The program requirements mandated under TRHCA have created a need for performance measures that CMS could use in the HOP QDRP. To assist CMS with the task of identifying both measurement opportunities and potential measures, the DHHS Assistant Secretary for Planning and Evaluation (ASPE) in partnership with CMS issued a contract to the RAND Corporation in September 2006 to conduct an initial assessment of the hospital outpatient measurement landscape. RAND was asked to determine the leading conditions treated and services/procedures provided in the outpatient setting as a function of both volume and costs, and to identify existing performance measures that may be applicable to care provided in this setting as well as measurement gaps. As part of the environmental scan, RAND:
- Conducted an analysis of 2005 Medicare facility data for services paid through the hospital Outpatient Prospective Payment System (OPPS) to determine the leading conditions and services/procedures;
- Scanned publicly available measures being used across a variety of settings to identify those that potentially apply to the care delivered in the hospital outpatient setting and to identify gaps, and
- Held discussions with medical specialty societies and hospital associations to determine whether they were aware of existing measures either being applied or that could be applied in the hospital outpatient setting, to learn about measure development work going on (to feed the measures pipeline), and to help identify measurement gaps.
For the purposes of our environmental scan, we defined the hospital outpatient setting as visits and/or services/procedures paid for under the Medicare OPPS. This care was further categorized for analyses and discussion in this report as either rendered in: (1) the ED, or (2) any other hospital-affiliated outpatient setting that is paid under OPPS (hereafter referred to as HOPS). We first classified services/procedures that obviously occur in the ED to the ED; all other services/procedures paid under the OPPS were classified as HOPS.