The changing quality reporting requirements for CMS' OPPS: 5 key takeaways

Policy and payment changes in CMS' Outpatient Prospective Payment System (OPPS) final rule have wide-reaching implications for healthcare providers, including quality reporting requirements for 2025.

A Dec. 3 blog post by Coronis Health breaks down changes to quality reporting requirements for inpatient and outpatient programs, including new measures focused on health equity, social drivers of health and guidelines for rural emergency hospitals.

Five takeaways:

1. The Hospital Inpatient Quality Reporting (IQR) and Outpatient Quality Reporting (OQR) Programs continue as pay-for-reporting initiatives that impose penalties on hospitals that do not meet reporting requirements. For IQR, non-compliance results in a one-fourth reduction in the Annual Payment Update, while for OQR, non-compliance results in a two-percentage-point reduction.
   
   
2. Four new measures, such as the Hospital Commitment to Health Equity and Screening for Social Drivers of Health, aim to increase healthcare access and equitable health outcomes. Most of the measures have a phased implementation starting with voluntary reporting; reporting for Hospital Commitment to Health Equity is mandatory for 2025. The final rule also removes measures including MRI Lumbar Spine for Low-ack Pain and Cardiac Imaging for Preoperative Risk Assessment for Non-Cardiac, Low-Risk Surgery.
   
   
3. CMS is finalizing proposals to modify the immediate measure removal policy to a suspension policy; require EHR technology certification for all reporting measures; and publicly report specific emergency department measures on the HHS Compare tool.
   
   
4. There is also an extension of the reporting period for certain measures from one year to two years.This will help assess how hospitals address social factors that affect patient outcomes, as well as provide a more comprehensive evaluation of hospital performance, allowing for better tracking of long-term trends and impact on patient care.
   
   
5. CMS also outlined changes to the Rural Emergency Hospital Quality Reporting (REHQR) Programs to enable increased measurement and reporting of quality of care in the outpatient setting. The changes will extend the reporting period for risk-standardized hospital visits within seven days and after hospital outpatient surgery measures from one year to two years beginning with the 2025 reporting period. It will also establish when, after conversion to REH status, REHs would be required to report data under the REHQR program.