CMS recently released the CY 2027 Outpatient Prospective PaymentSystem (OPPS) Proposed Rule, which included proposals for the HospitalOutpatient Quality Reporting Program (OQR) Program. For the full text of therule, see the FederalRegister.

Measure Proposals:

In this rule, CMS is proposing to remove OP-29 AppropriateFollow-Up Interval for Normal Colonoscopy in Average Risk Patients measurebeginning with the CY 2027 reporting period/CY 2029 payment determination. CMSproposes to remove this web-based measure because the program includes anothermeasure that is tied more closely to outcomes of continued interest andimportance—the Facility 7-Day Risk-Standardized Hospital Visit Rate afterOutpatient Colonoscopy measure. CMS is not proposing any other changes to theHospital OQR measure set.

 CMS is requesting feedback on the possible inclusion of an AdvanceCare Planning eCQM and other quality measure concepts related to advance careplanning in the Hospital OQR Program. The Advanced Care Planning eCQM waspreviously proposed for the Hospital IQR and Medicare PromotingInteroperability Programs in the FY 2027 IPPS Proposed Rule.

 Validation Process Proposal

CMS is also proposing updates to the validation process. Beginningwith hospital selections affecting the CY 2030 payment determination, up to 200hospitals would be selected at random and up to 200 hospitals would be selectedusing targeting criteria, for a total of up to 400 hospitals selected forvalidation. This proposal would reduce the number of hospitals selected forvalidation each year from 500 to 400 hospitals. Additionally, CMS proposes transitioningvalidation to a three-year cycle. During the transition, CY 2027chart-abstracted data would impact both the CY 2029 and CY 2030 paymentdeterminations. Beginning with CY 2028 data, validation results would affectpayment three years later.

 Beginning with the CY 2030 payment determination year (CY2027reporting period), CMS proposes to incorporate eCQM validation into theexisting validation process as a full year of eCQM reporting is mandatory forthe OP-40 STEMI measure. Under this proposal, hospitals selected for validationwould be required to submit records for both chart-abstracted measures andapplicable eCQMs. CMS proposes that eCQM validation would use the same 75%passing threshold currently applied to chart-abstracted measures. Missingmedical records would be treated as mismatches, and hospitals would need tosuccessfully pass both chart-abstracted and eCQM validation to receive the fullOPPS annual payment update.

 Lastly, beginning with data from CY 2026 reporting period, CMS proposes to remove the requirement for hospitals to resubmit medical documentation as part of their request for reconsideration of validation.

 Should you have any questions or need help with reporting your OQR measures, contact us.