CMS eCQM and Kidney Care: Preparing for the Next Reporting Cycle

20/11/25

As regulatory requirements continue to evolve in line with promoting quality outcomes in value-based care, to address acute kidney injury (AKI), the Centers for Medicare and Medicaid Services (CMS) recently published an update to its new rule for CY2025 which designated AKI as a hospital harm, reportable in electronic clinical quality measures (eCQMs). While this designated AKI reporting as optional, the proposed rule for CY2027 mandates reporting of AKI beginning in October 2026.

This eCQM highlights the need for reliable, early identification of AKI. Fortunately, health systems who wish to proactively address quality outcomes in renal disease management have options. One strategy is implementation of digitized fluid management to improve kidney care and decrease the risk of mandatory AKI reporting and associated penalties.

Impacts of eCQM AKI Reporting for Health Systems

Acute care hospitals who fall under subsection (d) are required by CMS to submit data on quality measures each year under the Hospital Inpatient Quality Reporting program (IQR), which was originally mandated in 2003. These hospitals are paid for care delivered based on these quality outcomes under the Inpatient Prospective Payment System (IPPS).

eCQMs leverage standardized data available in electronic health records (EHRs) and other health IT systems to measure the quality of healthcare provided. For CY2025, hospitals participating in the IQR must submit three self-selected eCQMs and three eCQMs selected by CMS, with HH-AKI (CMS 832v2) Hospital Harm-Acute Kidney Injury as one of the available self-selected CQMs.

There are two negative impacts to health systems when adverse quality outcomes are reported:

Information collected through the IQR program is available to the public on Medicare’s Care Compare website. This transparency empowers patients to make informed healthcare choices.
Health systems who fail to meet quality requirements or to submit data appropriately are subjected to a one-quarter reduction of their annual payment update, an annual adjustment to payment rates for healthcare services.

The Crucial Intervention Phase for eCQM and Kidney Care

In the case of AKI, early and proactive intervention is crucial to avoiding detrimental outcomes. One key detail of the AKI eCQM is that it captures Stage 2 AKI and beyond. Determining the stage of AKI is based on KDIGO criteria.

Identifying AKI at Stage 1 has marked impacts on patient outcomes. Stage 1 AKI is associated with lower mortality, decreased risk of ICU admission, reduced likelihood of requiring dialysis and fewer readmissions. Besides being the eCQM threshold, Stage 2 AKI (and beyond) result not only in worsening mortality and increased length of stay, but also in increased physical debility and poor quality of life. This makes it imperative for clinicians to identify and treat Stage 1 AKI whenever possible.

The primary challenge in early identification for health systems is access to targeted, highly sensitive measures of kidney damage and renal impairment. Serum creatinine (SCr) alone is not a reliable indicator, as SCr increases can lag by as much as 24-36 hours following kidney injury. A decrease in urine output can serve as a valuable clue, but manual measurements are error prone.

Automated, electronic urine output (UO) monitoring is an alternative strategy that aids in rapid, early identification of Stage 1 AKI, supporting a decreased risk of eCQM reporting and also representing the potential to interrupt kidney failure progression.

The Role of Digitized Fluid Management and its Impact on AKI eCQMs

Electronic UO monitoring provides continuous, real-time urine output data. It is significantly more accurate than manual UO measurements, both in terms of timeliness and recording accurate volumes. Digitized fluid management offers a valuable additional vital sign for clinicians who need an accurate, sensitive and easily visible way to monitor early clinical warning signs of AKI.

Additionally, the eCQM AKI measure requires accurate recording of dates and times across several data elements. One of these data elements is urine output. It is easy to see how manual recording could result in missed or delayed entries. Electronic UO monitoring, on the other hand, seamlessly connects with a health system’s EHR, ensuring consistent, ongoing capture of all data required for correctly reporting any events. Incomplete data can result in exclusions such as “performance not met” and ultimately, lower validation scores and reduction of payments.

The Time to Act is Now

With less than a year until mandatory AKI eCQM reporting begins, healthcare organizations must implement steps now to both proactively address this quality measure as well as ensure accuracy in the data they share.

FIZE kUO offers an actionable solution for health systems with an automated urine output monitoring tool powered by proprietary AI algorithms. Urine output is measured as soon as it enters the bladder, a beside monitor alerts clinicians to potential imbalances, and details are automatically uploaded to the EHR. By leveraging this powerful tool, providers can meaningfully improve quality outcomes, reduce risk of deficiencies and satisfy AKI eCQM requirements in time for CY 2027.

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