Proposed HOPPS rule calls for colonoscopy complication reporting

The Centers for Medicare & Medicaid Services (CMS) has proposed adding a claims-based quality reporting measure for colonoscopy to the Hospital Outpatient Quality Reporting (QPR) program.

The proposed measure--OP-32 or "Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy"--would be added to the QPR program starting in 2017 and is contained in CMS's 2015 Outpatient Prospective Payment System proposed rule.

According to CMS, colonoscopies are associated with a range of "well-described and potentially avoidable" complications, such as perforation of the colon or gastrointestinal bleeding--complications that often result in visits to hospital emergency rooms within seven days of the procedure.

With the new proposed measure, hospitals would be evaluated based on the number of times Medicare beneficiaries ended up being treated for such complications.

"This measure provides the opportunity for providers to improve quality of care and to lower the rates of adverse events leading to hospital visits after outpatient colonoscopy," CMS wrote in the proposed rule. "We expect the measure would promote improvement in patient care over time because transparency in publicly reporting measure scores will make patient unplanned hospital visits following colonoscopies more visible to providers and patients and encourage providers to incorporate quality improvement activities in order to reduce these visits."

The proposed rule also would significantly increase breast biopsy payments. It represents a fix to last year's HOPPS rule, which resulted in payment reductions for stereotactic, ultrasound, and MRI-guided vacuum-assisted breast biopsy.

Research published in March 2013 determined that the complication rate associated with colonoscopy is low enough to be justifiable, considering the benefits of screening.

To learn more:
- see the proposed rule (.pdf)