Eligible professionals (EPs) must attest to an alternate core clinical quality measure (CQM) for every core CQM for which the denominator(s) is/are zero. For the two core CQMs (NQF 0028 and NQF 0421) for which there are two sets of denominators, both denominators must equal zero for an alternate core CQM to be required. EPs who must attest to fewer than three alternate core CQMs should select those CQMs relevant to their scope of practice. For pediatricians and nurse practitioners with a pediatric scope, all three alternate core CQMs are often required given the adult population focus of the core CQMs, but only two of the three alternate core CQMs focus on a pediatric population. The design of the Stage 1 CQMs means that many EPs will likely report on measures not relevant to their scope of practice, but where there is a choice to report a relevant measure, EPs should do so.
Even if the alternate core CQMs may be more appropriate for a provider’s scope of practice than the additional CQMs available through his certified EHR technology, the alternate core CQMs cannot be substituted for attesting to three of the 38 additional CQMs.
CQMs should be reported exactly as generated by certified EHR technology. EPs should use the electronic specifications linked for each of the alternate core CQMs below, along with the TennCare notes on the measure, to
NQF 0024 Weight Assessment and Counseling for Children and Adolescents 
The percentage of patients 217 years of age who had an outpatient visit with a Primary Care Physician (PCP) or OB/GYN and who had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year. 
NQF 0024 Notes: Each population criteria delineates an age range, with population criteria 1 capturing patients (217 years) subdivided in population criteria 2 (211 years) and 3 (1217 years). This measure has three sets of numerators for each of the three population criteria, but the denominator is technically the same within each population criteria, although the attestation portal lists a denominator for each numerator. The numerators, like the population criteria, also have a specific order, chronicling whether a BMI was calculated for numerator 1, nutrition counseling for numerator 2, and physical activity counseling for numerator 3.
As the patient population captures a pediatric population, EPs who serve an adult population may have a denominator of zero for this measure. Also, given the age ranges, even EPs who serve a pediatric population will likely not have all of their unique patients reflected in the denominator of this measure. 

NQF 0038 Childhood Immunization Status 
The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP), three polio (IPV); one measles, mumps and rubella (MMR); two H influenza type B (HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and two separate combination rates. 
NQF 0038 Notes: The denominator is technically the same for each of these numerators, although the attestation portal lists a denominator for each numerator. There are twelve numerators reflecting 10 series of immunizations and two combinations, but these combinations do not align with the HEDIS combinations 2 and 3 because the HiB series is omitted. As the patient population captures a pediatric population, EPs who serve an adult population may have a denominator of zero for this measure. Also, given the age range of children between one and two, even EPs who serve a pediatric population will likely not have all of their unique patients reflected in the denominator of this measure. 

NQF 0041 Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years Old 
Percentage of patients aged 50 years and older who received an influenza immunization during the flu season (September through February). 
NQF 0041 Notes: This singular numerator and denominator reflects the rate of providing influenza vaccines to this adult population during the flu season. Given the criteria that the patient has two encounters or one preventive encounter, even EPs who serve an adult patient population will likely not have all of their unique patients reflected in the denominator of this measure. This is the only alternate core measure to include exclusion criteria, with excluded patients exempt from the denominator because of the inappropriateness of providing the influenza vaccine to those particular patients. 