CMS Announces Results of Hospital Outpatient Quality Data Reporting

On January 8, 2009, the Centers for Medicare & Medicaid Services (CMS) announced in a Press Release that 3,313 hospitals (or 99.3 percent of Medicare participating hospitals) will receive a full payment update for calendar year (CY) 2009 as part of the Hospital Outpatient Quality Data Reporting Program.

The quality data reporting program was established by the Tax Relief and Health Care Act of 2006 (TRHCA) and pertains to hospitals paid under the Medicare hospital outpatient prospective payment system (OPPS).

Pursuant to the TRHCA, hospitals that failed to successfully report outpatient quality data in 2008 will receive a CY 2009 payment update that is reduced by 2.0 percentage points. In 2008, hospitals participating in the quality data reporting program were required to report data on:

• Percentage of heart attack patients given aspirin when they arrive at the emergency room;
• Amount of time it takes for a heart attack patient to receive clot-busting drugs;
• Percentage of heart attack patients who received cost-busting drugs within 30 minutes of arriving in the emergency room:
• Average time it takes a heart attack patient to receive an electrocardiogram test to assess heart damage once they arrive in the emergency room;
• Average time it takes for a heart attack patient to transfer to another hospital to receive a coronary angioplasty as acute treatment for a heart attack;
• Percentage of surgery patients who receive an antibiotic within 1 hour before surgery to help prevent infection; and
• Percentage of surgery patients who receive the right kind of antibiotic to help prevent infection.

In the CY 2009 OPPS Final Rule, CMS added 4 imaging efficiency measures (to the 7 original measures) for hospitals to receive a full payment update in CY 2010.

CMS intends for the quality data to serve as a baseline of data from which an eventual pay-for-performance Medicare outpatient system can be created.