CMS plans to improve ties between hospital outpatient care and quality

The Centers for Medicare & Medicaid Services (CMS) today announced plans to strengthen the tie between the quality of care furnished to people with Medicare in hospital outpatient departments (HOPDs) and the payments hospitals receive for those services.

A CMS press release notes that in a final rule announced October 30 CMS emphasized an urgent and compelling rationale to develop and implement a policy in which hospitals would not be paid for care related to illnesses or injuries acquired during a hospital encounter. CMS plans to issue a policy to address payment for these conditions in the outpatient setting.

The final rule emphasizes that an urgent and compelling rationale exists for CMS to exercise its existing administrative authority under the Medicare statute to develop and implement a policy that would not pay hospitals for care related to illness or injuries acquired by the patient during a hospital outpatient encounter. Such a policy, which we expect to propose in the future, would be known as hospital outpatient healthcare-associated conditions (HOP-HACs), and it would make adjustments to OPPS payments to ensure equitable and appropriate payment for care, similar to the quality adjustments applied to payment for hospital-acquired conditions in the inpatient setting.

(SOURCES: HCPro Accreditation Connection,, November 3, 2008; Center for Medicare and Medicaid Services,, Accessed November 7, 2008)