CMS Finalizes Hospital Outpatient and Ambulatory Surgical Centers Quality Reporting Program Changes for 2015
The Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2015 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates final rule with comment period [CMS-1613-FC] on October 31, 2014.
The OPPS/ASC final rule is one of several rules for calendar year 2015 that reflect a broader Administration-wide strategy to deliver better care at lower cost by finding better ways to deliver care, pay providers, and use information. Provisions in these rules are helping to move our health care system to one that values quality over quantity and focuses on reforms such as measuring for better health outcomes, focusing on disease prevention, helping patients return home, helping manage and improve chronic diseases and fostering a more efficient and coordinated health care systems.
This fact sheet addresses the quality reporting provisions of the Hospital OPPS and ASC final rule with comment period for CY 2015. A separate fact sheet addressing the payment provisions of the proposed rule can be found here: http://cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets.html
More than 4,000 hospitals, including general acute care hospitals, children’s hospitals, and cancer hospitals, and over 70 CMHCs are paid under the OPPS. There are approximately 5,300 Medicare-participating ASCs paid under the ASC payment system.
Quality Program Changes
Hospital Outpatient Quality Reporting (OQR) Program and ASC Quality Reporting (ASCQR) Program. CMS continues to align measures across the Hospital OQR and ASCQR Programs. CMS is finalizing the addition of one outcome-based measure (OP-32 and ASC-12: Facility Seven-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy) for the CY 2018 payment determination and subsequent years for both the Hospital OQR and ASCQR Programs. In addition, CMS is excluding one previously adopted measure from the measure set for the CY 2016 payment determination (OP-31 and ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery (NQF #1536)) and changing this measure from required to voluntary for the CY 2017 payment determination and subsequent years for both the Hospital OQR and ASCQR Programs. Facilities will not be subject to payment reductions with respect to OP-31 and ASC-11 while the measure is voluntary.
CMS also is adopting criteria for determining when to remove a measure for the ASCQR Program and is refining the “topped out” criteria previously adopted for the Hospital OQR Program so that the same criteria are used for both programs and is consistent with other quality reporting programs, including the Hospital IQR Program.
Additionally, for the Hospital OQR Program, CMS is: 1) removing two “topped-out” prophylactic antibiotic surgery measures (OP-6: Timing of Prophylaxis Antibiotics and OP-7: Prophylactic Antibiotic Selection for Surgical Patients), 2) clarifying data submission requirements for OP-27: Influenza Vaccination Coverage among Healthcare Personnel, and 3) noting a delayed data collection for OP-29: Endoscopy/Polyp Surveillance: Appropriate Follow-up Interval for Normal Colonoscopy in Average Risk Patients and OP-30: Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps – Avoidance of Inappropriate Use.
Also, for the Hospital OQR Program, CMS is formalizing a review and corrections period for chart-abstracted measures, and updating validation procedures. Specifically, hospitals will only be eligible for random selection for validation if they submit at least 12 cases to the Hospital OQR Program Clinical Data Warehouse during the quarter with the most recently available data. Hospitals will also have the option to submit validation data using electronic methods and must identify the medical record staff responsible for submission of records to the designated CMS contractor.
The final rule with comment period will appear in the November 10, 2014 Federal Register and can be downloaded from the Federal Register at: http://www.ofr.gov/inspection.aspx?AspxAutoDetectCookieSupport=1. The provisions in the rule will generally take effect on January 1, 2015. The public comment period will close on December 30, 2014.