Hospital Inpatient Quality Reporting (IQR) Program
The Hospital IQR Program is a pay-for-reporting quality program that reduces payments to hospitals that do not meet program requirements. Hospitals that do not submit quality data or do not meet all Hospital IQR Program requirements are subject to a one-fourth reduction in their Annual Payment Update under the IPPS. In the FY 2026 IPPS/LTCH PPS final rule, CMS sought input on measure concepts of well-being and nutrition for future years in the Hospital IQR Program and received many comments to evaluate and consider. CMS is modifying four current quality measures and removing four quality measures.
CMS is finalizing the modification of four current measures:
- Hospital-Level, Risk-Standardized Complication Rate (RSCR) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) to add Medicare Advantage patients to the current cohort of patients and shorten the performance period from 3 years to 2 years. CMS is also making technical updates to the risk adjustment methodology to use International Classification of Diseases (ICD)-10 codes instead of Hierarchical Condition Categories (HCCs).
- Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate (RSMR) Following Acute Ischemic Stroke Hospitalization with Claims-Based Risk Adjustment for Stroke Severity to add Medicare Advantage patients to the current cohort of patients and shorten the performance period from 3 years to 2 years. CMS is also making technical updates to the risk adjustment methodology to use International Classification of Diseases (ICD)-10 codes instead of Hierarchical Condition Categories (HCCs).
- Hybrid Hospital-Wide Readmission (HWR) and Hybrid Hospital-Wide Mortality (HWM) measures to lower the submission thresholds to allow for up to two missing laboratory results and up to two missing vital signs, reduce the core clinical data elements (CCDEs) submission requirement to 70% or more of discharges, and reduce the submission requirement of linking variables to 70% or more of discharges.
CMS is finalizing the removal of four measures beginning with the CY 2024 reporting period/FY 2026 payment determination:
- Hospital Commitment to Health Equity
- COVID–19 Vaccination Coverage among Health Care Personnel
- Screening for Social Drivers of Health
- Screen Positive Rate for Social Drivers of Health
CMS is also finalizing and codifying an update to the current Extraordinary Circumstances Exception (ECE) policy to clarify that CMS has the discretion to grant an extension in response to ECE requests. After reviewing public comments, CMS is modifying our original proposal by extending the length of time to submit an ECE request from the proposed 30 days to 60 days.
Additionally, CMS is implementing a technical update to include patients with a principal or secondary diagnosis of COVID-19 in the numerator and denominator for seven measures.
Medicare Promoting Interoperability Program
In 2011, CMS established the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (now known as the Medicare Promoting Interoperability Program and the Promoting Interoperability performance category of the Merit-based Incentive Payment System) to encourage eligible professionals, eligible hospitals, and critical access hospitals (CAHs) to adopt, implement, upgrade, and demonstrate the meaningful use of certified EHR technology (CEHRT).
In the FY 2026 IPPS/LTCH PPS final rule, CMS will:
- Define the EHR reporting period in CY 2026 and subsequent years as a minimum of any continuous 180-day period within that CY for eligible hospitals and CAHs participating in the Medicare Promoting Interoperability Program and make corresponding revisions at 42 CFR 495.4.
- Modify the Security Risk Analysis measure for eligible hospitals and CAHs to attest “Yes” to having conducted security risk management in addition to security risk analysis, beginning with the EHR reporting period in CY 2026.
- Modify the Safety Assurance Factors for EHR Resilience (SAFER) Guides measure by requiring eligible hospitals and CAHs to attest “Yes” to completing an annual self-assessment using all eight 2025 SAFER Guides, beginning with the EHR reporting period in CY 2026.
- Add an optional bonus measure under the Public Health and Clinical Data Exchange objective for data exchange to occur with a public health agency (PHA) using the Trusted Exchange Framework and Common Agreement®(TEFCA), beginning with the EHR reporting period in CY 2026.
In addition, the final rule refers readers to the CY 2026 Physician Fee Schedule (PFS) proposed rule, and invites public comments on:
- A proposal to suppress the Electronic Case Reporting measure from scoring in the EHR reporting period in CY 2025.
- A proposal to adopt a measure suppression policy, allowing the suppression of measures from scoring for the EHR reporting period in CY 2026.
CMS did not propose any changes to the previously finalized performance-based scoring threshold of 80 points, beginning with the EHR reporting period in CY 2026.
CMS requested information on:
- Future modifications to the Query of Prescription Drug Monitoring Program (PDMP) measure, including seeking public input on changing the Query of PDMP measure from an attestation-based measure (“Yes” or “No”) to a performance-based measure (numerator and denominator), and expanding the types of drugs to which the Query of PDMP measure applies.
- The Medicare Promoting Interoperability Program’s objectives and measures moving toward performance-based reporting.
- Improvements in the quality and completeness of the health information eligible hospitals and CAHs are exchanging across systems.