Fact Sheets

CMS proposes hospital outpatient and ambulatory surgical centers quality changes for 2015

CMS proposes hospital outpatient and ambulatory surgical centers quality 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 proposed rule [CMS-1613-P] on July 3, 2014. 

This fact sheet addresses the general quality provisions of the Hospital OPPS and ASC proposed rule 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

Overview

More than 4,000 hospitals, including general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, children’s hospitals, and cancer hospitals are paid under the OPPS.  There are approximately 5,300 Medicare-participating ASCs paid under the ASC payment system.

Proposed Quality Program Changes

Hospital Outpatient Quality Reporting (OQR) Program.  CMS is proposing to remove three measures -- a cardiac care measure (OP-4: Aspirin at Arrival (NQF #0286)) and two prophylactic antibiotic surgery measures (OP-6: Timing of Prophylaxis Antibiotics and OP-7: Prophylactic Antibiotic Selection for Surgical Patients (NQF #0528)) as performance is high with little variation between hospitals. CMS is proposing the addition of one claims-based measure (OP-32: Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy) for the CY 2017 payment determination and subsequent years. CMS also proposes to change one chart-abstracted measure (OP-31: Cataracts -- Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery (NQF #1536)) from required to voluntary reporting. 

CMS also is proposing modifications to the Hospital OQR Program validation process and formalization of a review and corrections period. 

ASC Quality Reporting Program.  CMS continues to propose measure alignment across the Hospital OQR and Ambulatory Surgical Center Quality Reporting (ASCQR) Programs.  Therefore, we are proposing the addition of one outcome measure (Facility Seven-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy) and the transition of one outcome measure (Cataracts -- Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery (NQF #1536)) to voluntary reporting for both the Hospital OQR and ASCQR Programs.

CMS will accept comments on the proposed rule until September 2, 2014 and will respond to comments in a final rule to be issued on or around November 1, 2014.  The proposed rule will appear in the July 14, 2014 Federal Register and can be downloaded from the Federal Register at: http://www.ofr.gov/inspection.aspx?AspxAutoDetectCookieSupport=1.
 

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