Hospital Quality Initiative - Hospital Outpatient Quality Reporting Program

Overview

The Hospital Outpatient Quality Reporting Program (Hospital OQR) is a pay for quality data reporting program implemented by the Centers for Medicare & Medicaid Services (CMS) for outpatient hospital services. The Hospital OQR Program was mandated by the Tax Relief and Health Care Act of 2006, which requires subsection (d) hospitals to submit data on measures on the quality of care furnished by hospitals in outpatient settings. Measures of quality may be of various types, including those of process, structure, outcome, and efficiency.

Under the Hospital OQR Program, hospitals must meet administrative, data collection and submission, validation, and publication requirements, or receive a 2 percentage point reduction in payment for failing to meet these requirements, by applying a reporting factor of 0.980 to the Outpatient Prospective Payment System (OPPS) payments and copayments for all applicable services.

In addition to providing hospitals with a financial incentive to report their quality of care measure data, the Hospital OQR Program provides CMS with data to help Medicare beneficiaries make more informed decisions about their healthcare. Hospital quality of care information gathered through the Hospital OQR Program is available on the Care Compare on the Medicare website.

Outpatient Department Measures

Outpatient care can refer to numerous types of health services, such as emergency department (ED) services, observation services, outpatient surgical services, lab tests, and X-rays, provided to those who visit a hospital or other healthcare facility. Outpatient often refers to a patient who leaves the facility after treatment on the same day but may include a patient who spends the night at the hospital for whom a doctor has not written an order for inpatient admission.

Care Compare provides results on ED and outpatient quality measures, which evaluate the quality of care provided to patients. A quality measure converts medical information from patient records into a rate or time that allows facilities to assess their performance and consumers to compare how well patients are being cared for at their local hospitals. Previous years' facility results are available in the Provider Data Catalog; previous years payment adjustment results are available at QualityNet.cms.gov.

The outpatient measures evaluate the regularity with which a healthcare provider administers the outpatient treatment known to provide the best results for most patients with a particular condition. An example includes patients receiving appropriate fibrinolytic therapy within 30 minutes of arrival to the ED.

The Hospital OQR measures include data collected from various methods to measure patient care outcomes, process of care, imaging efficiency patterns, care transitions, ED-throughput efficiency, care coordination, and patient safety. Data may be collected through chart abstraction, claims volumes, or reporting on a hospital process. Specialty areas were identified by CMS as having common and frequent procedures in the hospital outpatient setting. These procedures were identified as colonoscopies and outpatient imaging procedures. Other areas of future focus are outpatient surgery and chemotherapy.

        Measures for Payment Determination can be found here.

        Read more about the Hospital OQR Program in the most recent final rule found here.

        More information regarding the Hospital OQR measures can be found on the QualityNet website here.

Public Reporting

Data collected through the Hospital OQR program is publicly reported so people with Medicare and other consumers can find and compare the quality of care provided in the hospital outpatient setting. Publishing these data can improve facility performance by providing benchmarks for selected clinical areas and public view of facility data.

The CMS Care Compare website publishes information on the quality of care provided to patients; this information is made available to inform consumers and to encourage healthcare facilities to make continued improvements in care quality. Care Compare is generally refreshed quarterly for the Hospital OQR program. Information on Public Reporting can be found in Section 1833(t)(17)(E) of the Social Security Act and requires that the Secretary establish procedures to make data collected under the Hospital OQR program available to the public.

Contact Us

Submit questions and search for answers on the Hospital OQR Program through the Quality Question and Answer Tool or call the Hospital OQR Support at (866) 800-8756 weekdays from 7 a.m. to 6 p.m. Eastern Time.