The Hospital Outpatient Quality Reporting (OQR) Program is a quality data reporting program implemented by the Centers for Medicare & Medicaid Services (CMS) for outpatient hospital services. Under this program, hospitals report data using standardized measures of care to receive the full annual update to their Outpatient Prospective Payment System (OPPS) payment rate, effective for payments beginning in calendar year (CY) 2009.
The Hospital OQR Program is modeled on the current quality data reporting program for inpatient services, the Hospital Inpatient Quality Reporting Program.
Summary of Hospital OQR Requirements
To meet hospital OQR requirements and receive the full Annual Payment Update (APU) under the OPPS, hospitals must meet administrative, data collection and submission, and data validation requirements. The current measure set for the Hospital OQR Program includes measures that assess processes of care, imaging efficiency patterns, care transitions, ED throughput efficiency, the use of health information technology, care coordination, patient safety, and volume.. Participating hospitals agree that they will allow CMS to publicly report data for the quality measures (as stated in the current OPPS Final Rule).
Imaging Efficiency Measures
For Calendar Year (CY) 2017 payment determinations, six Outpatient Imaging Efficiency (OIE) measures are publicly reported within the Hospital Outpatient Quality Reporting (OQR) Program: OP-8, OP-9, OP-10, OP-11, OP-13, and OP-14.
The six publicly reported imaging efficiency measures listed below are calculated from hospital Medicare fee-for-service claims data paid under the OPPS. Hospitals need not submit any additional data for the seven imaging efficiency measures.
Measures for CY 2017 Payment Determination
MRI Lumbar Spine for Low Back Pain
Mammography Follow-up Rates
Abdomen CT — Use of Contrast Material
Thorax CT — Use of Contrast Material
Cardiac Imaging for Preoperative Risk Assessment for Noncardiac Low-Risk Surgery
Simultaneous Use of Brain Computed Tomography (CT) and Sinus Computed Tomography (CT)
For more information on all Hospital OQR measures, visit the CMS QualityNet website.
Hospital Inpatient Quality Reporting (IQR) Program
The Hospital Inpatient Quality Reporting (IQR) Program was developed as a result of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. Section 5001(a) of Public Law 109-171 of the Deficit Reduction Act of 2005 provided new requirements for the Hospital IQR Program, which built on the voluntary Hospital Quality Initiative.
The Hospital IQR Program is intended to equip consumers with quality of care information to make more informed decisions about healthcare options. It is also intended to encourage hospitals and clinicians to improve the quality of inpatient care provided to all patients. The hospital quality of care information gathered through the program is available to consumers on the Hospital Compare website.