Hospital Digital Quality Measures

Hospital Reporting of Electronic Clinical Quality Measures (eCQMs) and Hybrid Measures

Each year, the Health Services Cost Review Commission requires Maryland hospitals to submit digital quality measures. CRISP and Medisolv work in partnership to support the HSCRC to collect the Electronic Clinical Quality Measures (eCQMs) and the Core Clinical Data Elements for the HWR and HWM hybrid measures for July 2026-June 2027. For CY 2026, hospitals are required to submit 7 eCQMs and data elements for two hybrid measures. All eCQM data is being submitted in the Quality Reporting Document Architecture (QRDA) I format to Medisolv ENCOR portal via CRISP Portal. While these measures align with federal IQR measures, it does not replace IQR Reporting requirements for Maryland hospitals.

For documentation see:

eCQM Reporting Schedule for MD Hospitals CY 2026

Calendar Year 2026 Required Data Submission

For CY 2026, HSCRC will require submission of QRDA I files for the eCQM’s listed below (unchanged from CY 2025).

eOPI-1: Safe Use of Opioids-Concurrent prescribing
PC-02: Cesarean Birth
PC-07: Severe Obstetric Complications (risk adjusted)
HH-01: Hospital Harm- Severe Hypoglycemia
HH-02: Hospital Harm- Severe Hyperglycemia
For the self-selected measures, HSCRC is aligning with CMS and requiring that hospitals submit three additional eCQM measures of the hospital’s choosing (from the “self-selected” measures listed in Appendix A)

In alignment with the CMS reporting requirements, hospitals that do not qualify for the PC-02 and PC-07 obstetric measures must submit zero denominators for those measures. In the case of “self-selected” measures, hospitals must commit to reporting the same optional measures for each of the four quarters in the reporting period. Data submissions will be required in accordance with the options listed below.

eCQM Measures Reporting Timeline

eCQM CY 2026 Performance Period Submission Windows for Hospitals to be Eligible for the $150K Expedited Reporting Bonus for RY 2028

Data Quarter	Open	Close
Q1 2026 Data	7/15/2026	9/30/2026
Q2 2026 Data	7/15/2026	9/30/2026
Q3 2026 Data	10/15/2026	12/31/2026
Q4 2026 Data	1/15/2027	3/31/2027

eCQM CY 2026 Performance Period Submission Windows Required for HSCRC Reporting Compliance

For hospitals that do not opt for the expedited reporting bonus, they must report all required eCQM measures data consistent with the CMS CY 2026 reporting timeline as follows:

Data Quarter	Open	Close
Q1-Q4 CY 2026	1/15/2027	3/31/2027

Hybrid Measures Submission Requirements

Hybrid Measure Specifications

HSCRC requires submission of the Core Clinical Data Elements (CCDE) – July 1 2026 to June 30 2027 Performance Data)

Hybrid HWR: Hospital-Wide 30-day Readmission
Hybrid HWM: Hospital-Wide 30-day All-Cause Risk Standardized Mortality Measure

Hybrid HWR and HWM CCDE Reporting

RY 2028 Hybrid HWR and HWM Core Clinical Data Elements (CCDE):

Hospitals must submit CCDE measures for all payer hospitalizations for patients aged 18 and older for July 1, 2026 to June 30, 2027 reporting period; hospitals must submit an ECE request for HSCRC consideration if they are unable to comply with the reporting requirement. Hospitals must notify HSCRC of their reporting timeline (Quarterly or Annual as outlined below).

Data Quarter	Open	Close
Q3 2026 Data	1/15/2027	3/31/2027
Q4 2026 Data	1/15/2027	3/31/2027
Q1 2027 Data	4/15/2027	6/30/2027
Q2 2027 Data	7/15/2027	9/30/2027

Annual Time Period	Open	Close
Q3 2026 - Q2 2027	7/15/2027	9/30/2027

For hospitals that do not opt for expedited reporting bonus, they must report all required CCDE data consistent with the CMS July 1, 2026 to June 30, 2027 Hybrid Measures reporting timeline as follows

Data Quarters	Open	Close
Q3 2026 - Q2 2027	7/15/2027	9/30/2027

CCDE Data Completeness

The Commission will reevaluate data completeness standards as all-payer CCDE is received and analyzed, and will update hospitals accordingly.

