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Blueprint Measure Lifecycle

Measure Specification

This section provides an overview of how measure developers can create detailed, clear, rigorous, and precise specifications. Specifications are instructions for how to build and calculate a measure. The intent of measure specification is that each measure should reach its appropriate target/initial population, but not over-reach or under-reach. Errors in specifying the target/initial population not only waste resources, but also may generate misleading conclusions about care quality.

The measure specification stage consists of both specification and harmonization, along with interested parties' engagement through public comment and technical expert panels (TEPs). Final specifications provide comprehensive details that allow collection of measure data and implementation of the measure to be consistent, reliable, and effective.

Measure Lifecycle

Measure specification follows the conceptualization stage, when the measure developer identifies the initial intent of the measure based on clinical practice guidelines or a patient-reported outcome measure, and evidence identified in the environmental scan. Development of measure specifications is an iterative process throughout the Measure Lifecycle, with specifications informing and being informed by later stages of the measure development process, particularly measure testing.

Measure Specification & Measure Testing 

As a measure developer moves from alpha (formative) testing to beta (field) testing, the specification becomes more fully developed. As a result of testing, specifications continue to evolve, becoming more detailed and precise. 

  • For measures based on electronic, administrative, or claims-based data, the measure developer may provide draft specifications to the programming staff responsible for data retrieval and for developing programming logic necessary to produce the measure. Programmers will assess feasibility of the specifications as written and may provide feedback. 
  • For measures based on chart abstraction, the measure developer develops and tests data collection tools.

Paperwork Reduction Act Guidance for CMS Measure Developers

There may be a requirement for CMS measure developers to prepare a Paperwork Reduction Act (PRA) package. The Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA) exempted most measure development activities from PRA. However, all CMS measure developers should discuss this requirement with their Contracting Officer's Representative. CMS measure developers can find more information about PRA in the Blueprint Contractual Guidance and Considerations found on the Measure & Instrument Development and Support (MIDS) Library. The MIDS Library is a protected website restricted to CMS and CMS MIDS contractors. You must have an invitation to view the MIDS Library. 

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  • Determine the measure ingredients and calculation formula
  • Collect input and testing findings on initial measure specifications to aid in refinement
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  • Includes annual update and comprehensive reevaluation every 3 years
  • Early maintenance review may be necessary
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  • Identify ideas or topics that are most important to interested parties and address a gap in measurement
  • Scan the environment
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  • Collect qualitative and quantitative data to establish whether the measure meets evaluation criteria
  • Iterate with Measure Specification
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  • Pre- and rulemaking processes
  • Collect user input on initial measure specifications to aid in refinement
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