CMS-10621 2021 Qualified Clinical Data Registry (QCDR) Measure Sub

Instructions for populating the 2021 Merit-Based Incentive Payment System (MIPS) Performance Period Self-Nomination Qualified Clinical Data
Registries (QCDR) Measure Submission Template
Disclaimer: The information is subject to change based upon what is finalized in the Calender Year 2021 Physician Fee Schedule Final Rule for the Quality
Payment Program. If needed, this document will be updated to what is finalized in the final rule and reposted accordingly.
The QCDR Measure Submission Template should ONLY be filled out by QCDRs who meet the 2020 definition of a QCDR, are self-nominating as a QCDR for
2021, and wish to submit QCDR measures for CMS consideration.
A QCDR may submit a maximum of 30 QCDR measures for review and approval by CMS consideration for reporting.
Complete the fields for each proposed 2021 MIPS Performance Period QCDR Measure. (Note: If you do not own the measure, please provide your
information in all unshaded columns.) Please ensure that the QCDR measure specifications are checked for grammar and typographical errors
before submission.
Please follow these steps when completing the QCDR Measure Submission Template:
1. Open the QCDR Measure Submission Template and save it with your organization's name (i.e., 2021 QCDR Measure Submission_QCDRName_vX).
Please update the version number, when an updated QCDR Measure Submission Template is uploaded or attached.
2. Navigate to the "QCDR Information" tab. For existing QCDRs in good standing, please update row 5 (Self-Nomination ticket #) and row 6 (Expected
number of QCDR measures to be submitted (to be entered by QCDR)). For new QCDRs, enter information for all the rows except for row 4 (QCDR Vendor ID
(if applicable)). Your organization will be assigned a QCDR Vendor ID upon approval.
3. Navigate to the "2021 QCDR Measure Subm Template" tab. Complete all required fields denoted with an asterisk (*). The table below shows which
columns are required or optional. (If you do not own or co-own the QCDR measure, please provide your information in all unshaded columns.
4. Upload or attach the 2021 QCDR Measure Submission Template to your organization's 2021 Self-Nomination form. Please note that the 2021 QCDR
Measure Submission Template does not need to include all of the proposed QCDR measures to be uploaded or attached to your organization's 2021 SelfNomination form. You may upload or attach an updated 2021 QCDR Measure Submission Template with additional QCDR measures prior to the end of the
2021 Self-Nomination period which ends at 8 p.m. Eastern Time (ET) on September 1st.
Column
A
B

Column Header
PIMMS Tracking ID
(PIMMS USE ONLY)
Input Row Completeness

C

Error Messages for Required
Fields

D

Measure ID: Measure Title
(Reference only)
Measure Ready for PIMMS
Review?

E

Required/Optional?
Instructions/Notes
This is a unique ID that is used for PIMMS tracking purposes and internal use only.
N/A
N/A

Provides the status of "Complete" or "Incomplete" for each row. "Incomplete" will
display if all of the REQUIRED fields have not been populated for a given entry.

N/A

Provides the user with an error message(s) regarding missing REQUIRED
information for each entry. Also, missing REQUIRED information for each entry will
have the cell highlighted in red after five REQUIRED fields have been populated in
the template for the specific proposed measure.

N/A

This is a locked autofilled cell that gives a reference point of Measure ID and
Measure Title.
Indicate if the given entry is "Ready for PIMMS Team Review", a "Work in Progress"
or "Withdrawn". Entries with a "Work in Progress" status will not be reviewed until
the status is updated to "Ready for PIMMS Team Review".

Required

F

Do you own this measure?

Required

Enter "Yes", "No" or "Co-owned by 2 or more QCDRs" for this field. By selecting
"No" you are attesting that you do not own or co-own the measure and currently
have the appropriate documentation (i.e., email, letter) giving your organization
permission from the QCDR measure owner/steward to use the QCDR measure.
Documentation to support permission will be verified. Please provide information in
all unshaded columns. Please note that the QCDR who owns the measure must
be an active and approved QCDR for the given self-nomination period.