CMS CY 2026 eCQM and Hybrid List of Measures

Title	Short Name	CMS eCQM ID	2024	2025	2026	HSCRC* (CY 2026)	CMS (CY 2026)
Anticoagulation Therapy for Atrial Fibrillation/Flutter	STK-3	CMS71	X	X	X	Self-Selected	Self-Selected
Antithrombotic Therapy By End of Hospital Day 2	STK-5	CMS72	X	X	X	Self-Selected	Self-Selected
Cesarean Birth	PC-02	CMS334	X	X	X	Required	Required
Discharged on Antithrombotic Therapy	STK-2	CMS104	X	X	X	Self-Selected	Self-Selected
Excessive Radiation Dose or Inadequate Image Quality for Diagnostic CT in Adults (Facility IQR)	IP-ExRad	CMS1074	-	X	X	Self-Selected	Self-Selected
Global Malnutrition Composite Score	GMCS	CMS986	X	X	X	Self-Selected	Self-Selected
Hospital Harm - Acute Kidney Injury	HH-AKI	CMS832	-	X	X	Self-Selected	Self-Selected
Hospital Harm - Opioid-Related Adverse Events	HH-ORAE	CMS819	X	X	X	Self-Selected	Self-Selected
Hospital Harm - Pressure Injury	HH-PI	CMS826	-	X	X	Self-Selected	Self-Selected
Hospital Harm - Severe Hyperglycemia	HH-Hyper	CMS871	X	X	X	Required	New Required
Hospital Harm - Severe Hypoglycemia	HH-Hypo	CMS816	X	X	X	Required	New Required

*For CY 2026 HSCRC will require 3 self-selected measures, consistent with CMS requirements.

Title	Short Name	CMS ID	2024	2025	2026	HSCRC*	CMS
ICU Venous Thromboembolism Prophylaxis	VTE-2	CMS190	X	X	X	Self-Selected	Self-Selected
Safe Use of Opioids - Concurrent Prescribing	Safe use of opioids	CMS506	X	X	X	Required	Required
Severe Obstetric Complications	PC-07	CMS1028	X	X	X	Required	Required
Venous Thromboembolism Prophylaxis	VTE-1	CMS108	X	X	X	Self-Selected	Self-Selected
Hospital Harm - Postoperative Respiratory Failure	HH-RF	CMS1218	-	-	X	Self-Selected	Self-Selected
Hospital Harm - Falls with Injury	HH-FI	CMS1017	-	-	X	Self-Selected	Self-Selected
Core Clinical Data Elements for the Hybrid Hospital-Wide Readmission Measure with Claims and Electronic Health Record Data	Hybrid HWR	CMS529	X	X	X	Required age 18+	Required age 65+
Core Clinical Data Elements for the Hybrid Hospital-Wide All-Condition All-Procedure Risk-Standardized Mortality Measure	Hybrid HWM	CMS844	X	X	X	Required age 18+	Required age 65+
Emergency Care Access and Timeliness (Hospital Outpatient Reporting Program)	ECAT	CMS1244	-	-	-	Required 2027**	Required 2028

*For CY 2026 HSCRC will require 3 self-selected measures, consistent with CMS requirements.

**The state will vet the potential early adoption of the Emergency Care Access and Timeliness measure.

What if our hospital needs an Exception?

For hospitals unable to comply with the data submission requirements (including the measures and the timelines) for reasons beyond their control and who wish to seek an exception from the requirements, they must submit an Extraordinary Circumstance Exception (ECE) request in accordance with the Maryland Hospital Extraordinary Circumstances Exception (ECE) Policy for HSCRC consideration.

During this webinar, HSCRC reviews the timeline and regulatory requirements and Medisolv offers expertise on how to effectively collect this data. HSCRC now requires all hospitals to submit the core clinical data elements needed to calculate the following hybrid measures: Hospital-Wide 30-day Readmission (HWR) and Hospital-Wide All-Cause Risk Standardized Mortality Measure (HWR).