Health Information Management

Tip: CMS finalizes quality program changes in 2015 OPPS final rule

APCs Insider, January 23, 2015

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CMS finalized several changes to the Hospital Outpatient Quality Reporting (OQR) program in order to align it with the Ambulatory Surgical Center Quality Reporting (ASCQR) program, including revising the criteria to determine topped-out measures. The criteria will be the same for OQR and ASCQR programs, while also being consistent with the Inpatient Quality Reporting program.
CMS finalized one outcome-based quality measure for 2018 payment determination and subsequent years for the OQR and ASCQR programs: OP-32 and ASC-12, Facility Seven-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy.
CMS is excluding a previously adopted measure for 2016 payment determination: OP-31 and ASC-11, Cataracts: Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery (National Quality Forum 1536).
For both the OQR and ASCQR programs, this will be a voluntary measure for 2017 payment determination and subsequent years, which means providers will not be subject to payment reductions regarding this measure during this period.
Both OP-6 (Timing of Prophylaxis Antibiotics) and OP-7 (Prophylactic Antibiotic Selection for Surgical Patients) have been removed after reaching the topped out criteria.
This tip is adapted from “CMS adds data collection for services in off-campus, provider-based departments” in the January issue of Briefings on APCs.

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