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Frequently Asked Questions about
PQA Measure Development and Measures


Getting Involved in PQA’s Measure Development


Q:  How does PQA determine measure concepts for new measure development?

A:   PQA staff completes a review of national priorities and creates an initial list of potential measure concepts to address important measure gaps.  Also added to the list are measure concept ideas submitted to PQA staff, typically from our membership.  PQA then seeks input from the Measure Advisement Group (MAG), which is composed of leaders who are engaged in the measure development process and/or have an understanding of the national measurement landscape and priorities.  The MAG is convened quarterly (dependent on measure concepts identified for consideration) to review and provide input on measure concept ideas that meet clinical needs, align with the National Quality Strategy, and address measure gaps based on literature review and environmental scans.  The MAG discusses each measure concept, considers where it might be implemented (once developed) and then rates each on the measure evaluation criteria of importance, feasibility, and implementation opportunity.  The MAG discussions and ratings inform PQA staff’s determination of highest priority measure concepts to begin development.  PQA staff then creates measure development timelines for selected measure concepts.

Q:  How can I participate in PQA measure development?

A:  Representatives of PQA member organizations have the opportunity to participate in measure development efforts through various groups that include:  Measure Development Teams, Stakeholder Advisory Panels and Task Forces.  Visit the Measure Development Information page for information related to new measure development timelines and opportunities to participate.

Q:  How can I introduce a new measure concept for development within the Measure Development Teams?

A:  Any PQA member can recommend a new idea for a measure concept by completing the Measure Concept Idea Submission Form.  Each measure concept idea then is evaluated for the potential to meet standardized measure evaluation criteria (importance, feasibility, usability) and prioritized for possible development with input from the Measure Advisement Group, Implementation Advisory Panel, and Patient & Caregiver Advisory Panel.



Using the PQA Measures


Q:  How can I get a list of the PQA measure specifications?

A:  The PQA Measure Manual, which includes all measure specifications, is provided on request to PQA members for non-commercial purposes.  For clarity around the definition of non-commercial purposes, PQA staff is happy to schedule a call to discuss.  

Non-members can request individual measure specifications for quality improvement purposes. Requests can be sent to LHines@PQAalliance.org.

Q:  How can my company use PQA measures in a commercial product?

A:  Organizations interested in using the PQA measures, as part of a commercial product, will need to license the measures.  Additional information about what measure use requires a license and how to obtain a license can be found at the Licensing PQA Measures page or by contacting Jackie Green at JGreen@PQAalliance.org.

Q:  What is the difference between a performance measure and a quality improvement indicator?

A:  PQA performance measures use pre-established, fully specified criteria. This allows a performance measure to be used to compare rates across organizations since the measure is calculated the exact same way. Quality improvement indicators are more flexible and some of the measure criteria may not be fully specified.  Quality improvement indicators are used internally to improve a process and are not intended for comparative use.  For more information, visit the Quality Improvement Indicators page.


Measure-Specific Questions


Q:  How often are the PQA measures updated?

A:  The PQA Measure Manual and the supporting
National Drug Code (NDC) files are updated twice annually, in February and July, by adding new medications and NDCs within therapeutic categories for each endorsed measure.  The Measure Update Panel (MUP) reviews all PQA measures annually and makes recommendations for changes to measures based on new or updated clinical evidence and guidelines, or to provide additional clarity to measure specifications.  Minor measure changes recommended by the MUP are incorporated into the Measure Manual updates.  Material measure changes recommended by the MUP are then also considered for approval by the Quality Metrics Expert Panel (QMEP) before being incorporated into the Measure Manual updates.

Q:  How are PQA NDC lists compiled?

A:  To create a comprehensive NDC list for each measure, PQA’s NDC lists are derived from three sources: First DataBank, Medi-Span, and the Comprehensive NDC Structured Product Label (SPL) Data Elements File (NSDE).  The lists include:

  • All active NDCs for each measure from January 1 through December 31 of the measurement year; and

  • NDCs with obsolete dates up to 6 months prior to the measurement year, to include obsolete NDCs that may still be dispensed in the measurement year. 

