What’s the Deal with Specification & Value Set Versions? (And Why You Should Care)

What’s the Deal with Specification & Value Set Versions?

Ah, that age-old question…or maybe I’ve just been working with Electronic Clinical Quality Measures (eCQMs) for way too long! For the past 14 years, I’ve been knee-deep in eCQM specifications, and let me tell you, they’ve changed a lot.

Remember VTE-6: Incidence of Potentially-Preventable Venous Thromboembolism? Yup, that once was an eCQM, and I must admit, I did a little dance when it was finally retired.

And there was a time when submitting eCQMs came with a payment instead of the risk of a penalty. Those were the days!

The submission process for eCQMs has also evolved. We've moved from manual attestation to uploading QRDA l files.

It’s been quite a journey since 2011. However, one thing has remained constant: the eCQM specifications are the ultimate source of truth for calculating accurate and submittable eCQM results. And, every year, like clockwork, a new version of the specification and value sets are released, bringing with it a set of changes.

What is a "Version" and Why Does It Change?

Think of the specifications and value sets as the rulebook for your eCQMs. This rulebook provides detailed guidelines on how to measure, map, and report your data. Just as a football rulebook is updated before each new season, the specifications and value sets are updated to new versions before each new measurement period. These updates can include new logic that changes your populations and results; new data elements that weren't previously captured, and new codes that need to be mapped.

While keeping up with these changes year after year can be challenging, there are several important reasons CMS updates these versions:

1. To Align with Changes in Clinical Processes and Guidelines:

For example, the CMS871 Hospital Harm Severe Hyperglycemia measure has new exclusions for the 2025 measurement period:

• Comfort or hospice care ordered or provided during the encounter
• Discharge disposition to home for hospice care or to a health care facility with hospice care
• Any glucose test with a result of ≥1000 mg/dL anytime between one hour before the start of the encounter to six hours after the start of the encounter

You can see why these updates can be crucially important to your performance score.

2. To Update Value Sets with Relevant Codes:

Medications are constantly changing, with new ones entering the market and old ones being discontinued. For the 2025 measurement period, the Antithrombotic Therapy value set for STK-2 has been updated to include 13 new medications (RxNorm codes) and to remove three medications/codes that are no longer applicable.

3. To Incorporate Feedback from Users:

Hospitals provided feedback that the timeline to capture the first instance of weight for the Hybrid readmission measure, was too short. As a result, the most recent version of the specification logic (for the July 1, 2025 – June 30, 2026 measurement period) was updated to allow the first weight documentation to be evaluated at any time during the hospitalization.

4. To Fix Measure Logic and Value Set Issues:

For the 2024 measurement period, the blood transfusion value set for PC-07 incorrectly included 33 codes that erroneously placed patients in the numerator. This issue has been corrected for the 2025 measurement period by removing those codes from the value set.

Using the correct specification version is crucial. Here’s why:

Data Accuracy: If you use the wrong version, your eCQM data, populations, and results will be incomplete and inaccurate. Even if you’ve updated your mappings and documentation to align with the new version, these changes won’t be reflected in your results if your reports / software are still using the old version. This makes it impossible to validate your results for completeness and accuracy, which is especially important now that eCQMs are publicly reported AND impact your Hospital Star Ratings.

Performance Insights: CMS updates the specifications annually to align with the latest clinical guidelines and coding systems. This ensures the eCQMs remain relevant and useful for quality improvement. If you use an outdated specification, your eCQM results won’t accurately reflect the care you’re providing, making it hard to identify areas for improvement.

Regulatory Compliance: The correct specification version is mandatory for submitting data to CMS’s Hospital Quality Reporting (HQR) system and TJC’s DDSP portal. Using the wrong version can lead to your files being rejected, leaving you at risk of missing the submission deadline.

Let me paint one final picture for you:

The 2025 version of the specification and value sets for CMS506 Safe Use of Opioids- Concurrent Prescribing have been significantly updated and include the following changes-

These changes impact all populations and results. In other words, if you’re still using the 2024 version of the spec, all of the results in your report, including the Initial Population, Denominator, Exclusions, Numerator and Performance rates, are incorrect.

Differentiating between specification versions

The eCQM version number is listed in the top right corner of the specification, and the ‘higher’ number indicates the most recent version. In the example below, version 6.1 applies to the 2024 measurement period while version 7.0 applies to the 2025 measurement period.

Notice anything missing? The specification does not include the measurement period! This information is found on the eCQM download page of the eCQI website. So, when you are downloading the specifications, be sure to label that file to align with the measurement period you selected from the drop-down menu:

Similarly, the value set versions are differentiated by the date of publication found on the Value Set Authority Center (VSAC) website. In the example below, the eCQM update for 2024-05-02 includes all updated value sets for the 2025 measurement period.

The next obvious question is, of course, how can you tell if your reports or reporting vendor is using the correct specifications and value sets? Wish I had an easy answer for you, but if you can’t tell by looking at the reports/software, you’ll need to reach out to your eCQM reporting resource or vendor to confirm.

Medisolv delivers updated specifications at the beginning of each calendar year. We pride ourselves on getting the measures out earlier so our quality leaders can drive improvements using accurate eCQM results. If you're still waiting on updated specs or new eCQMs from your EHR vendor, reach out to us today to see how Medisolv’s software delivers those measures without waiting for your EHR updates.