Coding professionals should familiarize themselves with three new measures in particular.
In 2009, the Centers for Medicare & Medicaid Services (CMS) implemented a quality data reporting program for hospital outpatient services. The Hospital Outpatient Quality Reporting Program (Hospital OQR) is a pay-for-quality data reporting program mandated by the Tax Relief and Health Care Act of 2006, which requires a subsection of hospitals to submit data on the quality of care furnished in outpatient settings.
The Hospital OQR Program measures focus on areas of high impact that support improving quality and efficiency for Medicare beneficiaries. Measures of quality may be of various types, including those of process, structure, outcome, and efficiency.
Under the Hospital OQR Program, hospitals must meet administrative, data collection and submission, validation, and publication requirements, or else receive a 2-percentage-point reduction in the Outpatient Prospective Payment System (OPPS) payment in the next calendar year (CY). In addition to providing hospitals with a financial incentive to report their quality-of-care data, the Hospital OQR Program provides CMS data to help Medicare beneficiaries make more informed decisions about their healthcare. Hospital quality-of-care information gathered through the Hospital OQR Program is available on the CMS Hospital Compare website.
The 2022 Hospital OQR Program measures affecting payment determination remain the same as 2021 and are listed in the table below, with two exceptions: OP-33 Measure, External Beam Radiotherapy for Bone Metastases has been removed, and OP-31 Measure, Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery, has been moved from voluntary reporting to mandatory reporting, beginning with the CY 2027 payment determination.
The three new measures finalized as part of the CY 2022 OPPS/ASC Final Rule are:
Measure OP-38, COVID-19 Vaccination Coverage among Healthcare Personnel (HCP), reports the percentage of personnel who have received a complete COVID-19 vaccination. Hospitals will be required to begin reporting data beginning Jan. 1, 2022, for payment determination in CY 2024. To report this measure, hospitals collect the numerator and denominator for the COVID-19 HCP vaccination measure for at least one self-selected week during each month of the reporting quarter, and submit the data to the National Healthcare Safety Network. The numerator is the cumulative number of HCP eligible to work in the hospital or facility for at least one day during the reporting period who received a complete vaccination course against SARS-CoV-2. The Denominator is the number of HCP eligible to work in the hospital or facility for at least one day during the reporting period, excluding HCP with contraindications to SARS-CoV-2 vaccination. Healthcare personnel are defined as employees, licensed independent practitioners, and adult students and volunteers. Additionally, other personnel providing care, treatment, or services at the facility through a contract can be optionally collected as part of the denominator.
Measure OP-39, The Breast Screening Recall Rates, reports breast screening recall rates at the facility level. It calculates the percentage of Medicare fee-for-service (FFS) beneficiaries for whom a traditional mammography or digital breast tomosynthesis (DBT) screening study was performed that was then followed by a diagnostic mammography, diagnostic DBT, ultrasound of the breast, or magnetic resonance imaging (MRI) study of the breast performed in an outpatient or office setting on the same day or within 45 calendar days of the initial images. Facilities with performance rates that are less than 12 percent and greater than 5 percent are likely recalling an appropriate number of Medicare FFS beneficiaries. Hospitals will be required to begin reporting data by Jan. 1, 2022 for payment determination in CY 2023.
Measure OP-40, The ST-Segment Elevation Myocardial Infarction (STEMI) electronic clinical quality measure (eCQM), reports the percentage of emergency department patients with a diagnosis of ST-segment elevation myocardial infarction (STEMI) who received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival. Reporting this measure begins with voluntary reporting for the CY 2023 with mandatory reporting in CY 2024 for payment determination in CY 2026. With the addition of this measure, two existing measures, OP-2 and OP-3, are removed as a result and will no longer need to be reported, beginning with CY 2023.
The accuracy of the documentation and the accuracy of coded data impacts healthcare organizations and patient care. As coding and documentation integrity professionals, we should know what is being measured and why, and how we can help. Perhaps we can assist with abstracting the data, or bring awareness of the measures and the data collected and provide it to the impacted clinical areas. Or perhaps we can collaborate with the quality department to strengthen the data collected and reported. For outpatient CDI programs, quality reporting is something in which to consider getting involved.
Programming Note: Listen to Colleen Deighan report this story live today during Talk Ten Tuesdays, 10 Eastern.
UnitedHealthcare (UHC) Medicare Advantage will begin reinforcing denialsbased on its interpretation of the International Classification of Disease, 10 thEdition, Clinical Modification (ICD-10-CM) Excludes 1.(https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-reimbursement/rpub/UHC-MEDADV-RPUB-JAN-2026.pdf) As
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