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Step 1: Program Requirements

Step 1 for Hospital Reporting Image

Two of CMS' primary hospital data-reporting and quality incentive programs are the Hospital Inpatient Quality Reporting (IQR) Program and the Hospital Outpatient Quality Reporting (OQR) Program.

All hospitals paid under the hospital Prospective Payment System (PPS) must report both the IQR and OQR quality measures in order to receive their full Annual Payment Update (APU) in the ensuing year.

At this time, Critical Access Hospitals (CAHs) are exempt from the pay-for-performance requirements of the CMS hospital quality data reporting programs, but other pay-for-reporting quality programs (like the MBQIP Program) incentivize CAHs to voluntarily collect and report quality data to CMS.
 

The Hospital Inpatient Quality Reporting (IQR) Program is intended to encourage hospitals and clinicians to improve the quality of inpatient care provided to all patients.  The program also equips consumers with quality of care information to make more informed decisions about healthcare options, as many of the Hospital IQR measures are displayed on Hospital Compare.

In addition, IQR measures are used in calculating hospital’s total performance score and incentive payments for Hospital Value-Based Purchasing (VBP).

The Hospital Outpatient Quality Reporting (OQR) Program is intended to encourage hospitals and clinicians to improve the quality of outpatient care provided to all patients.  The program also equips consumers with quality-of-care information to make more informed decisions about healthcare options, as many of the Hospital OQR measures are displayed on Hospital Compare

At this time, OQR measures are not used for value-based purchasing.

Be prepared for revisions

The program requirements for IQR and OQR are updated annually. 

Be sure that your hospital routinely monitors for updates to the measures included in each program, the measure specifications, and the program deadlines. 

Each year, program additions and changes can be found in the Final Rule published in the Federal Register. 

  • Inpatient are proposed in April and finalized in August. 
     
  • Outpatient are proposed in July and finalized in November.

When there are major changes to the programs, the support contractors will schedule national teleconferences and webinars to review those changes. Qualis Health also schedules local calls to discuss topics of interest, and share best practices.