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

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PCMH immunization measures with CMS eCQM number and measure steward
Measure CMS eCQM # Measure Steward
Childhood Immunization Status: Combination 10 (CIS) CMS 117 NCQA

Adult practices submit a custom immunization measure of their choice. Select the custom measure option in Q-PASS and enter information.

PCMH preventive measures with CMS eCQM number and measure steward
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
Sexually Transmitted Infection (STI) Testing for People with HIV CMS 1188 HRSA
Kidney Health Evaluation CMS 951 National Kidney Foundation

PCMH behavioral health measures with CMS eCQM number and measure steward
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
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

 

PCMH chronic or acute care measures with CMS eCQM number and measure steward
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
HIV Viral Suppression CMS 314 HRSA
HIV Retention in Care CMS 1157 HRSA

 

PCMH care coordination measures with CMS eCQM number and measure steward
Measure CMS eCQM # Measure Steward
Closing the Referral Loop CMS 50 CMS
Documentation of Current Medications in the Medical Record CMS 68 CMS

 

PCMH health care costs measures with CMS eCQM number and measure steward
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.

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The following are examples of acceptable custom measures for pediatric populations:

Examples of acceptable custom measures for chronic or acute care
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).

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