Annals of Health Law
READY OR NOT
to report on the requisite quality data resulted in a penalty of a 0.4
percentage point reduction in the Annual Payment Update (APU) for
inpatient hospital services. 28 Then, the Deficit Reduction Act (DRA) of
2005 expanded the program adding additional quality measures and
increasing the penalty for failure to report to two percentage points of
Medicare’s APU. 29 The 2012 IPPS final rule requires providers to
successfully report on a total of fifty-five measures, and increases the
number of measures to fifty-seven in fiscal year 2013.30
Effective for payments in calendar year 2009, CMS implemented a
parallel quality program for outpatient hospital settings. 31 The Hospital
Outpatient Quality Reporting (OQR) Program32 measures how regularly a
healthcare provider administers the outpatient treatment known to provide
the best results for the most patients with a particular condition. 33 Like the
IQR program, outpatient provider participants are required to satisfy
program reporting and performance requirements (including data
submission for fifteen measures in 2012 and twenty-three measures in
28. MMA at §501(b).
29. In 2006, Congress passed the Deficit Reduction Act of 2005 (“DRA”), Deficit
Reduction Act of 2005, Pub. L. No. 109-171, §5001(b), 120 Stat. 4 (2006). See also
PROPOSALS supra note 10, at 19-37. The Act expanded the measures list from ten to twenty-one quality measures starting in 2007. See CTRS. FOR MEDICARE & MEDICAID SERVS.,
MEDICARE HOSPITAL VALUE-BASED PURCHASING PLAN DEVELOPMENT, ISSUES PAPER 29 (1st
Sess., 2007), available at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/downloads//hospital_VBP_plan_issues_paper.pdf.
30. See FY 2012 IPPS Final Rule Home Page, CENTERS FOR MEDICARE & MEDICAID
SERVICES, http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/
AcuteInpatientPPS/ FY-2012-IPPS-Final-Rule-Home-Page.html. The current Hospital IQR
program maintains the same two percent downward adjustments to the hospital AMBU for
failure to report on quality data applicable to the required quality targets. See Hospital
Inpatient Quality Reporting (IQR) Program Overview, QUALITYNET, http://
www.qualitynet.org/dcs/ContentServer?cid=1138115987129&pagename=QnetPublic%2FPa
ge%2FQnetTier2&c=Page . For a discussion of current developments regarding the IQR,
see Anderson & Van Leer, supra note 15, at 36. Additionally, CMS finalized the measures
for Fiscal Year 2014 (fifty-five measures) and Fiscal Year 2015 (seventy-two measures).
CMS continues to evaluate the usefulness of existing measures and will retire those that it
considers “topped out,” which means the measure no longer has significant room for
improvement. See id.
31. Hospital Outpatient Quality Reporting (OQR) Program Overview, QUALITYNET,
http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2F
QnetTier2&cid=1191255879384.
32. The OQR is a P4R program mandated by the Tax Relief and Health Care Act of
2006 requiring “subsection (d) hospitals” to submit data on measures on the quality of care
furnished by hospitals in outpatient settings.” See Hospital Outpatient Quality Reporting
Program, CENTERS FOR MEDICARE & MEDICAID SERVICES, https://www.cms.gov/
Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/
HospitalOutpatientQualityReportingProgram.html.
