Nearly all acute care hospitals receive full CMS payment update for outpatient quality reporting

The Centers for Medicare & Medicaid Services (CMS) has notified more than 3,000 of the nation’s hospitals that they will receive the full payment update for calendar year (CY) 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.


As noted in the Press Release, the new reporting program was mandated by the Tax Relief and Health Care Act (TRHCA) of 2006, and applies to all hospitals paid under the hospital outpatient prospective payment system (OPPS). 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. In addition CMS’s goals of improving outpatient care quality, the outpatient reporting program also provides CMS with a baseline of data from which an eventual pay-for-performance outpatient system could be created.


In 2008, hospitals participating in the program were required to report data on the seven quality measures that measure important elements of high-quality heart attack and surgical care, which is of particular importance to Medicare beneficiaries. These measures were:

•1. % of heart attack patients given aspirin upon arrive at the emergency room;

•2. amount of time it takes for a heart attack patient to receive clot-busting drugs;

•3. percentage of heart attack patients who received clot-busting drugs within 30 minutes of arriving in the emergency room;

•4. average time it takes a heart attack patient to receive an electrocardiogram test to assess heart damage once they arrive in the emergency room;

•5. average time it takes for a heart attack patient to transfer to another hospital to receive a coronary angioplasty as acute treatment for a heart attack;

•6. percentage of surgery patients who receive an antibiotic within one hour before surgery to help prevent infection; and

•7. percentage of surgery patients who receive the right kind of antibiotic to help prevent infection.


The OPPS CY 2009 final rule added four imaging efficiency measures to the seven original measures for reporting to receive the full update in CY 2010.


(SOURCES: Advisory Board Daily Briefing,, January 9, 2009; Center for Medicare and Medicaid Services,, accessed January 17, 2009)