A Review of Hybrid Measure Changes: 2024 – 2027

July 1st marks the beginning of the first mandatory reporting period for the two hybrid measures. Do you feel like you’ve been here before? Well, you have. First, they were voluntary, then they were mandatory, then they were voluntary again, and now they’re mandatory again.If I was placing bets on what happens next, I might go all in on voluntary BUT based on CMS’s refusal to fold, I’m pretty sure Hybrid measures are here to stay.  

There are a few reasons I don’t think Hybrid measures are on the chopping block: CMS has proposed to lower the reporting thresholds to 70% and to allow up to 2 missing lab results and 2 missing vital signs – making it easier to meet requirements while reducing burden (and minimizing risk of penalty). Additionally, CMS has included the Hybrid Hospital-Wide Readmission measure as a key component of the shiny new TEAM model. It’s clear they believe they’re finally seeing the light at the end of Hybrid’s long, challenge-filled tunnel. 

So, what now? The most critical step is to assess whether you’ve kept up with the changes to the measure specifications and value sets. Mandatory or not, CMS has continued to refine the Hybrid measures every year, which means you may need to adjust your EHR workflows, mapping, and data submissions to stay both compliant and accurate. 

For those who left their Hybrid efforts on the table when CMS switched from mandatory to voluntary reporting for the latest performance year (7/1/2024 – 6/30/2025), and maybe let mapping and data capture slip, this one is for you. Time to get back in the game. 

The Hybrid measure specifications have been updated each year for the reporting periods 7/1/2024 – 6/30/2025; 7/1/2025 – 6/30/2026; and 7/1/2026 – 6/30/2027. Across these updates, some changes have been subtle, while others more significant, shaping how data is captured and directly affecting the accuracy of CMS’s risk adjustment methodology (applied after submission). 

Let’s unpack these changes, explain their implications, and highlight why quality teams, IT staff, and other stakeholders must work together proactively to keep documentation and EHR configurations aligned with CMS’s expectations. 

As a reminder, there are two mandatory hybrid measures: 

• Hybrid Hospital-Wide Readmission Measure (HWR) 

• Hybrid Hospital-Wide All-Condition All-Procedure Risk-Standardized Mortality Measure (HWM) 

Most of the changes apply to both measures, but we’ll call out where there are differences. 

Key Changes & Action Items  

See the table below for a full list of year-over-year changes. 

• Addition of Medicare Advantage (MA) Payer 
  The inclusion of Medicare Advantage (MA) payer in addition to Fee For Service (FFS) Medicare was initiated in the 2024 – 2025 reporting period. 

• To-do: Make sure your MA payer mapping is complete and accurate. If not, MA patients won’t be evaluated, and this will impact your performance. 

• Linking Variables Updated 
  For the 2025 – 2026 reporting year, CMS removed the outdated Health Insurance Claim Number (HICN) and introduced the National Provider Identifier (NPI) for Medicare Advantage patients, alongside keeping the CMS Certification Number (CCN) and Medicare Beneficiary Identifier (MBI). But don’t panic, there was a lot of feedback to CMS around the complexity of capturing NPI so once again, they changed their minds with this statement: Hospitals are not required to submit NPI for Medicare Advantage patients as long as CCN is submitted. Hospital - Inpatient eCQMs - eCQMs | eCQI Resource Center

And then, of course, for the 2026 - 2027 reporting year, CMS decided to completely remove the NPI for MA patients. Narrowing the linking variables to CCN, MBI, admission, and discharge dates. 

• To-do: Linking variables are key to a successful hybrid measure submission. Make sure all linking variables are accurately captured on every qualifying patient and that those linking variables are in the QRDA files at the time of submission. CMS will use the linking variables in the file to match the patient’s claim. Mismatched or missing linking variables may cause you to fall below the required 70% threshold (proposed). 

• Measure Type Explicitly Defined 
  The most recent specification finally designates the hybrid measures as “Outcome” measures. 

• To-do: No change needed, but note that with this change, CMS is reinforcing the importance of the hybrid measure’s role in evaluating readmission and mortality risk. 

• Refined Clinical Data Extraction Language 
  The specification switched from “first resulted set” to “first valid set” of clinical data, emphasizing the exclusion of invalid results. For example, CCDE results such as NP (not performed) or QNS (quantity not sufficient), would be ignored during evaluation and the next valid result (numeric) would be used as the first instance of documentation. This is a good thing; you won’t be penalized for an invalid result. The measure logic just skips those and looks at the next valid result. 

• To-do: Emphasize the importance of accurate/complete documentation. If results are missing or documented incorrectly, you risk losing key clinical data that reflects how sick the patient was at the time of arrival, which can directly impact risk adjustment and performance scores. 

• Mapping, mapping and more mapping 
  Many value sets were updated in order to remove and/or add codes. 

• To-do: Review each value set and then review your mapping to make sure it aligns with the changes. Every instance of documentation needs to be mapped correctly to effectively capture the first instance of CCDE documentation. Wrong or missing mapping = missing CCDEs and a possible impact on your performance. 

Let’s take a closer look at the hybrid measure specs and see what other changes CMS has slipped in. 

