In response to a legislative mandate set forth in Section 109 (Title I) of the Tax Relief and Health Care Act of 2006 (PL 109-432) (TRHCA), which established new requirements for reporting quality data for services paid under the Outpatient Prospective Payment System (OPPS), the Centers for Medicare & Medicaid Services (CMS) is currently working to identify performance measures that can be used to evaluate care provided to Medicare beneficiaries in the hospital outpatient setting. This mandate was motivated by recognized deficits in quality of care across all settings of care and ongoing concerns about the growth in utilization of services and costs.
In September 2006, the Assistant Secretary for Planning and Evaluation (ASPE) within the U.S. Department of Health and Human Services (DHHS), in collaboration with CMS, contracted with the RAND Corporation to identify the key reasons for visits and costs in the hospital outpatient setting, to review existing performance measures to assess their applicability to conditions evaluated as well as services/procedures and drugs/biologicals provided in the hospital outpatient setting, and to begin to identify measurement gaps. This report presents the results of this review.
This work was sponsored by ASPE and CMS under Task Order No. DHHSP2330000T under Contract No. 100-03-0019, for which Susan Bogasky served as the Project Officer.