G

If you answered "No" or "Coowned by 2 or more QCDRs",
please indicate the approved
owner or co-owners
Program Submission Status

Optional

Provide the name of the active and approved QCDR(s) that own or co-own the
QCDR measure.
Example: XXX QCDR

Required

Select the measure submission status from the drop down list that describes the
measure submitted for review. (New or existing measure with/without changes). If
you select ‘Existing Approved QCDR Measure With No Changes’, all cells that
should not be changed will be shaded. Please ONLY update the cells that are
unshaded.
Please enter the most recent CMS assigned QCDR measure ID if the QCDR
measure was included in any MIPS performance period as an approved measure.
Enter "N/A" if not applicable. Please do NOT self-assign a QCDR measure ID.
CMS is responsible for assigning QCDR measure IDs.

H

I

If this is a previously CMS
approved measure, please
provide the CMS assigned
measure ID

Required

J

If existing measure with changes,
please indicate what has changed
to the existing measure

Optional

Provide a detailed explanation of what changes were made to the measure.
Example: Denominator exclusion added

K

Can the measure be
benchmarked against the
previous performance period
data?
If applicable, please provide
details why the previous
benchmark can or cannot be used

Optional

Enter "Yes" or "No" to indicate if the benchmark from prior years is able to be used
for comparison.

Optional

M

Measure Title

Required

N

Measure Description

Required

O

Denominator

Required

P

Numerator

Required

Q

Denominator Exclusions

Required

Provide details regarding why the previous benchmark can or cannot be used in
response to the changes to the existing measure.
Example: The improvement addition to the numerator will make this measure an
Outcome measure and therefore cannot be compared to the measure from last
year.
Provide the measure title, which should begin with a clinical condition of focus,
followed by a brief description of action.
Example: Preventive Care and Screening: Screening for Depression and Follow-Up
Plan.
Describe the measure in full detail.
Example: Percentage of patients aged 12 years and older screened for depression
on the date of the encounter using an age appropriate standardized depression
screening tool AND if positive, a follow-up plan is documented on the date of the
positive screen.
Describe the eligible patient population to be counted to meet the measures'
inclusion requirements.
Example: All patients aged 12 years and older at the beginning of the
measurement period with at least one eligible encounter during the measurement
period.
The clinical action that meets the requirements of the measure.
Example: Patients screened for depression on the date of the encounter using an
age appropriate standardized tool AND, if positive, a follow-up plan is documented
on the date of the positive screen.
An exclusion is anything that would remove the patient, procedure, or unit of
measurement from the denominator. Enter “N/A” if not applicable.
Example: Women who had a bilateral mastectomy or who have a history of a
bilateral mastectomy or for whom there is evidence of a right and a left unilateral
mastectomy.

R

Denominator Exceptions

Required

Allow for the exercise of clinical judgement. Applied after the numerator calculation
and only if the numerator conditions are not met. Enter “N/A” if not applicable.
Example:
Medical Reason(s): Patient is in an urgent or emergent situation where time is of the
essence and to delay treatment would jeopardize the patient’s health status.
OR
Situations where the patient’s functional capacity or motivation to improve may
impact the accuracy of results of standardized depression assessment tools. For
example: certain court appointed cases or cases of delirium.

S

Numerator Exclusions

Required

An exclusion is anything that would remove the patient, procedure, or unit of
measurement from the numerator, typically used in ratio or inverse proportional
measures. Applied before the numerator calculation. Enter “N/A” if not applicable.
Example: If the number of central line blood stream infections per 1,000 catheter
days were to exclude infections with a specific bacterium, that bacterium would be
listed as a numerator exclusion.

T

Primary Data Source Used for
Abstraction

Required

Indicate the primary data source used for the measure. This may include but is not
limited to administrative claims data, facility discharge data, chronic condition data
warehouse (CCW), claims, CROWNWeb, EHR (enter relevant parts), Hybrid, IRFPAI, LTCH CARE data set, National Healthcare Safety Network (NHSN), OASIS-C1,
paper medical record, Prescription Drug Event Data Elements, PROMIS, record
review, Registry (enter which Registry), Survey, Other (describe source).

U

If applicable, please enter
additional information regarding
the data source used

Optional

Provide additional information when "Registry" and/or "Other" is selected. Example:
ABC Registry
You may list additional data sources used in addition to the primary data source.