The July 2018 update includes the February 2018 file with the addition of new NDCs released from January 1, 2018 through May 31, 2018. The obsolete date range does not change for this update.

Q:  Why does the
Use of High-risk Medications in the Elderly (HRM) measure require two prescription fills before the person is included in the numerator?

A:  CMS requires plan sponsors to continue medications for newly enrolled Medicare beneficiaries or as a member transfers from one plan to another (i.e., the new plan sponsor must provide the beneficiary with one fill). Requiring two fills avoids penalizing plan sponsors that fill the first prescription of the HRM to meet their contractual obligation.

Q:  How did PQA determine which drug-drug pairs to include in the
Drug-Drug Interaction (DDI) measure?

A: The list of drug-drug pairs in the measure is intended to be a subset of important DDIs and not a complete list of all interactions.  The subset was compiled after a review of the literature to identify significant interactions, and based on recommendations from an expert panel.  The purpose of this performance measure is for the evaluation of prescription drug plans and ambulatory/community pharmacies.

Q:  Why does PQA use the proportion of days covered (PDC) methodology, rather than medication possession ratio (MPR) for the adherence measures?

A:  After reviewing the extant literature and conducting tests of draft measure specifications, PQA chose to endorse the PDC methodology. Both methodologies, MPR and PDC, have pros and cons.  Based on analyses, PQA believes that: 1) PDC and MPR will provide nearly identical results when examining adherence to a single drug (e.g., only levothyroxine); and 2) PDC will provide a more conservative estimate of adherence when examining adherence to a class of drugs that are prone to frequent switching and concomitant therapy with multiple drugs within the class.

For information that describes both methods, please access the Proportion of Days Covered (PDC) as a Preferred Method of Measuring Medication Adherence paper on the Resources/Adherence page

Q:  Why are individuals who use insulin excluded from the Diabetes Adherence Measure?

A:  Days supply information attributed to multi-dose vials such as insulin is not very accurate.  Insulin dosing also is adjusted frequently, making days supply inaccurate. For these reasons, the measure does not include insulin.  The PQA measure specifications for Proportion of Days Covered: Diabetes Medications exclude from the denominator any patient that has one or more claims for insulin.  If an individual were included in the measure and switched from an oral hypoglycemic medication to insulin, they would appear to be non-adherent (since the numerator does not include insulin).  Therefore, excluding any patient that receives a claim for insulin during the measurement year mitigates this issue.

Q:  Are PQA measures risk adjusted?

A:  PQA is proposing draft recommendations on sociodemographic status (SDS) risk adjustment of the three PQA medication adherence measures used in the CMS Medicare Part D Star Ratings program: Medication Adherence for Diabetes Medications, Medication Adherence for Hypertension, and Medication Adherence for Cholesterol. The draft recommendations are as follows:

  • All three adherence measures should be risk adjusted for SDS characteristics to adequately reflect differences in patient populations.

  • The measures should be adjusted for the following beneficiary-level SDS characteristics: age, gender, dual eligibility/Low-Income Subsidy (LIS) status, and disability status.

  • The three adherence measures should be stratified by the beneficiary-level SDS characteristics listed above to allow health plans to identify disparities and understand how their patient population mix is affecting their measure rates.

These draft recommendations will be finalized in 2019 once PQA completes the National Quality Forum (NQF) measure endorsement maintenance of the three measures (NQF #0541).


SDS Risk Adjustment PQA PDC CMS Part D Stars for more information about PQA’s draft recommendations.

For additional FAQs on SDS risk adjustment, see SDS Risk Adjustment FAQs.

For questions about PQA measures and/or the measure development process, please contact:

Lynn Pezzullo, Sr. Director, Quality Innovation LPezzullo@PQAalliance.org
Lisa Hines, Sr. Director, Measure Operation & Analytics LHines@PQAalliance.org


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