Key Changes: Core Clinical Data Elements (CCDEs) 

Across all three specification versions, the list of CCDEs has not changed (some good news!). These elements include labs and vitals:  

What has changed are refinements around when and how these values are extracted, the units of measure required, and capturing additional data to improve risk adjustment: 

• New Data to Collect for Risk Adjustment 
  The most recent version (applies to the 2026 – 2027 reporting year) introduces logic to capture additional data for patients arriving on oxygen therapy, preventing artificially inflated oxygen saturation readings from skewing risk adjustment. 

• To-do: Confirm electronic documentation of oxygen therapy. Documentation needs to occur in a structured field that is mapped to the correct code. You’ll need to review this new value set closely to make sure you get everything set up correctly. And documentation time matters. It must be done within an hour of the start of the ED visit or during the ED visit. Capturing this data will improve accuracy of final risk-adjusted rates. 

• Units of Measure and Fallback Logic 
  Units of measure have been a persistent thorn in hybrid measure reporting for years. A key change is coming for the 2026 – 2027 reporting year, but it’s still unclear whether this will finally tip the scales or if CMS is just upping the ante without improving the odds. The updated specification states: “For each CCDE, it is recommended that hospitals report the Unified Code for Units of Measure (UCUM) units; however, any units may be submitted. Where the reported unit is not easily converted to the requested UCUM units, the value will be set to missing and the (national) median value reported for that CCDE will be imputed.” 

Translation: CMS requires units submitted using UCUM standards. If a submitted unit is missing, non-standard, or cannot be converted to a standard unit, CMS will treat the CCDE data as missing but then will fill in (imputes) the national median value for that data element. This fallback can distort a hospital’s risk profile. 

If you’re like me, you need a little more clarification on what this means… 

When a hospital submits a lab or vital sign results, it needs to include a standard unit of measure (like "mmHg" for blood pressure).  

So, what happens if: 

• You use a non-standard unit, or 

• The unit is missing, or 

• The unit is misspelled and can’t be converted to a standard unit by CMS 

In this case, CMS will not discard the data. Instead, they use fallback logic, which means CMS will substitute the CCDE value submitted with a default (median) value for that specific data element, based on national data. 

For example: 

If blood pressure is reported with a unit like “mnHg” (a misspelling which isn’t convertible), CMS won’t guess the correct unit. They will consider the BP result invalid. CMS replaces the patient’s blood pressure result with the national median value from all valid submissions.  

• To-do: Align the units of measure as much as possible, with the UCUM standard units. Review all CCDE units of measure for typos, non-standard units or missing units. Wrong units mean missing data and inaccurate final results. 

CCDE Data Capture  
Starting with the 2025 – 2026 reporting year, CMS has added a new encounter type for CCDE data capture, outpatient surgery service. CCDE data documented in the ED or observation unit, prior to an inpatient admission, has always counted.  With this change, data documented in an outpatient surgery encounter will be included as well, as long as the services are contiguous with the inpatient stay. All this means is that if the first instance of documentation occurs during the outpatient surgery encounter and the patient is subsequently admitted inpatient, it will be evaluated for the hybrid measures.  

• Todo: Be sure to map the Outpatient Surgery encounter type to the correct SNOMED code in your EHR, otherwise, the data documented there won’t be considered.

CCDE Timing

*Applies to Hybrid Hospital-Wide Readmission only. 

The timing requirements for the documentation of weight have been loosened starting with the 2025 – 2026 reporting period. Now, the first instance of weight can be captured at any time during hospitalization; all other timing requirements have been lifted. 

• To-do: No changes are needed but be sure this change is understood; you still want to capture the weight as early as possible in the encounter so that it’s representative of the patient’s severity of illness. 

Why These Changes Matter  

1. EHR Workflow and CCDE Tracking Must Keep Pace 
   The refined timing rules, unit requirements, and new data elements mean hospitals need to review their EHR processes closely and make sure CCDE reports are in alignment with specification updates.  
2. Unit Standardization Cannot Be Overlooked 
   Failing to submit UCUM-standard units leads to data substitution, which can harm score accuracy and comparability. Teams must rigorously validate units before submission. 
3. Provider and Staff Education Is Key 
   Staff need clear guidance on documentation expectations, especially around vitals timing.  
4. Cross-Functional Collaboration Is Non-Negotiable 
   Quality, IT, clinical, and coding teams must collaborate to audit workflows, update EHR builds, and monitor compliance well ahead of the July 1 effective dates for each specification version.

Final Thoughts 

The Hybrid measure updates over the past three years demonstrate CMS’s push toward greater data precision and meaningful clinical capture. While the core clinical data elements have stayed consistent, refinements around data timing, unit standardization, and data elements are game-changers for hospitals serious about quality measurement and improvement. 

If your hospital isn’t proactively adjusting workflows, validating data, and educating providers on these evolving requirements, you risk incomplete or inaccurate reporting that could unfairly impact your readmission rates and, ultimately, reimbursement. Remember, you must meet the 70% thresholds for labs, vitals and linking variables – performance below those thresholds’ risk APU penalties. 

Stay ahead by engaging your cross-functional teams to interpret these specifications in detail and align your clinical documentation, mapping, and CCDE tracking report workflows. As the significance (and complexity) of Hybrid measures continues to rise, so does the opportunity for savvy, forward-thinking leaders to play their cards right and gain a reporting advantage.