V

NQF ID Number
(if applicable)

Optional

Provide the assigned NQF ID number, if the submitted QCDR measure fully aligns
with the NQF endorsed version of the measure. If no NQF ID number, enter 0000.
Example: 0418

W

High Priority Measure?

Required

Enter "Yes" or "No" to indicate if the measure is a high priority measure.

X
Y
Z
AA

High Priority Type
Measure Type
NQS Domain
Care Setting

Required
Required
Required
Required

Indicate the high priority measure type.
Select which measure type applies to the measure.
Select which NQS domain applies to the measure.
Select which care setting is included within the measure. If multiple care settings
apply, select the option "Multiple Care Settings" and enter them in the next cell.

Optional

L

AB

If Multiple Care Settings selected,
list Care Settings here

AC

Includes Telehealth?

AD

Which Meaningful Measure Area
applies to this measure?
Meaningful Measure Area
Rationale

Required

Inverse Measure

Required

AE

AF

Required

Required

If "Multiple Care Settings" was selected, enter all Care Settings that apply.
Please answer "Yes" or "No" if the QCDR measure’s denominator includes services
provided via telehealth. (Please review the quality action to ensure that it is
appropriate via telehealth.)
Select ONLY one Meaningful Measure Area that best applies to the measure.
Provide a rationale for the selected Meaningful Measure Area for the QCDR
measure.
Example: This measure identifies patients with depression and an appropriate
follow-up treatment plan.
Indicate if the measure is an inverse measure. This is a measure where a lower
calculated performance rate for this type of measure would indicate better clinical
care or control. The “Performance Not Met” numerator option for an inverse measure
is the representation of the better clinical quality or control. Submitting that
numerator option will produce a performance rate that trends closer to 0%, as
quality increases.

Column
AG

AH

Column Header
Proportional Measure

Continuous Variable Measure

Required/Optional?
Instructions/Notes
Indicate if the measure is a proportional measure. This is a measure where the
Required
score is derived by dividing the number of cases that meet a criterion for quality (the
numerator) by the number of eligible cases within a given time frame (the
denominator). The numerator cases are a subset of the denominator cases (e.g.,
percentage of eligible women with a mammogram performed in the last year).
Required

Indicate if the measure is a continuous variable measure. This is a measure where a
measure score in which each individual value for the measure can fall anywhere
along a continuous scale and can be aggregated using a variety of methods such as
the calculation of a mean or median (e.g., mean time to thrombolytics, which
aggregates the time in minutes from a case presenting with chest pain to the time of
administration of thrombolytics).
CMS encourages QCDRs to construct the numerators to be proportional by
establishing an expected benchmark based on guidelines or national performance
data. Applying MIPS scoring methodology has proven to be challenging for nonproportional measures because variability in the data points makes decile creation
based on a mathematical analysis very unpredictable.

AI

Ratio Measure

Required

Indicate if the measure is a ratio measure. This is a measure where a score that may
have a value of zero or greater that is derived by dividing a count of one type of data
by a count of another type of data. The key to the definition of a ratio is that the
numerator is not in the denominator (e.g., the number of patients with central lines
who develop infection divided by the number of central line days). Rates closer to 1
represent the expected outcome.

AJ

If Continuous Variable and/or
Ratio is chosen, what is the range
of the score(s)?

Optional

Please provide a defined range of performance. If it is not a continuous variable
and/or ratio measure, enter "N/A".
Example: 0-250 minutes

AK

Number of performance rates to
be calculated and submitted

Required

Indicate the number of performance rates submitted for the measure. If only one is
calculated, enter '1'.

AL

Performance Rate Description(s)

Optional

Provide a brief description for each performance rate to be calculated and
submitted.
Example: This measure will be calculated with 7 performance rates:
1) Overall Percentage for patients (aged 5-50 years) with well-controlled asthma,
without elevated risk of exacerbation
2) Percentage of pediatric patients (aged 5-17 years) with well-controlled asthma,
without elevated risk of exacerbation
3) Percentage of adult patients (aged 18-50 years) with well-controlled asthma,
without elevated risk of exacerbation
4) Asthma well-controlled (submit the most recent specified asthma control tool
result) for patients 5 to 17 with Asthma
5) Asthma well-controlled (submit the most recent specified asthma control tool
result) for patients 18 to 50 with Asthma
6) Patient not at elevated risk of exacerbation for patients 5 to 17 with Asthma
7) Patient not at elevated risk of exacerbation for patients 18 to 50 with Asthma

AM

Indicate an Overall Performance
Rate

Required

Specify which of the submitted rates will represent an overall performance rate for
the measure or how an overall performance rate could be calculated based on the
data submitted (for example, simple average of the performance rates submitted) or
weighted average (sum of the numerators divided by the sum of the denominators),
etc. If only 1 performance rate is being submitted, enter 1st performance
rate.

