Healthcare Glossary→CMS Quality Reporting
Regulatory & Compliance

CMS Quality Reporting

CMS Quality Reporting encompasses the full portfolio of federal programmes that link quality measurement to Medicare payment — including MIPS, Hospital VBP, HRRP, Inpatient Quality Reporting (IQR), and Outpatient Quality Reporting (OQR) — publicly reported on Care Compare.

The CMS Quality Reporting Landscape

The Centers for Medicare & Medicaid Services (CMS) administers the largest collection of quality reporting and value-based payment programmes in the United States. These programmes collectively affect hundreds of billions of dollars in Medicare payments annually and cover virtually every type of healthcare provider — from solo primary care physicians to academic medical centres. Quality reporting has evolved from voluntary submission for public transparency to mandatory reporting with direct payment consequences.

Physician and Clinician Programmes

  • MIPS (Merit-based Incentive Payment System): The main pay-for-performance programme for Medicare-eligible clinicians under MACRA QPP. Performance on Quality, Cost, PI, and IA categories determines payment adjustments of ±9%.
  • Physician Quality Reporting System (PQRS): MIPS predecessor, retired 2016. Mentioned as historical context for practices transitioning quality data infrastructure.
  • Advanced APM Track: Physicians qualifying as Qualifying APM Participants (QPs) receive a 5% Medicare incentive bonus and are exempt from MIPS. ACOs, BPCI Advanced, and PCF are common APM vehicles.

Hospital Quality Programmes

  • Inpatient Quality Reporting (IQR): Mandatory for IPPS hospitals; failure to report results in a 2% reduction in the annual IPPS market basket update. IQR measures include PSI composites, mortality rates, and HCAHPS.
  • Hospital Value-Based Purchasing (VBP): Links IPPS payment adjustments (±2% of base operating DRG payments) to Total Performance Score across Clinical Outcomes, Safety, Person/Community Engagement (HCAHPS), and Efficiency/Cost Reduction domains.
  • Hospital Readmissions Reduction Programme (HRRP): Reduces payments for excess readmissions in 6 conditions, up to 3% of base payments.
  • Hospital-Acquired Condition (HAC) Reduction Programme: Reduces payments by 1% for hospitals in the worst-performing quartile on HAC measures (CAUTI, CLABSI, SSI, MRSA, C. diff).
  • Outpatient Quality Reporting (OQR): Mandatory for hospital outpatient departments; failure to report results in a 2% reduction in OPD fee schedule. Quality measures include emergency department throughput measures and imaging quality.

Care Compare: Public Reporting

CMS publicly reports quality performance data on Care Compare (formerly Hospital Compare, Physician Compare, and related websites). Publicly available data includes: hospital star ratings (combining IQR, HCAHPS, VBP, and other measures), physician quality payment programme performance, nursing home star ratings, and home health quality data. Public reporting creates reputational incentives beyond the direct financial payment adjustments — patients and referring physicians increasingly consult Care Compare data in choosing providers.