practice Management LTC Qualified Clinical Data Registry
Geriatric Practice Management LTC Registry
GI Quality Improvement Consortium’s GIQuIC 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
Louisiana State University Health Care Quality Improvement Collaborative [Louisiana
State University, Quality in Health Care Advisory Group, LLC (QHC Advisory Group),
CECity]
Lumeris Registry
M2S Registry
Mankato Clinic Registry
Massachusetts eHealth Collaborative Quality Data Center QCDR
Massachusetts General Physicians Organization Registry
McKesson Population Manager

19

MDinteractive
MDSync LLC
MedAmerica/CEP America Registry
Meditab Software, Inc.
MedXpress Registry
MEGAS, LLC Alpha II Registry
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program
(MBSAQIP) QCDR
Michigan Bariatric Surgery Collaborative QCDR
Michigan Spine Surgery Improvement Collaborative
Michigan Urological Surgery Improvement Collaborative QCDR
myCatalyst
National Osteoporosis Foundation and National Bone Health Alliance Quality
Improvement Registry in collaboration with CECity
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
None
OBERD QCDR
OmniMD
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)
Patient360
Physician Health Partners QCDR
PMI Registry
PQRS Solutions
PQRSPRO NetHealth LLC
Premier Healthcare Alliance Physician RegistryTM
Pulse PQRS Registry
Quintiles PQRS Registry
Renal Physicians Association Quality Improvement Registry in collaboration with CECity
ReportingMD Registry
RexRegistry by Prometheus Research
Society of Thoracic Surgeons National Database
Solutions for Quality Improvement (SQI) Registry
Specialty Benchmarks Registry
SunCoast RHIO

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SupportMed Data Analytics & Registry
Surgical Care and Outcomes Assessment Program (SCOAP)
SwedishAmerican Medical Group
TeamPraxis-Allscripts CQS
The Guideline AdvantageTM (American Cancer Society, American Diabetes Association,
American Heart Association) supported by Forward Health Group's PopulationManagerR
The Pain Center USA PLLC
Unlimited Systems Specialty Healthcare Registry
Vancouver Clinic
Venous Patient Outcome Registry
Vericle, Inc.
Webconsort LLC
WebOutcomes LLC
WebPT, Inc.
Wellcentive, Inc.
Wisconsin Collaborative for Health Care Quality Registry
Wisconsin Collaborative for Healthcare Quality
Wound Care Quality Improvement Collaborative (Paradigm Medical Management,
Patient Safety Education Network (PSEN), Net Health Systems, Inc., CECity)

20

A.63-65 Choices for Measure Steward (63) and Long-Term Measure Steward (if different) (65)
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

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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 Row 63 or Row 65)
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

21

Space for Placing Lengthy Text (If Applicable)
If you have lengthy text to insert, place it below here, clearly indicating for each answer the intended row number and/or field label from the template
above.

Send any questions or your completed form and any accompanying files to [email protected]

4/10/2020

22

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File Typeapplication/pdf
File TitleMeasures under Consideration 2020 Data Template
SubjectHealth, physician, hospital, quailty, measure, efficiency
AuthorCenters for Medicare & Medicaid Services
File Modified2020-07-30
File Created2020-07-30

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