AN
AO

Risk-Adjusted Status?
If risk-adjusted, indicate which
score is risk-adjusted
Is the QCDR Measure able to be
abstracted?

Required
Required

Indicate if the measure is risk-adjusted.
Indicate the score that is risk-adjusted for the measure.

Required

Please attest that the measure element can be abstracted and is feasible. If
borrowing the measure, it is expected that the ability to abstract the data
according to the QCDR measure owner’s specifications is a condition of selfnominating the QCDR measure. Withdrawing of the QCDR measure during
an active performance period is not acceptable.

AP

AQ
AR
AS
AT
AU

Was the QCDR measure tested
at the individual clinician level?
Validity Testing Summary
Feasibility Testing Summary
Reliability Testing Summary
Describe Link to Cost
Measure/Improvement Activity

Optional

Enter "Yes" or "No" to indicate if the QCDR measure was tested at the individual
clinician level.

Optional
Optional
Optional
Required

Provide validity testing summary if available.
Provide feasibility testing summary if available.
Provide reliability testing summary if available.
Describe the link between the QCDR measure, cost measure, and an improvement
activity. Please document "no link identified", if there is no link to a cost measure or
an improvement activity. In cases where a QCDR measure does not have a clear
link to a cost measure and an improvement activity, we would consider exceptions if
the potential QCDR measure otherwise meets the QCDR measure requirements
and considerations.

AV

Clinical Recommendation
Statement

Required

Provide a concise statement regarding the clinical recommendation for this QCDR
measure including the current clinical guideline from which the measure is derived.
Example: Adolescent Recommendation (12-18 years)
“The USPSTF recommends screening for MDD in adolescents aged 12 to 18 years.
Screening should be implemented with adequate systems in place to ensure
accurate diagnosis, effective treatment, and appropriate follow-up (B
recommendation)” (Sui, A. and USPSTF, 2016, p. 360).

AW

Provide the rationale for the
QCDR measure

Required

Provide a concise statement regarding the rationale for the QCDR measure.
Example: Depression is a serious medical illness associated with higher rates of
chronic disease increased health care utilization, and impaired functioning (Pratt,
Brody 2014). 2014 U.S. survey data indicate that 2.8 million (11.4%) adolescents
aged 12 to 17 had a major depressive episode (MDE) in the past year and that 15.7
million (6.6%) adults aged 18 or older had at least one MDE in the past year, with
10.2 million adults (4.3%) having one MDE with severe impairment in the past year
(Center for Behavioral Health Statistics and Quality, 2015).

AX

Provide measure performance
data (# months data collected,
average performance rate,
performance range, and number
of clinicians or groups)

Optional

Please provide the # of months the data was collected, average performance rate,
performance range and the number of eligible clinicians and/or TINs submitting the
measure within your self-nomination.
Example: 12 months, Average performance rate 75%, range 52-89%, 112
Clinicians submitting data

AY

If applicable, provide the study
citation to support performance
gap for the measure

Optional

AZ

If applicable, provide a
Participation Plan if QCDR
measure has low adoption by
clinicians

Optional

Provide the study citation for the measure to support the performance gap. Citations
should be the most current available or within 5 years.
Example: Negative outcomes associated with depression make it crucial to screen
in order to identify and treat depression in its early stages. While Primary Care
Providers (PCPs) serve as the first line of defense in the detection of depression,
studies show that PCPs fail to recognize up to 50% of depressed patients (Borner,
2010, p. 948)
If a QCDR measure fails to meet benchmarking thresholds for 2 consecutive
performance periods (i.e. the data submitted is insufficient in meeting the case
minimum and volume thresholds required for benchmarking), the QCDR may
submit a participation plan for CMS consideration if is believed that the measure is
important and relevant to a specialist’s practice.
Participation Plan requirements:
Detailed plan and methods to encourage eligible clinicians and groups to increase
QCDR measure adoption.
As examples, a QCDR measure participation plan could include one or more of the
following: Development of an education and communication plan; update the QCDR
measure’s specification with changes to encourage broader participation; require
reporting on the QCDR measure as a condition of reporting through the QCDR.

