CHPR to develop better electronic clinical quality measures for Medicare program
February 14, 2025
By Nadine Yehya
The UC Davis Center for Healthcare Policy and Research (CHPR) was recently awarded a $3.9 million five-year contract to develop and validate electronic clinical quality measures (eCQMs) for clinicians participating in the Medicare program. The project, led by CHPR’s health care quality expert Patrick Romano, will test and evaluate measures used to award performance-related payments to physicians and physician groups across the United States.
“We spend about $5 trillion a year on health care in the U.S. We want to know what we are getting for that spending and what is the value. So, quality measures are how we assess that,” Romano said.
CHPR’s leadership in quality measurement
CHPR is a national leader in defining what is high quality care for Medicare beneficiaries and others across the country. It has developed quality indicators for the state and the federal government, including the Agency for Healthcare Research and Quality (AHRQ).
The CHPR has extensive experience developing, testing, refining and validating quality measures. In the previous five years (2019-2024), the center developed or validated a set of seven hospital harm measures that focus on various adverse events that may occur to patients in hospitals. This new project will focus on measures for physicians, physician organizations and other clinicians.
“UC Davis and CHPR are on the cutting edge of developing and testing the measures used to evaluate the quality of health care across the country. This project is a natural outgrowth of the work we have done before on hospital measures,” Romano explained.
Romano, a UC Davis professor of internal medicine and pediatrics, leads CHPR’s quality and safety research. He has led the development and evaluation of metrics and resources to measure and publicly report patient safety and quality outcomes for a variety of health care settings.
Importance of quality indicators and measures
There are several reasons why developing quality indicators in health care is important. According to Romano, the top three reasons are:
- Transparency and accountability are valued in the health care system. This transparency can lead to a more effective market in which people can make better informed choices, ask questions and demand higher quality care from health care providers.
- The government requires quality indicators and measures. The Affordable Care Act mandates health care quality measures that can be used to reward health care providers for providing high-quality care. To get payment bonuses, physicians must select and report from a menu of measures. The new project will contribute to that menu.
- Accurate and valid measures drive quality improvement within health care organizations.
“Classic wisdom is that you can't improve what you don't measure. So, measurement provides the necessary platform for prioritizing quality improvement, evaluating whether quality improvement has worked, and adjusting our quality improvement efforts as needed,” Romano said.
Clinical quality measures vary by practice
Over the next five years, the CHPR will develop and validate new eCQMs using electronic health records data from UC Davis Health and the UC Health Data Warehouse. For the first year, it will work on measures related to screening for hepatitis C, screening patients with diabetes for foot problems, and another topic. As each measure has its own focus, clinicians can decide which ones to report, based on their practice.
“For example, in general internal medicine, we see a lot of patients with diabetes. We may select to report the diabetes foot measure. Family medicine might focus on preventive care, so they may report on screening measures. So, it varies,” Romano said.
The CHPR team will support translating the newly validated eCQMs to the Fast Healthcare Interoperability Resources (FHIR). FHIR is a framework to standardize the exchange of patient data for better information sharing among physicians and organizations. It helps advance interoperability, improve alignment with clinical decision support, enhance health care, and reduce the overall reporting burden for clinicians.
We spend about $5 trillion a year on health care in the U.S. We want to know what we are getting for that spending and what is the value. So, quality measures are how we assess that.” —Patrick Romano, professor of internal medicine and pediatrics
Collaborators and partners
Monika Ray, a computational data and research scientist at the UC Davis Department of Internal Medicine and CHPR, will serve as the project’s analytic lead, and Meghan Weyrich from CHPR will manage the project. The CHPR team will also work with UC Davis professors Elizabeth Magnan in Family and Community Medicine and James Bourgeois in Psychiatry.
The main external partner on this project is the prime contractor, American Institutes for Research (AIR). The Centers for Medicare & Medicaid Services (CMS) awarded AIR a $30 million contract to support CMS in developing, maintaining and implementing of eCQMs used to assess Medicare clinician performance.
Smile Digital Health will provide software implementation and support. Electronic clinical quality measures are built on structured fields (such as laboratory values, vital signs, orders and medications) in electronic health records (EHRs). These measures do not require any direct reporting by the clinician.
The team will also partner with the American Board of Family Medicine (ABFM) for data. ABFM has thousands of family physicians who contribute to their PRIME registry.
