Hospital Quality Initiative - Hospital Outpatient Quality Reporting Program
Guidance for explaining the particulars of the Hospital Outpatient Quality Reporting Program.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 11, 2020
The Hospital Outpatient Quality Reporting Program (Hospital OQR) is a pay for quality data reporting program implemented by the Centers for Medicare & Medicaid Services (CMS) for outpatient hospital services. The Hospital OQR Program was mandated by the Tax Relief and Health Care Act of 2006, which requires subsection (d) hospitals to submit data on measures on the quality of care furnished by hospitals in outpatient settings. Measures of quality may be of various types, including those of process, structure, outcome, and efficiency.
Under the Hospital OQR Program, hospitals must meet administrative, data collection and submission, validation, and publication requirements, or receive a 2 percentage point reduction in payment for failing to meet these requirements, by applying a reporting factor of 0.980 to the Outpatient Prospective Payment System (OPPS) payments and copayments for all applicable services.
In addition to providing hospitals with a financial incentive to report their quality of care measure data, the Hospital OQR Program provides CMS with data to help Medicare beneficiaries make more informed decisions about their healthcare. Hospital quality of care information gathered through the Hospital OQR Program is available on the Care Compare on the Medicare website.
Outpatient Department Measures
Outpatient care can refer to numerous types of health services, such as emergency department services, observation services, outpatient surgical services, lab tests, and X-rays, provided to those who visit a hospital or other healthcare facility. Outpatient often refers to a patient who leaves the facility after treatment on the same day but may include a patient who spends the night at the hospital for whom a doctor has not written an order for inpatient admission.
Care Compare provides results on emergency department and outpatient quality measures, which evaluate the quality of care provided to patients. A quality measure converts medical information from patient records into a rate or time that allows facilities to assess their performance and consumers to compare how well patients are being cared for at their local hospitals. Previous years' facility scores and payment adjustment results are available in the Provider Data Catalog.
The outpatient measures evaluate the regularity with which a healthcare provider administers the outpatient treatment known to provide the best results for most patients with a particular condition. An example includes patients receiving appropriate fibrinolytic therapy within 30 minutes of arrival to the emergency department.
The Hospital OQR measures include data collected from various methods to measure patient care outcomes, process of care, imaging efficiency patterns, care transitions, ED-throughput efficiency, care coordination, and patient safety. Data may be collected through chart abstraction, claims volumes, or reporting on a hospital process. Specialty areas were identified by CMS as having common and frequent procedures in the hospital outpatient setting. These procedures were identified as colonoscopies and outpatient imaging procedures. Other areas of future focus are outpatient surgery and chemotherapy.
Measures for the CY 2022 Payment Determination
- OP-2: Fibrinolytic Therapy Received Within 30 Minutes of ED Arrival
- OP-3: Median Time to Transfer to Another Facility for Acute Coronary Intervention
- OP-8: MRI Lumbar Spine for Low Back Pain
- OP-10: Abdomen CT—Use of Contrast Material
- OP-13: Cardiac Imaging for Preoperative Risk Assessment for Non-Cardiac, Low-Risk Surgery
- OP-18: Median Time from ED Arrival to ED Departure for Discharged ED Patients
- OP-22: Left Without Being Seen
- OP-23: Head CT or MRI Scan Results for Acute Ischemic Stroke or Hemorrhagic Stroke who Received Head CT or MRI Scan Interpretation Within 45 minutes of ED Arrival
- OP-29: Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients
- OP-31: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery*
- OP-32: Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy
- OP-33: External Beam Radiotherapy for Bone Metastases
- OP-35: Admissions and Emergency Department (ED) Visits for Patients Receiving Outpatient Chemotherapy
- OP-36: Hospital Visits after Hospital Outpatient Surgery
* Measure voluntarily collected as set forth in section XIII.D.3.b. of the CY 2015 OPPS/ASC final rule with comment period (79 FR 66946 through 66947).
More information regarding the Hospital OQR measures can be found on the QualityNet website here.
Data collected through the Hospital OQR program is publicly reported so people with Medicare and other consumers can find and compare the quality of care provided at ambulatory surgical centers. Publishing these data can improve facility performance by providing benchmarks for selected clinical areas and public view of facility data.
The CMS Care Compare website publishes information on the quality of care provided to patients; this information is made available to inform consumers and to encourage healthcare facilities to make continued improvements in care quality. Care Compare is generally refreshed quarterly for the Hospital OQR program. Information on Public Reporting can be found in Section 1833(t)(17)(E) of the Social Security Act and requires that the Secretary establish procedures to make data collected under the Hospital OQR program available to the public.
Submit questions and search for answers on the Hospital OQR Program through the Quality Question and Answer Tool or call the Hospital OQR Support at (866) 800-8756 weekdays from 7 a.m. to 6 p.m. Eastern Time.
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.