CMS’s 2026 Hospital Outpatient Prospective Payment System (OPPS) proposed rule outlines notable changes to outpatient quality programs. These updates affect reporting requirements, hospital star ratings, and methodologies that influence payment and public transparency.
An August 7 blog post by Coronis Health breaks down the proposal and CMS’s ongoing shift toward emphasizing outcomes, equity, and data-driven care.
Here are four key takeaways from the proposed changes:
1. Updates to the Outpatient Quality Reporting (OQR) program
The OQR program ties payments to data submission and publicly reports hospital performance on Care Compare. For 2026 and beyond, CMS proposes:
- Adding the Emergency Care Access & Timeliness eCQM, with voluntary reporting in 2027 and mandatory reporting in 2028.
- Removing four measures, including COVID-19 Vaccination Coverage Among HCP (2024 reporting period), Hospital Commitment to Health Equity (2025), and both SDOH screening-related measures (2025).
- Phasing out two ED measures (Median Time to Departure and Left Without Being Seen) by 2028, contingent on finalizing the new ED eCQM.
- Extending voluntary reporting for the CT Radiation Dose eCQM through 2027.
CMS is also updating its Extraordinary Circumstances Exception (ECE) Policy to formally allow reporting extensions.
2. Rural emergency hospitals will see similar eCQM transitions.
The REH Quality Reporting (REHQR) program parallels the OQR’s goals. CMS proposes:
- Adding the Emergency Care Access & Timeliness eCQM as an optional measure starting in 2027.
- Setting requirements for submitting and reporting eCQM data beginning with that same year.
- Removing the Hospital Commitment to Health Equity and both SDOH screening-related measures from the 2025 reporting period onward.
These changes suggest alignment between rural and urban reporting efforts while streamlining measure sets to focus on clinically meaningful data.
3. The changing hospital star rating system
The Overall Hospital Quality Star Rating system is being restructured in two stages:
- Stage 1 (2026): Hospitals in the lowest quartile of the Safety of Care measure group will be capped at a maximum of 4 stars.
- Stage 2 (2027 and beyond): These same hospitals will see a blanket 1-star reduction, with a minimum possible rating of 1 star.
Importantly, these stages are not cumulative, CMS will replace Stage 1 with Stage 2 in 2027, not layer both penalties. The change aims to incentivize performance improvement on patient safety measures.
4. Performance & transparency in focus
The removal of legacy and redundant measures, and the introduction of eCQMs, demonstrates CMS’s intention to modernize quality programs through more timely, electronic, and actionable data.
Hospitals that fail to submit data will continue to face a two-percentage point payment reduction under the OQR. Meanwhile, star rating changes will impact reputational standing in a public-facing way, reinforcing the importance of strong safety performance.
These updates continue CMS’s long-term trend toward value-driven, data-supported accountability in outpatient care.
To read the full proposed rule (CMS-1834-P), visit the Federal Register: Link to CMS-1834-P.
