Imaging Efficiency Measures

For Calendar Year (CY) 2020 payment determinations, six Outpatient Imaging Efficiency (OIE) measures are publicly reported within the Hospital Outpatient Quality Reporting (OQR) Program:

  • MRI Lumbar Spine for Low Back Pain (OP-8)
  • Mammography Follow-up Rates (OP-9)
  • Abdomen Computed Tomography – Use of Contrast Material (OP-10)
  • Thorax CT – Use of Contrast Material (OP-11)
  • Cardiac Imaging for Preoperative Risk Assessment for Non-Cardiac Low-Risk Surgery (OP-13)
  • Simultaneous Use of Brain CT and Sinus CT (OP-14)

These six publicly reported OIE measures are calculated using data from hospital outpatient claims paid under Medicare’s Outpatient Prospective Payment System (OPPS). Hospitals need not submit any additional data for calculation of the OIE measures.

The Centers for Medicare & Medicaid Services (CMS) has posted individual, measure-specific documentation (re-evaluation reports) for each OIE measure. Each re-evaluation report contains: measure background and methodology; summary data from 2019 public reporting; results from the most recent environmental scan and literature review (ES/LR); measure specifications and annual updates; and measure minimum case count rationale and methodology.

This year, the reevaluation reports for OP-9, OP-11, and OP-14 do not include findings from the recent ES/LR or summary data for 2019 public reporting, as CMS is retiring these measures from the Hospital OQR Program beginning with CY 2021 payment determinations.

The specifications included in the documents below were used to calculate results reported on Hospital Compare beginning in July 2019. The OIE measures’ technical specifications are subject to periodic review that can result in changes reflecting advancements in clinical decision-making and technology. Specification changes may occur in a measure's numerator, denominator, and/or exclusions. Specifications are updated in response to Technical Expert Panel feedback (convened annually) and other stakeholder input, as well as from results found in annual literature reviews.

CMS has provided a link to the reevaluation report for each measure, as well as page numbers for the measure specifications, annual updates, ES/LR results, and minimum case count table within each document to facilitate stakeholder review of the reports.

The specifications used to calculate results posted on Hospital Compare prior to July 2019 can be found on the Archived Measure Specifications page.

Facility-Specific Reports
CMS distributes facility-specific reports (FSRs) to facilities eligible to report the OIE measures. The FSR is an Excel workbook file, which includes information on the facility’s patients, scores, state, and national results for each OIE measure. CMS will release the FSRs to facilities in April 2019, and the results will use claims data from July 1, 2017 through June 30, 2018, and will be reported on Hospital Compare beginning in summer 2019.

CMS releases an accompanying FSR User Guide which provides an overview of the methodology used to calculate each OIE measure, describes how to interpret its results, and offers detailed guidance on using the FSR. CMS encourages facilities to review the FSR User Guide along with their FSRs. CMS has created a mock FSR for facilities who do not receive reports to reference. The mock FSR contains simulated facility-level data.

For more information on the FSRs and FSR User Guide, please refer to the Reports page.

Measure Reevaluation Reports for the OIE Measures

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