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CMS announces first results of Hospital Outpatient Quality Reporting program

CMS announces first results of Hospital Outpatient Quality Reporting program

January 08, 2009 | Richard Pizzi, Editor

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WASHINGTON – The Centers for Medicare & Medicaid Services has notified more than 3,000 of the nation's hospitals that they will receive the full payment update for calendar year 2009 as part of the new Hospital Outpatient Quality Data Reporting Program.

The successful hospitals represent 99.3 percent of all hospitals that participated in the program that began in 2008 as an effort to strengthen the tie between the quality of care furnished to people with Medicare in hospital outpatient departments and the payments hospitals receive for those services.

"We are extremely pleased to find that hospitals have responded so successfully to the new outpatient quality measure reporting program," said CMS acting administrator Kerry Weems. "The reporting program represents another major step toward value-based purchasing of healthcare services."

The new reporting program was mandated by the Tax Relief and Health Care Act, or TRHCA, of 2006, and applies to all hospitals paid under the hospital outpatient prospective payment system. The program does not apply to:

• Hospitals excluded from the OPPS;

• Maryland hospitals subject to special payment rules reflecting state hospital payment laws;

• Hospitals situated outside of the 50 states, the District of Columbia and Puerto Rico;

• Indian Health Service Hospitals; and

• Certain other OPPS-exempt hospitals.

Under TRHCA, eligible hospitals that successfully report outpatient quality data receive the full market basket update; those that do not receive an update that is reduced by 2.0 percentage points.

CMS says data culled from the hospital reporting program will help Medicare and the broader healthcare community learn more about the quality of services available to beneficiaries in outpatient care settings. CMS also hopes quality data provides a baseline from which an eventual pay-for-performance outpatient system could be created.

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