Please indicate applicable
specialty/specialties
Preferred measure published
clinical category

Required

BC

QCDR Notes

Optional

BD

CMS QCDR Measure Feedback

N/A

BE

Vendor QCDR Measure
Response

N/A

BF

QCDR Measure Reconsideration
Meeting Summary

N/A

BG

Final CMS Measure Decision

N/A

BA
BB

Required

Indicate the specialty/specialties the measure applies to.
Example: Anesthesiology, Neurology, and Urology
Please provide a preferred clinical or specialty category. Please note that if a
preferred measure published clinical category is not provided, one will be assigned
to the measure by CMS.
Example: Diabetes and Substance Use/Management
Provide any additional notes that would assist in the review or clarification of the
QCDR measure.
QCDR measure review feedback will be entered in this column. Feedback will be
dated with the most current feedback at the top of the cell. Please note that the
column will be locked until CMS has provided their feedback.
Vendor provides their response to the QCDR measure review feedback provided by
CMS. Response(s) should be dated with the most current feedback at the top of the
cell. Please note that this column will be locked until CMS has provided their
feedback.
This column will be populated for each QCDR measure that is discussed during the
resolution meeting between CMS, PIMMS MIPS Team and the vendor.
This column will be populated or updated for each QCDR measure that is discussed
during the resolution meeting between CMS, PIMMS MIPS Team and the vendor.

Please enter QCDR information in cells B3 through B6.
QCDR Information Fields
QCDR Information Entries

Instructions/Notes

QCDR Organization Name:

To be completed by the QCDR.

QCDR Vendor ID (if applicable):

To be completed by the QCDR, if a
Vendor ID has been assigned.
To be completed by the QCDR, once a
self-nomination ticket is available in the
QPP Self-Nomination Portal.

Self-Nomination ticket #:

Expected number of QCDR measures
to be submitted (to be entered by
QCDR):
Total number of QCDR measures
entered in 2021 QCDR Measure
Submission Template:
Total number of QCDR measures
"Ready for PIMMS Review" status in
2021 QCDR Measure Submission
Template:
Total number of QCDR measures in
"Work in Progress" status in 2021
QCDR Measure Submission Template:
Total number of QCDR measures in
missing required information:

To be completed by the QCDR. Should
include the number of QCDR measures
the QCDR plans to submit for the 2021
self-nomination period.
For reference only. Count allows check
against expected number of QCDR
0 measures to be submitted.
For reference only. Allows confirmation
that all expected QCDR measures are
ready for PIMMS review at time of
0 submission.
For reference only. Allows confirmation
that all expected QCDR measures are
no longer in a work in progress status at
time of submission.
0
For reference only. Allows confirmation
of the number of QCDR measures
missing required information.
0

Column Title
changed for 2021
PIMMS
Tracking ID
(PIMMS USE
ONLY)

Input Row
Completenes
s

Error Messages for
Required Fields

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Measure ID: Measure Title
(Reference only)

Measure Ready for
PIMMS Review?*

If "NO", see
instructions tab

Do you own this
measure?*

Column Title changed for 2021

Column Title changed for
2021

Column Title changed for 2021

If you answered "No" or "Co-owned by
2 or more QCDRs", please indicate the
approved owner or co-owners
Program Submission Status*

If this is a previously CMS
approved measure, please
provide the CMS assigned
measure ID*

If existing measure with changes, please indicate what
has changed to the existing measure

Can the measure be
benchmarked
against the previous
performance period
data?

