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. Hospitals must submit data for 23 quality measures: 14 clinical performance measures; seven imaging efficiency measures; and two Web-based structural measures. 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
Beginning with Calendar Year (CY) 2011 payment determinations, four imaging efficiency measures were included in the OQR program reporting requirements: OP-8, OP-9, OP-10 and OP-11. Two additional new measures — OP-13 and OP-14 — were added beginning with CY 2012 payment determinations.
As indicated in the most recent OPPS rule, published Nov. 15, 2012 (Federal Register, Volume 77, Issue 221, p. 68210), CMS will postpone public reporting of OP-15 to allow time for thoughtful refinement of the measure in collaboration with a technical expert panel and stakeholders. Public reporting for OP-15 will occur in July 2013 at the earliest, and this measure will not be used in the CY 2014 payment determination. CMS will confirm the inclusion or exclusions of this measure in future rulemaking for the CY 2015 payment determination.
The seven 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 2013 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)
Use of Brain Computed Tomography (CT) in the Emergency Department for Atraumatic Headache — on hold (Public reporting of OP-15 is postponed in order to allow time for thoughtful refinement of the measure in collaboration with a technical expert panel and stakeholders.)
For more information on all Hospital OQR measures, visit the CMS QualityNet website.