2023 OPPS Final Rule

CMS recently released the CY 2023 OPPS Final Rule, which included updates to the Hospital Outpatient Quality Reporting Program (OQR) Program. For the full text of the rule, see the Federal Register.

Measures

The OP-31 measure has been a voluntary measure to report but was previously finalized as mandatory beginning with the CY 2025 reporting period. In this rule, CMS finalized removing the mandatory requirement and will continue to make OP-31 a voluntary measure.

Since the removal of OP-26, the Hospital OQR Program does not capture outpatient surgical procedure volume in hospitals. CMS sought comment on reimplementing OP-26 measure or another volume measure because the shift from the inpatient to outpatient setting has placed greater importance on tracking the volume of outpatient procedures. CMS will take comments received into consideration as part of future rulemaking.

Data Submission Timing

CMS finalized aligning the patient encounter quarters for chart-abstracted measures with the calendar year beginning with the CY 2024 reporting period (CY 2026 payment determination). All four quarters of patient encounter data for chart-abstracted measures will be based on the calendar year two years prior to the payment determination year. This aligns the patient encounter quarters for chart-abstracted measures with those of the Hospital IQR program.

To transition to this timeframe beginning with the CY 2024 reporting period (CY 2026 payment determination), CMS finalized using only three quarters of data for chart-abstracted measures for the CY 2023 reporting period (CY 2025 payment determination).

The following tables were excerpted from the final rule:

* All deadlines occurring on a Saturday, Sunday, or legal holiday, or on any other day all or part of which is declared to be a nonwork day for Federal employees by statute or Executive order would be extended to the first day thereafter
** The August 1st, November 1st, and May 1st deadlines are recurring

Validation

For validation purposes, CMS selects a random sample of 450 hospitals and selects an additional 50 hospitals based on targeting criteria. Beginning with validation affecting the CY 2023 reporting period (CY 2025 payment determination) CMS finalized a fifth criterion for the targeting criteria. CMS finalized that a hospital with less than four quarters of data subject to validation due to receiving an Extraordinary Circumstances Exception (ECE) for one or more quarters and with a two-tailed confidence interval that is less than 75% would be targeted for validation in the subsequent validation year.

If you have questions about reporting your OQR measures, please contact us.