Quality Reporting and Improvement

Print

Acumentra Health, the Medicare Quality Improvement Organization (QIO) for Oregon, assists Oregon hospitals in meeting Medicare program requirements for quality data reporting and data validation.

All hospitals that are part of the Medicare Prospective Payment System must submit data to the Centers for Medicare & Medicaid Services (CMS) on required quality and safety measures in order to receive full Medicare payment for services. For Critical Access Hospitals, reporting is voluntary but encouraged.

The hospital reporting program is intended to equip consumers with quality-of-care information that can help them make more informed decisions about healthcare options. It is also intended to encourage hospitals and clinicians to improve the quality of care provided to all patients. The hospital quality-of-care information is available to consumers on the Hospital Compare website.

The program has two branches: Hospital Inpatient Quality Reporting (IQR) and Hospital Outpatient Quality Reporting (OQR). Hospitals can find the most up to date information about the two programs on the QualityNet website (www.qualitynet.org).

Hospital IQR

The Hospital IQR program was developed as a result of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003. Section 5001(a) of Pub. 109-171 of the Deficit Reduction Act (DRA) of 2005 provided new requirements for the Hospital IQR program, which built on the voluntary Hospital Quality Initiative.

The Hospital IQR program requires most acute-care hospitals to submit data for specific inpatient quality measures for health conditions that are common among people with Medicare and that typically result in hospitalization. Eligible hospitals that do not participate in the Hospital IQR program will receive an annual payment update (APU) with a 2.0 percentage point reduction.

Detailed information is available on the “Hospitals—Inpatient” tab on the QualityNet website.

Hospital OQR

Hospital OQR is a quality data reporting program implemented by CMS for outpatient hospital services. Under this program, hospitals report data using standardized measures of care to receive the full annual update to their Outpatient Prospective Payment System (OPPS) payment rate, effective for payments beginning in calendar year (CY) 2009. The Hospital OQR program is modeled on the Hospital IQR program.

To meet Hospital OQR requirements and receive the full APU under the OPPS, hospitals must meet administrative, data collection and submission, and data validation requirements. Hospitals must submit data for outpatient quality measures. Participating hospitals agree that they will allow CMS to publicly report data on the Hospital Compare website for the quality measures (as stated in the current OPPS Final Rule).

Detailed information is available on the “Hospitals—Outpatient” tab on the QualityNet website.