CMS is proposing to modify several hospital quality measures and remove four others, including those focused on health equity and social drivers of health.
The agency outlined the changes April 11 as part of its 2026 proposed rule for the Medicare payment systems that cover inpatient and long-term care hospitals.
Under the hospital inpatient quality reporting program, hospitals that fail to meet requirements or submit quality data face a 25% reduction in their annual payment update.
The agency has proposed modifying four current quality measures:
- Total hip arthroplasty/Total knee arthroplasty complication rate and 30-day stroke mortality rate: CMS is proposing to include Medicare Advantage patients, shortening the performance period from three to two years, and revising the risk adjustment methodology for both measures (including a refinement for stroke severity in the latter).
- Hybrid, hospitalwide readmission and mortality measures: CMS is proposing allowing up to two missing lab results and two missing vital signs per case, and reducing the submission thresholds for core clinical data elements and linking variables to 70% of discharges for both hybrid measures.
CMS is also proposing to remove four measures from the IQR program, beginning with the 2024 reporting period and fiscal 2026 payment determination period. The measures are:
- Hospital commitment to health equity
- COVID-19 vaccination coverage among healthcare personnel
- Screening for social drivers of health
- Screen positive rate for social drivers of health
CMS is accepting comments on the proposed changes through June 13.
