CMS recently released the CY 2027 Outpatient Prospective Payment System (OPPS) Proposed Rule, which included proposals for the Hospital Outpatient Quality Reporting Program (OQR) Program. For the full text of the rule, see the Federal Register.

Measure Proposals:

In this rule, CMS is proposing to remove OP-29 Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients measure beginning with the CY 2027 reporting period/CY 2029 payment determination. CMS proposes to remove this web-based measure because the program includes another measure that is tied more closely to outcomes of continued interest and importance—the Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy measure. CMS is not proposing any other changes to the Hospital OQR measure set.

 CMS is requesting feedback on the possible inclusion of an Advance Care Planning eCQM and other quality measure concepts related to advance care planning in the Hospital OQR Program. The Advanced Care Planning eCQM was previously proposed for the Hospital IQR and Medicare Promoting Interoperability Programs in the FY 2027 IPPS Proposed Rule.

 Validation Process Proposal

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

 Beginning with the CY 2030 payment determination year (CY2027 reporting period), CMS proposes to incorporate eCQM validation into the existing validation process as a full year of eCQM reporting is mandatory for the OP-40 STEMI measure. Under this proposal, hospitals selected for validation would be required to submit records for both chart-abstracted measures and applicable eCQMs. CMS proposes that eCQM validation would use the same 75% passing threshold currently applied to chart-abstracted measures. Missing medical records would be treated as mismatches, and hospitals would need to successfully pass both chart-abstracted and eCQM validation to receive the full OPPS 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.