CMS recently published the CY 2024 Outpatient Prospective Payment System (OPPS) Final Rule, which finalized changes for the Hospital Outpatient Quality Reporting (OQR) Program. In the final rule, CMS finalized modifications to three measures and finalized the adoption of two measures in the OQR Program. These modifications aim to further meaningful measurement and reporting of the quality of care provided in the outpatient setting. For the full text of the rule, see the Federal Register.
Outpatient Prospective Payment System (OPPS)
Beginning with the CY 2024 reporting period/CY 2026 payment determination, CMS finalized modifying the COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) measure to align with the updated Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network measure specifications. CMS has updated the numerator to specify timeframes for which an HCP is up to date with the CDC’s recommendations for the COVID –19 vaccinations and this will include booster doses. The measure calculation has not changed, and the data collection continues to require 1 week of data per month for each month of the quarter.
Beginning with the voluntary CY 2024 reporting period, CMS is standardizing the use of survey instruments that can be utilized to assess visual function pre- and post-cataract surgery for the Cataracts: Improvement in Patient’s Visual Function Within 90 Days Following Cataract Surgery measure. Survey instruments are limited to: The National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25), The Visual Functioning Patient Questionnaire (VF-14) and The Visual Functioning Index Patient Questionnaire (VF-8R).
Beginning with the CY 2024 reporting period/CY 2026 payment determination, CMS has aligned the Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients measure with updated clinical guidelines. The measure denominator has been modified to “all patients aged 45 years to 75 years receiving screening colonoscopy without biopsy or polypectomy” from “all patients aged 50 years to 75 years receiving screening colonoscopy without biopsy or polypectomy”.
CMS adopted the Risk-Standardized Patient-Reported Outcomes Following Elective Primary Total Hip and/or Total Knee Arthroplasty measure beginning with three voluntary reporting periods (CY 2025, CY 2026 and CY 2027) followed by mandatory reporting beginning with CY 2028 affecting CY 2031 payment determination. This measure requires pre-op and post-op data collection.
CMS adopted the Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults eCQM beginning with two voluntary reporting periods (CY 2025 and CY 2026) followed by mandatory reporting beginning with CY 2027 affecting CY 2029 payment determination.
CMS did not finalize the removal of the Left Without Being Seen (LWBS) measure as there has been a recent increase (worsening) of LWBS rates that warrants further investigation. CMS also did not finalize the re-adoption of the original Hospital Outpatient /ASC Facility Volume Data on Selected Outpatient Surgical Procedures.
Hospitals that fail to meet all OQR program requirements will incur a 2.0 percentage point reduction to their annual payment update.
If you have questions about your hospital reporting of OQR measures, please contact us.