CMS Measure Selection Criteria
CMS measure selection criteria help ensure that each measure
- Supports the CMS and national health care priorities including prioritizing outcome measures, patient-reported outcome measures, digital measures, and equity
- Is responsive to specific program goals and statutory requirements
- Addresses an important condition or topic with a performance gap and has a strong scientific evidence base to demonstrate the measure can lead to the desired outcomes and/or more affordable care
- Has written consent for any proprietary algorithms needed for measure production
- Promotes alignment with CMS program attributes and across Department of Health and Human Services (HHS) programs and health care settings
- Identifies opportunities for improvement (e.g., not topped out)
- Does not result in negative unintended consequences (e.g., overuse or inappropriate use of care or treatment, limiting access to care)
- Does not duplicate another measure currently implemented in one or more programs
- If an electronic clinical quality measure (eCQM), it must have a Measure Authoring Tool (MAT) number (i.e., created in the MAT) and expressed in Health Quality Measure Format using the Quality Data Model and Clinical Quality Language
Fully Developed Measure
To meet these selection criteria, the measure developer must fully develop the measure. A fully developed measure means the measure developer has completed
- Person/encounter-level testing, when appropriate, for each critical data element and the measure specifications do not need changes based on the results.
- Reliability testing, when appropriate, at the accountable entity level and the measure specifications do not need changes based on the results.
- Empiric validity testing, when appropriate, at the accountable entity level and measure specifications do not need changes based on the results.
- Completion of face validity testing as the sole type of validity testing does not meet the criteria for fully developed. However, face validity is acceptable for new measures (i.e., those not currently in use in CMS programs and undergoing substantive changes) only.
Additionally, for measures based on survey data or patient-reported tools, including patient-reported outcome-based performance measures (PRO-PMs), the measure developer has tested the survey or tool and the survey or tool does not need changes based on the results. For measures based on assessment tools, the measure developer must have completed patient/encounter-level testing for each critical data element and complete testing of the assessment tool itself with no changes to the tool needed based on the results.