Hospital Outpatient Quality Reporting Program

Overview

Mandated by the Tax Relief and Healthcare Act of 2006, the Hospital Outpatient Quality Reporting Program (Hospital OQR) is a pay-for-reporting program which collects quality measure data from short-term acute care hospitals paid under the Outpatient Prospective Payment System (OPPS) for care provided in the hospital outpatient departments (HOPDs).

Under the Hospital OQR Program, hospitals receive a 2-percentage point reduction in payment for failing to meet program requirements. This reduction is calculated by applying a reporting ratio of 0.980 to the OPPS payments and copayments for all applicable services. Payment adjustment results are available on the QualityNet website.

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 through the public reporting of measure data on the Care Compare website.

Program Requirements

Initial program requirements were finalized in the CY 2009 OPPS/ASC final rule with comment period.

Current information on Hospital OQR Program requirements is available on our QualityNet website.

Hospital Outpatient Department Measures

"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. Outpatient care can refer to numerous types of health services for this population, 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 care can refer to numerous types of health services for this population, 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.

The measures in the Hospital OQR Program collect data derived from various methods, including chart-abstraction, claims information, web-based entries, and surveys to measure aspects of patient care such as outcomes and processes, patient experience, patient safety, care transitions and coordination, and ED efficiency. In addition, measures for procedures performed in HOPDs that CMS identifies as being particularly consumer relevant (e.g., outpatient surgery, colonoscopies, and outpatient imaging procedures) are adopted for program use.

CMS continues to evaluate measures, ensuring meaningful information is collected to ensure quality of care, removing measures that are no longer needed, and adding measures to continue the quality improvement process.

More information regarding the Hospital OQR measures can be found on the "Hospitals - Outpatient" section of QualityNet.

Public Reporting

Section 1833(t)(17)(E) of the Social Security Act requires that the Secretary establish procedures to make data collected under the Hospital OQR Program available to the public.

The Care Compare website publishes information on the quality of care provided to patients, including data collected through the Hospital OQR Program. This information is made available to enable the public to compare the quality of care provided in various care settings (such as hospital outpatient and ED settings), and to encourage healthcare providers and facilities to make continued improvements in care quality, by providing benchmarks for selected clinical areas and through public transparency of quality data.

Care Compare data for the Hospital OQR Program is refreshed quarterly. Archived hospital results are also available at data.cms.gov.

Contact Us

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