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Proposed CMS rule would add quality reporting measures to outpatient care

Quality Improvement Monitor, July 20, 2007

CMS this week issued a proposed rule on the Outpatient Prospective Payment System that would require hospitals to report on 10 quality measures in the outpatient setting in order to receive their full Medicare reimbursement.

Hospitals that don't report the data to CMS would forfeit 2% of their full Medicare market basket update.

The proposal calls for hospitals that are paid under the Inpatient Prospective Payment System to report the applicable outpatient quality measures in the hospital outpatient department in 2008 in order to receive the full OPPS market basket update in 2009. The measures are as follows:  

1. Emergency department (ED) transfer for Acute Myocardial Infarction (AMI): aspirin at arrival

2. ED transfer for AMI: median time to fibrinolysis

3. ED department transfer for AMI: fibrinolytic therapy received within 30 minutes of arrival

4. ED transfer for AMI: median time to electrocardiogram

5. ED transfer for AMI: median time to transfer for primary percutaneous coronary intervention

6. Heart Failure: angiotensin-converting enzyme inhibitor or Angiotensin receptor blocker therapy for left ventricular systolic dysfunction

7. Perioperative Care: timing of antibiotic prophylaxis

8. Perioperative Care: Selection of prophylactic antibiotic

9. Empiric antibiotic for community-acquired pneumonia

10. Hemoglobin A1c poor control in Type 1 or 2 diabetes mellitus.

Comments on the proposed rule will be accepted until September 14, and a final rule will be published later this fall.

For more information, click here.

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