CMS releases final 2010 OPPS rules

CMS on Friday released its final outpatient prospective payment system (OPPS) rule for calendar year (CY) 2010, under which the agency will give providers a 2.1% annual inflation update and pay approximately $32.2 billion in 2010 for outpatient services—a $1.9 billion increase from projected payments in CY 2009. Hospitals that do not meet quality reporting requirements, however, will receive a 0.1% inflation update.

CMS will continue to require hospitals participating in the Hospital Outpatient Quality Data Reporting Program (HOP QDRP) to report the existing seven ED and perioperative care measures, as well as the four existing claims-based imaging efficiency measures for the CY 2011 payment determinations, and will implement a new HOP QDRP validation requirement to ensure hospitals are accurately reporting measures using chart-abstracted data. 

According to the CMS Fact Sheet, there are several aspects of quality now tied to payment:

  • Payment reduction for failure to report quality measures – As required by law, CMS will reduce the CY 2010 annual inflation update factor by two percentage points for most services furnished by hospitals that failed to meet the CY 2009 reporting requirements of the HOP QDRP.
  • Quality measures to be reported – CMS will continue to require hospitals subject to HOP QDRP requirements to provide quality data for the current 7 chart-abstracted emergency department and surgical care measures and 4 claims-based imaging efficiency measures for CY 2011 payment determinations. 
  • Validation of quality reporting – CMS will be implementing a HOP QDRP validation requirement to ensure that hospitals are accurately reporting measures using chart-abstracted data. 
  • Public reporting of quality data – CMS is establishing procedures to make HOP QDRP quality measure data publicly available as early as June 2010. 

Click here for the CMS news release

(SOURCES: Advisory Board Daily Briefing, http://advisory.com, November 2, 2009; Center for Medicare and Medicaid Services, http://cms.hhs.gov, accessed November 6, 2009)