Hospitals and ASCs that fail to meet Hospital OQR Program and ASCQR Program reporting requirements will receive a 2.0 percentage point reduction to their OPPS and ASC payment system reimbursements for the applicable payment year.
CMS is proposing to remove 2 measures from the Hospital OQR Program for the CY 2016 payment determination and subsequent years due to a variety of issues: (1) OP-19: Transition Record with Specified Elements Received by Discharged ED Patients; and (2) OP-24: Cardiac Rehabilitation Measure: Patient Referral from an Outpatient Setting. (These two measures are included among the 25 measures that have been previously adopted and retained for the CY 2014 and CY 2015 payment determinations.)
CMS also proposes to adopt 5 new measures for the CY 2016 payment determination and subsequent years, for which data collection would begin in CY 2014:
- OP-27: Influenza Vaccination Coverage among Healthcare Personnel (NQF #0431);
- OP-28: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures (NQF #0564);
- OP-29: Endoscopy/Polyp Surveillance: Appropriate follow-up interval for normal colonoscopy in average risk patients (NQF #0658);
- OP-30: Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps – Avoidance of Inappropriate Use (NQF #0659); and
- OP-31: Cataracts: Improvement in Patient’s Visional Function within 90 Days Following Cataract Surgery (NQF #1536).
The first proposed measure is a healthcare-associated infection measure for which data would be submitted through the Centers for Disease Control and Prevention via the National Healthcare Safety Network. The other 4 measures are chart-abstracted measures for which data would be submitted through a CMS Web-based tool via the QualityNet Web site. CMS also proposes to adopt these last 4 measures under the ASCQR program for the CY 2016 payment determination and subsequent years. (The second measure, “Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures,” is currently NQF-endorsed for the “Ambulatory Care: Clinic” setting, but not for the ASC setting.)
CMS is inviting comments on its plan to consider future measures for the Hospital OQR Program within the following measure domains: clinical quality of care; care coordination; patient safety; patient and caregiver experience of care; population/community health; and efficiency. Under the ASCQR Program, CMS proposes to develop future quality measures in the following areas: clinical quality of care, patient safety, care coordination, patient experience of care, surgical outcomes, surgical complications, complications of anesthesia, and patient reported outcomes of care.