PCMH Standardized Measurement
Starting the 2024 reporting year, NCQA is requiring standardized measures for PCMH QI 01, QI 02, AR QI 1, AR QI 2, BH 17 and AR BH. As a part of standardized measures reporting, practices will be required to submit the previous calendar year’s data (Jan 1 – Dec 31) unless otherwise specified in the measure description. Standardized measures are measures which are validated by a measure steward and have specific parameters for reporting. For PCMH, practices should utilize the specifications of electronic clinical quality measures (eCQMs) which were designed to be applied at the practice or clinician level of reporting. Specifications for these measures can be found at the eCQI Resource Center’s website.
PCMH Supported Measures
Immunization
| Measure | CMS eCQM # | Measure Steward |
|---|---|---|
| Influenza Immunization | CMS 147 | NCQA |
| Pneumococcal Vaccination Status for Older Adults | CMS 127 | NCQA |
| Childhood Immunization Status: Combination 10 (CIS) | CMS 117 | NCQA |
Preventive
| Measure | CMS eCQM # | Measure Steward |
|---|---|---|
| Cervical Cancer Screening | CMS 124 | NCQA |
| Colorectal Cancer Screening | CMS 130 | NCQA |
| Breast Cancer Screening | CMS 125 | NCQA |
| Body Mass Index Screening and Follow-Up Plan | CMS 69 | CMS |
| Tobacco Use: Screening and Cessation Intervention | CMS 138 | NCQA |
| Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented | CMS 22 | CMS |
| HIV Screening | CMS 349 | CDC |
| Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents | CMS 155 | NCQA |
| Chlamydia Screening in Women | CMS 153 | NCQA |
| Fall: Screening for Future Fall Risk | CMS 139 | NCQA |
Behavioral Health
| Measure | CMS eCQM # | Measure Steward |
|---|---|---|
| Follow-Up Care for Children Prescribed ADHD Medication (ADD) | CMS 136 | NCQA |
| Screening for Depression and Follow-Up Plan | CMS 2 | CMS |
| Initiation and Engagement of Substance Use Disorder Treatment | CMS 137 | NCQA |
| Adult Major Depressive Disorder (MDD): Suicide Risk Assessment | CMS 161 | Mathematica |
| Depression Remission at Twelve Months | CMS 159 | MN Community Measurement |
| Anti-depressant Medication Management | CMS 128 | NCQA |
| Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment | CMS 177 | Mathematica |
Chronic or Acute Care
| Measure | CMS eCQM # | Measure Steward |
|---|---|---|
| Controlling High Blood Pressure | CMS 165 | NCQA |
| Diabetes HbA1C Poor Control (>9%) | CMS 122 | NCQA |
| Diabetes Eye Exam | CMS 131 | NCQA |
| Statin Therapy for the Prevention and Treatment of Cardiovascular Disease | CMS 347 | CMS |
| Dementia: Cognitive Assessment | CMS 149 | American Academy of Neurology |
Care Coordination
| Measure | CMS eCQM # | Measure Steward |
|---|---|---|
| Closing the Referral Loop | CMS 50 | CMS |
| Documentation of Current Medications in the Medical Record | CMS 68 | CMS |
Health Care Costs
| Measure | CMS eCQM # | Measure Steward |
|---|---|---|
| Appropriate Testing for Pharyngitis | CMS 146 | NCQA |
| Appropriate Treatment for Upper Respiratory Infection (URI) | CMS 154 | NCQA |
Reporting Exceptions
In 2024, standardized measures reporting will be required for all practices seeking or renewing their recognition status. NCQA will allow exceptions to standardized measures reporting and will permit practices to submit custom measures in a few unique cases:
- Pediatric practices will be permitted to submit a custom measure for the chronic or acute component in QI 01 as there are currently no approved standardized measures for chronic or acute care for pediatric populations.
- In the event that no measures within a measure category are relevant to your patient population, please submit a case detailing why. Also include the measure name and the numerator and denominator descriptions of the custom measure the practice would like to submit for consideration.
As a part of standardized measures reporting, practices will be required to submit a full calendar year’s data (Jan 1 – Dec 31) unless otherwise specified in the measure description. NCQA recognizes that there can be unique challenges to obtaining a full calendar year of data if a practice were to change vendors mid-year. In such instances, NCQA may grant an exception to full calendar year reporting.
Please note that exceptions to standardized measures for 2024 reporting will be granted on a case-by-case basis. If a practice meets the exception criteria outlined above or faces other barriers that prevent the reporting of standardized measures, then they are asked to submit a PCS ticket through MyNCQA for consideration.
Custom Measures
The following are examples of acceptable custom measures for pediatric populations:
| Chronic or Acute |
|---|
| Nutrition consultation to obese patients |
| Physical activity consultation to obese patients |
| Asthma controller medications for persistent asthma |
| Influenza prevention in asthma patients |
| The Asthma Control Test (ACT) |
| Asthma self-management plan |
| ADHD medication management and monitoring |
| Treatment of an ear infection with antibiotic therapy |
| Diagnosis of UTI and follow-up care |
| Diagnosis of acute bronchitis and follow-up care |
Resources
The following resource may be used to explore measure specifications.
eCQI Resource Center: A resource website from The Office of the National Coordinator for Health Information Technology. Contains the most current resources to support electronic clinical quality improvement (eCQI).
WE’RE READY TO HELP