“Quality is job 1” was a famous tag line, beginning decades ago, for one of America’s major automakers. It did not escape the company’s attention that attention to detail would help propel their brand in the minds of millions of car buyers and advance sales in the process. Today, quality is one of the leading bywords in healthcare and for similar reasons. For the last several years, the government, through its Medicare program, has attempted to gradually shift payments to providers based on their level of clinical excellence. As part of this “pay for performance” emphasis, the Centers for Medicare and Medicaid Services (CMS) created a Quality Payment Program (QPP) and a Hospital Outpatient Quality Reporting (OQR) Program that financially penalize poor performance in the clinical context. Each year, new quality regulations are produced, and 2023 is no different.

The following will summarize the quality-related regulations found in the 2023 Outpatient Prospective Payment System (OPPS) Final Rule (FR). The summary is based in large measure on a fact sheet released by CMS last month.

Penalty

The Hospital OQR Program requires hospitals to meet program requirements or receive a reduction of 2.0 percentage points in their annual payment update.

Quality Star Ratings

CMS and the nation’s hospitals work collaboratively to publicly report hospital quality performance information on the Care Compare website located at www.medicare.gov/care-compare/ and the Provider Data Catalog on data.cms.gov. Care Compare displays hospital performance data in a consistent, unified manner to ensure the availability of credible information about the care delivered in the nation’s hospitals.

The Overall Hospital Quality Star Rating was first introduced and reported on the Hospital Compare website in July 2016 (now reported on its successor website at https://www.medicare.gov/care-compare/). The overarching goal of the Overall Hospital Quality Star Rating (Overall Star Rating) is to improve the usability and interpretability of information posted on Care Compare, a website designed for consumers to use along with their healthcare provider to make decisions on where to receive care. CMS developed this methodology to summarize the results of many measures that are currently being publicly reported. The Overall Star Rating provides consumers with a simple overall rating generated by combining multiple dimensions of quality into a single summary score.

CMS is finalizing a change to § 412.190(c) to use publicly available measure results on Hospital Compare or its successor websites from a quarter from within the previous twelve months (instead of the “previous year”).

Cataract Measure

The 2023 OPPS FR finalizes its proposed of policy of maintaining voluntary reporting of the Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery (OP-31) measure. This is due to the ongoing COVID-19 public health emergency (PHE).

Alignment and Addition

CMS is also finalizing the alignment of Hospital OQR Program patient encounter quarters for chart-abstracted measures to the calendar year, for annual payment update (APU) determinations, and the addition of adding a targeting criterion, in the selection of hospitals for data validation. This applies to hospitals with fewer than four quarters of data subject to validation due to receiving an extraordinary circumstance exception (ECE) for one or more quarters.

Rural Emergency Reporting

Section 1861(kkk)(7) of the Social Security Act, as added by section 125(a)(1)(B) of Division CC of the Consolidated Appropriations Act, 2021, requires the secretary of the U.S. Department of Health and Human Services (HHS) to establish quality measurement reporting requirements for Rural Emergency Hospitals (REHs).

CMS is finalizing that, in order for REHs to participate in the Rural Emergency Hospital Quality Reporting (REHQR) Program, they must have an account with the Hospital Quality Reporting (HQR) System secure portal and a designated Security Official (SO). CMS also sought information on several potential measures for the new Rural Emergency Hospital Quality Reporting Program, as well as on topics of interest for the REHQR Program for future rulemaking, including rural emergency department services, rural behavioral and mental health, rural maternal health, rural telehealth services, and health equity.

For more details on the 2023 OPPS OQR Program, please consult the relevant sections of the FR at 2022-23918.pdf (federalregister.gov), beginning at p. 918. For detailed information on the OQR Program measures, contact Janis Grady at Janis.Grady@cms.hhs.gov. Finally, for questions about our hospital business services, you can contact us at info@miramedgs.com.