8.
8.1 Introduction
The purpose of this section is to provide guidance to the measure contractor to ensure that measures developed for Centers for Medicare & Medicaid Services (CMS) have complete technical specifications that are detailed and precise. Final technical specifications provide the comprehensive details that allow the measure to be collected and implemented consistently, reliably, and effectively.
The process of developing measure specifications occurs throughout the measure development process. In the information gathering stage, the measure contractor identifies whether existing measures may be adopted or adapted to fit the desired purpose. If no measures are identified that match the desired purpose for the measure, the contractor must work with its technical expert panel (TEP) to develop new measures. Depending on the information gathering findings, the TEP will consider potential measures that are newly proposed or are derived from existing measures. The measure contractor submits the list of candidate measures, selected with TEP input, to the Contracting Officer Representative/Government Task Leader (COR/GTL) for approval. Upon approval from the COR/GTL, the measure contractor proceeds with the development of detailed technical specifications for the measures.
The Measure Information Form (MIF) is used to document the technical specifications of the measures. These forms may be found in the Measure Development section. At this stage, the technical
specifications section is likely to include high-level numerator and denominator statements and initial information on potential exclusions, if applicable, and will continue to be completed throughout the development process as more information is obtained. The fields in the MIF have been aligned with the NQF Measure Submission form, and collecting information on them throughout the development process will make the measure submission process easier. Depending upon the stage of measure development, the MIF can be modified to display only the available information or the developer may use a different format to display multiple measures (i.e., to present to the TEP). The ultimate goal of this process is to collect the information necessary to make the National Quality Forum (NQF) measure submission process easier.
The development of technical specifications is an iterative process. A brief overview of this process is as follows:
The measure contractor drafts the initial specifications and the TEP will review and advise the measure contractor of the recommended changes. (Refer to the Technical Expert Panel section.)
If directed by the COR/GTL, public comments may be obtained regarding the draft measures. (Refer to the Public Comment section.) Comments received during the public comment period
1The direction provided in this section is based on guidance from the National Quality Forum and in some instances the verbiage remains unchanged to
will be reviewed and taken into consideration by the measure contractor, CMS, and the TEP and often result in revisions to the measure specifications.
During the development process, alpha (formative) testing of the measure occurs. For measures based on electronic administrative data (e.g., claims-based), the draft technical specifications may be provided to the programming staff responsible for data retrieval and for developing the programming logic necessary to produce the measure. The programmers will assess the feasibility of the technical specifications as written and may provide feedback. For measures based on chart abstraction, data collection tools are developed and tested.
When the specifications are more fully developed, beta (field) testing occurs. (Refer to the Measure Testing section.) As a result, technical specifications will continue to evolve and become more detailed and precise.
After measure testing is complete, additional public comments should be obtained using the formal process outlined in the Public Comment section. All of these factors will result in enhancements to the technical specifications and make the measure more valid and reliable. Figure 8-1 illustrates the inputs to the process.
Figure 8-1 Factors Influencing the Development of the Measure Technical Specifications
Each measure is required to be precisely specified. Measures must be specified with sufficient details to be distinguishable from other measures and to support consistent implementation across providers. Most quality measures are expressed as a rate. Usually the basic construct of a measure begins with the numerator, denominator, exclusions, and measure logic. Then the measure concept is more precisely specified with increasing amounts of detail, including the appropriate codes sets and/or detailed and precisely defined data elements.
Figure 8-2 lists key components of the technical specifications used to produce valid and reliable quality measures. Technical Specifications TEP Alpha Testing Public Comment Literature Review Existing Measures CMS Beta Testing Measure Contractor
Figure 8-2 Key Components of the Technical Specifications of a Quality Measure
8.2 Deliverables
Measure Information Form or equivalent document containing the same elements, if approved by the COR/GTL. Refer to the Measure Development Section.
Measure Justification form (refer to the Measure Development section) to document the measure specifications for new or adapted measures, or measures that are developed and in use by another organization, but are not NQF endorsed.
The Measure Information Form without the Measure Justification form may be used to document existing measures with NQF endorsement that are being proposed for use by CMS.
o For contractors developing eMeasures, the Health Quality Measures Format (HQMF)
document- which includes a header and a body- should be used in lieu of the MIF. Refer to the eMeasure Specifications section for further details on this format.
List of potential measures to be developed and timelines