An Overview of Qualified Clinical Data Registries (QCDRs)

Qualified Clinical Data Registries (QCDRs) are organizations that adhere to the Centers for Medicare & Medicaid Services (CMS) standards for health care quality improvement through the collection and reporting of clinical data.1 CMS, established in 1965 and part of the United States Department of Health and Human Services (HHS), works with states to administer Medicare and Medicaid and to improve health care results for patients.2 Aligned with CMS’s goals, a CMS-approved QCDR is different from other patient data registries in that its main objective must be improving quality of care, as opposed to reporting for the sake of professional evaluation only.3 QCDRs can include national physicians’ associations, foundations and academic institutions; for example, the Anesthesia Quality Institute (AQI)’s National Anesthesia Clinical Outcomes Registry (NACOR), the Emergency Medicine Institute of Quality (EMIQ) and the Physical Therapy Outcomes Registry represent some QCDRs across different specialties.4

One of the purposes of a QCDR is to submit data to CMS on quality of care in order to access the Merit-based Incentive Payment System (MIPS). MIPS ties payment to quality and cost-efficient care, thus incentivizing better professional performance through alterations in payment. Clinicians or group practices that provide services under the Medicare Physician Fee Schedule (PFS) can change their MIPS score, and subsequently their payment, through four performance categories, all of which are measured by the QCDR. “Quality” represents quality of patient care delivered; “Promoting Interoperability (PI)” focuses on patient engagement through electronic health records; “Improvement Activities” evaluates improvement of patient care, engagement and access to care; and “Cost” measures cost of care during a year or hospital stay.5 Different QCDRs can customize the exact measures in these categories based on their specialties—such that, for example, the American Urological Association Quality (AQUA) Registry and the Mental and Behavioral Health Registry (MBHR) can both report adequate data to CMS that is also relevant to their individual fields. For one, the AQI’s NACOR submits measures to MIPS as specific as “Prevention of Central Venous Catheter-Related Bloodstream Infections” and “Anesthesiology Smoking Abstinence,” as well as measures as general as “Documentation of Current Medications in the Medical Record” and “Pain Assessment and Follow-Up.”6

Additionally, QCDRs can further customize their data by including non-MIPS measures in their collection and reporting processes. The NACOR includes, among many other non-MIPS measures, a measure of “Consultation for Frail Patients,” which measures the “percentage of patients aged 70 years or older, who undergo an inpatient procedure requiring anesthesia services and have a positive frailty screening result who receive a multidisciplinary consult or care.”6 Thus, the non-MIPS measures that are unique to QCDRs allow for flexibility, specialty-related customization and further evaluation of quality of care.

Because QCDR-based payment adjustment has only been in place since 2014, it remains unclear whether or not QCDRs can achieve their goal of improving patient care quality.7 However, QCDRs are projected to affect payment; a 2016 article predicted that QCDRs could lead to negative payment adjustments reaching nine percent.8 Regardless of QCDRs’ current relationships to patient care improvement and clinician payment, they serve as a stepping stone towards value-based healthcare, in which providers are paid based on patient outcomes rather than on the cost of the services they provide.9,10 QCDRs may help clinicians who are interested in the value-based healthcare model ease into the novel system by focusing on improving patient care and outcomes through monetary incentives.

1.         Centers for Medicare & Medicaid Services. A Brief Overview of Qualified Clinical Data Registries (QCDRs). cms.gov2018.

2.         Centers for Medicare & Medicaid Services. Our 16 Strategic Initiatives. 2019;

3.         Centers for Medicare & Medicaid Services. 2016 Physician Quality Reporting System (PQRS) Qualified Clinical Data Registry (QCDR) Training Guide. 2017.

4.         American Association of Nurse Anesthetists. 2019 Qualified Clinical Data Registries for MIPS. 2019.

5.         Quality Payment Program. MIPS Overview. 2019;

6.         Anesthesia Quality Institute National Anesthesia Clinical Outcomes Registry. 2019 QCDR Measure Specifications: Version 2.1.  February 4 2019.

7.         Chen MM, Rosenkrantz AB, Nicola GN, et al. The Qualified Clinical Data Registry: A Pathway to Success within MACRA. AJNR. American journal of neuroradiology. 2017;38(7):1292–1296.

8.         Centers for Medicare & Medicaid Services, HHS. Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models Federal Register. 2016;81(89).

9.         What Is Value-Based Healthcare? NEJM Catalyst. 2017.

10.       Robeznieks A. Use a Qualified Clinical Data Registry to boost Medicare bonus. Payment & Delivery Models 2018;

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