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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 health care. Hospital quality of care information gathered through the Hospital OQR Program is available on the Hospital Compare Web site.

Outpatient Department Measures

Outpatient care can refer to numerous types of health services, such as emergency department 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.

Hospital Compare provides results on emergency department and outpatient surgical 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.

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. Examples include administering the right kind of antibiotic to individuals having an outpatient surgical procedure performed or prescribing aspirin to heart attack patients upon arrival to the emergency department.

The Hospital  OQR measures includes data collected from various methods to measure process of care, imaging efficiency patterns, care transitions, ED-throughput efficiency, use of health information technology (HIT), care coordination, patient safety, and volume measures. Data may be collected through chart abstraction, claims volumes, or reporting on a hospital process. Specialty areas were identified by the Centers for Medicare & Medicaid Services (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 CY 2019 Payment Determination

  • OP-1: Median Time to Fibrinolysis
  • OP-2: Fibrinolytic Therapy Received Within 30 Minutes of ED Arrival
  • OP-3: Median Time to Transfer to Another Facility for Acute Coronary Intervention
  • OP-4: Aspirin at Arrival
  • OP-5: Median Time to ECG
  • OP-8: MRI Lumbar Spine for Low Back Pain
  • OP-9: Mammography Follow-up Rates
  • OP-10: Abdomen CT—Use of Contrast Material
  • OP-11: Thorax CT—Use of Contract Material
  • OP-12: The Ability for Providers with HIT to Receive Laboratory Data Electronically Directly into their ONC-Certified EHR System as Discrete Searchable Data
  • OP-13: Cardiac Imaging for Preoperative Risk Assessment for Non-Cardiac, Low-Risk Surgery
  • OP-14: Simultaneous Use of Brain Computer Tomography (CT) and Sinus Computed Tomography (CT)
  • OP-17: Tracking Clinical Results between Visits
  • OP-18: Median Time from ED Arrival to ED Departure for Discharged ED Patients
  • OP-20: Door to Diagnostic Evaluation by a Qualified Medical Professional
  • OP-21: Median Time to Pain Management for Long Bone Fracture
  • OP-22: Left Without Being Seen
  • OP-23: Heat CT or MRI Scan Results for Acute Ischemic Stroke or Hemorrhagic Stroke who Received Head CT or MRI Scan Interpretation Within 45 minutes of ED Arrival
  • OP-25: Safe Surgery Checklist Use
  • OP-26: Hospital Outpatient Volume on Selected Outpatient Surgical Procedures*
  • OP-27: Influenza Vaccination Coverage among Healthcare Personnel
  • OP-29: Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients**
  • OP-30: Colonoscopy Interval for Patients with a History of Adenomatous Polyps—Avoidance of Inappropriate Use**
  • OP-31: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery***
  • OP-32: Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy
  • OP-33: External Beam Radiotherapy for Bone Metastases

* OP–26: Procedure categories and corresponding HCPCS codes are located at: https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier3&cid=1196289981244.

** We note that measure name was revised to reflect NQF title.

*** Measure voluntarily collected as set forth in section XIII.D.3.b. of the CY 2015 OPPS/ASC final rule with comment period (79 FR 66946 through 66947).

More information regarding the Hospital OQR measures, can be found on the QualityNet website at https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1228775181731.

Contact Us

Submit questions and search for answers on the Hospital OQR Program at Hospital Outpatient - Questions/Answers or call the Hospital OQR Help-line, toll-free, (866) 800-8756 weekdays from 7 a.m. to 6 p.m. Eastern Time.

(NOTE: Questions regarding the HOQR should not be submitted via QualityNet Quest, the online question-and-answer database. Quest does not support the outpatient program.)

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