Outpatient Imaging Efficiency Measures
The outpatient imaging efficiency measures show how often a hospital provides specific imaging tests for Medicare beneficiaries under circumstances where they may not be medically appropriate. Lower percentages suggest more efficient use of medical imaging. The purpose of reporting these measures is to reduce unnecessary exposure to contrast materials and/or radiation, to ensure adherence to evidence-based medicine and practice guidelines, and to prevent wasteful use of Medicare resources. The measures only apply to Medicare patients treated in hospital outpatient departments. It does not include tests performed in other ambulatory care settings or hospital inpatient settings.
What Patients are Included
Outpatient imaging efficiency measures apply only to Medicare beneficiaries enrolled in Original Medicare who were treated as outpatients in hospital facilities reimbursed through the Outpatient Prospective Payment System (OPPS). They do not include Medicare managed care patients, non-Medicare patients, or patients who were admitted to the hospital as inpatients.
Where the Information Comes From
CMS calculates imaging efficiency measures using data from claims that hospitals and physicians submit for Medicare beneficiaries enrolled in Original Medicare (traditional fee-for-service Medicare). The data are calculated only for hospitals paid through the Outpatient Prospective Payment System (OPPS). The measures are part of the Hospital Outpatient Quality Reporting Program (OQR)- Opens in a new window.
Outpatient imaging efficiency measures are not risk adjusted. However, measures specifications do not include count cases where there were clear medical reasons for performing the tests.
CMS does not perform tests of statistical significance in reporting the outpatient imaging efficiency measures. Large differences between hospitals’ percentages may be significant, but small differences usually are not.
Comparing Individual Hospital Percentages to Benchmarks
Outpatient imaging percentages for individual hospitals are reported in comparison to both state and national averages. Hospitals with more efficient use of medical imaging will have lower percentages. For some measures, a normal or expected range of performance is also reported.
For more detail on the outpatient imaging efficiency measures, please refer to QualityNet.- Opens in a new window