If applicable, please provide details why the previous
benchmark can or cannot be used

Measure Title*

Measure Description*

Denominator*

Numerator*

Denominator Exclusions*

Denominator Exceptions*

Numerator Exclusions*

Primary Data Source Used
for Abstraction*

New for 2021

If applicable, please enter additional information
regarding the data source used

NQF ID Number
(if applicable)

High Priority
Measure?*

High Priority Type*

Measure Type*

NQS Domain*

Care Setting*

If Multiple Care Settings selected,
list Care Settings here

Column Title changed
for 2021

New for 2021

Includes Telehealth?*

Which Meaningful Measure Area
applies to this measure?*

Meaningful Measure Area
Rationale*

Inverse
Measure*

Proportional
Measure*

Continuous
Variable
Measure*

Ratio
Measure*

If Continuous Variable and/or Ratio is
chosen, what is the range of the
score(s)?

Number of
performance rates
to be calculated
and submitted*

Performance Rate
Description(s)

Indicate an Overall
Performance Rate*

New for 2021

Risk-Adjusted
Status?*

Was the QCDR measure
If risk-adjusted, indicate which Is the QCDR Measure able tested at the individual
score is risk-adjusted
to be abstracted?*
clinician level?

New for 2021

Validity Testing Summary

New for 2021

Feasibility Testing Summary

New for 2021

New for 2021

Describe Link to Cost
Reliability Testing Summary Measure/Improvement Activity*

Column Title changed for 2021

Clinical Recommendation
Statement*

Provide the rationale for the QCDR
measure*

Provide measure performance data (# months data
collected, average performance rate, performance range, If applicable, provide the study citation to support
and number of clinicians or groups)
performance gap for the measure

New for 2021

If applicable, provide a Participation Plan if QCDR
measure has low adoption by clinicians

Please indicate applicable
specialty/specialties*

Preferred measure published
clinical category*

QCDR Notes

CMS QCDR Measure Feedback

Vendor QCDR Measure Response

QCDR Measure Reconsideration Meeting Summary

Final CMS Measure Decision

2021 Excel Template:
PIMMS Tracking ID (PIMMS USE ONLY)
Input Row Completeness
Error Messages for Required Fields
Measure ID: Measure Title (Reference only)
Measure Ready for PIMMS Review?*
Do you own this measure?*
If you answered "No" or "Co-owned by 2 or more QCDRs", please
indicate the approved owner or co-owners
Program Submission Status*
If this is a previously CMS approved measure, please provide the
CMS assigned measure ID*
If existing measure with changes, please indicate what has changed
to the existing measure
Can the measure be benchmarked against the previous performance
period data?
If applicable, please provide details why the previous benchmark can
or cannot be used
Measure Title*
Measure Description*
Denominator*
Numerator*
Denominator Exclusions*
Denominator Exceptions*
Numerator Exclusions*
Primary Data Source Used for Abstraction*
If applicable, please enter additional information regarding the data
source used
NQF ID Number
(if applicable)
High Priority Measure?*
High Priority Type*
Measure Type*
NQS Domain*
Care Setting*
If Multiple Care Settings selected, list Care Settings here
Includes Telehealth?*
Which Meaningful Measure Area applies to this measure?*
Meaningful Measure Area Rationale*
Inverse Measure*
Proportional Measure*
Continuous Variable Measure*
Ratio Measure*
If Continuous Variable and/or Ratio is chosen, what is the range of
the score(s)?
Number of performance rates to be calculated and submitted*
Performance Rate Description(s)

2022 Webform Template Value
N/A
N/A
N/A

Indicate an Overall Performance Rate*
Risk-Adjusted Status?*
If risk-adjusted, indicate which score is risk-adjusted
Is the QCDR Measure able to be abstracted?*
Was the QCDR measure tested at the individual clinician level?
Validity Testing Summary
Feasibility Testing Summary
Reliability Testing Summary
Describe Link to Cost Measure/Improvement Activity*
Clinical Recommendation Statement*
Provide the rationale for the QCDR measure*
Provide measure performance data (# months data collected,
average performance rate, performance range, and number of
clinicians or groups)
If applicable, provide the study citation to support performance gap
for the measure
If applicable, provide a Participation Plan if QCDR measure has low
adoption by clinicians
Please indicate applicable specialty/specialties*
Preferred measure published clinical category*
QCDR Notes
CMS QCDR Measure Feedback
Vendor QCDR Measure Response
QCDR Measure Reconsideration Meeting Summary
Final CMS Measure Decision