Quality Measure Development

About this Page

The Centers for Medicare & Medicaid Services (CMS) follows a standard system for measure and instrument development for the Hospice Quality Reporting Program (HQRP). This webpage is intended as an overview and includes important links to related sites that contribute to the process.

MMS & Quality Measurement

The Measures Management System (MMS) is a standardized system for developing and maintaining the quality measures (QMs) used in various CMS initiatives and programs. MMS also supports quality-related activities across the agency. QMs are tools that help improve the quality of health care through an approach that is consistent and accountable.

Measure Lifecycle Stages

There are five stages in the Measure Lifecycle:

1. Conceptualization,
2. Specification,
3. Testing,
4. Implementation, and
5. Use, continuing evaluation, and maintenance. 

Measure developers start with measure conceptualization. These stages are not necessarily sequential, but are iterative, and can occur concurrently. 

• The measure conceptualization stage initiates information gathering and business case development. This stage also involves establishing the basic elements of the measure, including the numerator, calculation algorithm, and data source identification.
• The measure testing stage examines the specifications, usually with a limited number of real settings, to make sure the measure is scientifically acceptable and feasible.
• Measure specification and measure testing are iterative.
• The measure implementation stage begins with measure selection through various processes and then measure rollout.
• The measure use, continuing evaluation, and maintenance stage involves continued monitoring of the measure’s use, performance, importance, accuracy, and impact on individuals and the delivery of care.

Technical Expert Panels: As part of CMS’ Measure Management System (MMS) , CMS convenes a Technical Expert Panel (TEP) to assist in the development of QMs. As stated in the CMS MMS Hub, “TEPs are composed of representatives with diverse voices from multiple stakeholder groups, including marginalized communities, for the purpose of obtaining balanced input that represents varied perspectives. The measure developer and others desiring stakeholder engagement should include persons and family member representatives on their TEP because these individuals provide a vital perspective on what is important and useful to measure and evaluate.”

Consensus-Based Entity (CBE) and Pre-rulemaking: Battelle is a Centers for Medicare & Medicaid Services (CMS) certified consensus-based entity (CBE). Battelle’s Partnership for Quality Measurement (PQM)™ uses a consensus-based process involving a variety of experts - clinicians, patients, measure experts, and health information technology specialists - to ensure informed and thoughtful endorsement reviews of qualified measures. As part of the pre-rulemaking process, CMS posts a list of quality measures that the Department of Health and Human Services (HHS) is considering adopting (called the “Measures Under Consideration” or MUC list) during late fall or early winter each year. Interested parties convened by the CBE review measures on the MUC list. To access the MUC list, please visit CBE’s webpage. CMS encourages the public to review these materials and submit comments. Comments are reviewed before implementing any new quality measure. In this way, your valuable feedback is considered and becomes part of the ongoing measure development process.

See figure 2 below.

Graphic: CMS Measures Management System Pre-Rulemaking webpage

CMS Rulemaking: Some of the measures proposed on the MUC list and discussed at the MAP meeting will enter the federal rulemaking cycle. To view a Notice of Proposed Rulemaking, please visit the CMS.gov Hospice Center. During each fiscal year cycle of proposed rulemaking, CMS solicits public comment for 60 days from the date of display.

CMS encourages your participation in rulemaking. To submit comments, please visit Regulations.gov.

Public Reporting: Once QMs are adopted by the HQRP, CMS will publicly report them on Care Compare. More information about public reporting is available on the Public Reporting: Background and Announcements webpage.

The HQRP follows these processes to develop QMs, all of which encompass regular opportunities for provider and stakeholder engagement. Engagement opportunities are announced on the  Hospice QRP Announcements & Spotlight webpage, broadcast on the listserv, and can be found in the download section on the Provider and Stakeholder Engagement webpage.

Hospice Quality Reporting Program Archives