During some of my meetings with healthcare professionals and office managers, there are numerous questions and misconceptions in understanding an Inverse Measure. In this blog, I will provide an explanation along with two examples.

What is an Inverse Measure?

According to CMS.gov, “An inverse measure is a lower calculated performance rate for measures, which indicates better clinical care or control.” The Performance Not Met numerator option for measures is the representation of the better clinical quality or control. In the case of reporting an inverse measure, a score of 100 percent is actually showing a complete failure in providing quality care for this measure. You may report an inverse measure with a percentage or a numerical value, but you want it as low as possible.

Examples of Inverse Measures

Here are two examples of reportable quality measures commonly used in attestation for MIPS (Merit-based Incentive Payment System).

Use of High-Risk Medication in the Elderly (CMS 156v5) NQF Number 0022

This is a two-part measure to assist providers in monitoring Beers medications for patients 65 and older. The list was named after Mark H. Beers, MD, a geriatrician, who first created the Beers Criteria in 1991. This list of medications advises providers which high-risk medications not to prescribe to patients because they may alter his or her psychological state.

This measure has two components to meet the measure. The first component is the percentage of patients 65 and older that are prescribed at least one high-risk medication during a measurement period. The second component is the percentage of patients 65 and older that are prescribed at least two different high-risk medications during a measurement period. You want both areas to show a percentage of less than 100 percent. This provides CMS with the information that the provider is prescribing alternate medications to increase patient safety.


Diabetes A1c Poor Control (CMS 122) NQF Number 0059

This measure provides healthcare professionals with a percentage of patients between 18-75 years old who have a diagnosis of diabetes and had a hemoglobin A1c greater than 9.0 percent. This measure is reported at least once per performance period. The most recent quality data code submitted will be used for performance calculation. The lower the patient’s result, the better the patient’s diabetes is being managed. If the measurement is higher than 9 percent, the patient may have a higher chance of complications while managing his or her diabetes.

Remember, all inverse measures must ALWAYS score low.


Miyoushi Simpson, MHA, has 17 years working in healthcare and holds a Masters from the University of Phoenix in Healthcare Administration. She as truly enjoyed working with Alabama Quality Assurance Foundation (AQAF) and enhancing her knowledge in the quality aspect of healthcare and meeting additional colleagues in the field. You can reach Miyoushi at Miyoushi.Simpson@area-g.hcqis.org