What CMS’s latest proposal means for your eCQMs, equity measures, and Star Ratings
CMS released the 2026 Outpatient Prospective Payment System (OPPS) Proposed Rule, signaling significant shifts in healthcare quality reporting and a renewed focus on emergency care access and timeliness.
This year's proposed rule brings substantial updates across four regulatory programs: OQR (outpatient), ASCQR (Ambulatory Surgical Centers), REHQR (Rural Emergency Hospital), and the Overall Hospital Star Rating Program. Most notably, CMS is proposing to remove several measures they've deemed burdensome while introducing a new eCQM focused on emergency care.
There's quite a bit in this proposed rule. This article will provide you with the highlights.
2026 Payment Rate Change
CMS proposed a payment rate increase for 2026, with a Hospital Outpatient Department (HOPD) fee schedule of $91.747 for applicable services. Hospitals that fail to comply with the OQR program's reporting requirements will face a 2% reduction in their payment rate update, which equals a reduced conversion factor of $89.958.
Here’s a quick explainer on the OQR penalty.
2026 Proposed Changes: OQR Program
The biggest news in the OQR Program is CMS's proposal to adopt the Emergency Care Access & Timeliness eCQM while removing several existing abstracted measures. CMS is hyper-focused on fulfilling its digital measurement agenda. This represents one more step in that journey.
Summary of OQR Updates
New Measure:
- Emergency Care Access & Timeliness (ECAT) eCQM: This comprehensive new measure addresses four critical aspects of emergency care:
- Patient wait time (threshold: 1 hour)
- Patients leaving without being evaluated
- Patient boarding time (threshold: 4 hours)
- ED length of stay (threshold: 8 hours)
The measure will have voluntary reporting for CY 2027, followed by mandatory reporting starting CY 2028/CY 2030 payment determination. I’ve provided more info on this eCQM further down in this article.
Measure Removals:
CMS is proposing to remove several measures from the OQR program. The COVID and Equity measures are not surprising, given that CMS did the same thing in the 2026 IPPS ruling as well. And just like that ruling, you still must collect and submit or risk non-compliance in 2025. We will know if this is finalized around November 2025.
CMS is replacing two abstracted measures with the new ECAT eCQM. As that phase in (2028), those abstracted measures will phase out. It’s a little different if you’re in the REHQR program. Read on.
- COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP): removed starting CY 2024 reporting period/CY 2026 payment determination (still report for now!)
- Hospital Commitment to Health Equity (HCHE): removed starting CY 2025 reporting period/CY 2027 payment determination
- Screening for Social Drivers of Health (SDOH-01) and Screen Positive Rate for SDOH (SDOH-02): removed starting CY 2025 reporting period (still screen for now!)
- Median Time from ED Arrival to ED Departure for Discharged ED Patients: removed starting CY 2028
- Left Without Being Seen: removed starting CY 2028
2026 Proposed Changes: REHQR Program
The Rural Emergency Hospital Quality Reporting Program sees similar requirement changes. The major news for this program is that for the first time, REHs will have the option of submitting an eCQM to the program. The submission requirements and deadlines align with the OQR program. So, REHs can submit ECAT a full year’s worth of data, once a year by May 15 (of the following year) or continue to submit the abstracted measure four times a year as they had been doing.
New Measure:
- Emergency Care Access & Timeliness (ECAT) eCQM: REHs will have the option to report either this new eCQM or the existing Median Time for Discharged ED Patients measure starting CY 2027 reporting period/CY 2029 program determination.
Measure Removals:
- Hospital Commitment to Health Equity (HCHE)
- Screening for Social Drivers of Health (SDOH-01) and Screen Positive Rate for SDOH (SDOH-02)
All removals follow the exact timelines of the OQR program.
2026 Proposed Changes: ASCQR Program
The Ambulatory Surgical Center Quality Reporting Program receives updates focused on patient-reported outcomes:
New Measure:
- Information Transfer PRO-PM: This patient-reported outcome measure assesses patient understanding of discharge information across three domains: applicability to patient needs, medication, and daily activities. Voluntary reporting begins CY 2027-2028, with mandatory reporting starting CY 2029/CY 2031 payment determination. Also see: A Look at the Information Transfer PRO-PM.
Measure Removals:
- COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP)
- Facility Commitment to Health Equity (FCHE)
- Screening for Social Drivers of Health (SDOH-01) and Screen Positive Rate for SDOH (SDOH-02)
Emergency Care Access & Timeliness (ECAT) eCQM: A Closer Look
In this ruling, CMS provides information about the problems facing America’s EDs today. ED occupancy and boarding rates continue to worsen and exceed pre-pandemic levels, with recent studies showing that delays in emergency care are directly associated with patient harm. Long ED wait times are among the most cited reasons patients leave without being evaluated, while ED boarding, defined as holding patients in the ED due to inpatient bed shortages, creates dangerous overcrowding conditions.
Research demonstrates that for every patient boarded, the median ED length of stay for all admitted patients increases by at least 12 minutes, and ED crowding can harm sepsis patients by delaying lifesaving IV fluids and antibiotics.
The Agency for Healthcare Research and Quality (AHRQ) has characterized patient ED boarding as a growing public health crisis, prompting CMS to develop this comprehensive measure that captures four critical aspects of emergency care access and timeliness in a single, automated eCQM rather than relying on multiple manual chart-abstracted measures.
How It Works:
- Denominator: All ED encounters for patients of all ages, all payers, during a 12-month period
- Numerator: ED encounters where patients experience any of four negative outcomes:
- Wait longer than 1 hour to be placed in a treatment room
- Leave without being evaluated
- Board in the ED longer than 4 hours
- Have an ED length of stay longer than 8 hours
Scoring and Standardization:
The measure score is calculated as the proportion of ED encounters where any one of the four outcomes occurred. CMS will calculate the raw scores first and then standardize by ED case volume using z-scores. Your hospital will be put into an ED volume band (20,000 visits for each band). If your z-score is >0, that indicates worse performance compared to similar-volume EDs. If it’s <0, that indicates better performance.
If your hospital shares a CCN with othershospitals, CMS will create a volume-adjusted z-score by combining your volumes and creating a weighted average.
Results are stratified into four results: by age (18+ and under 18) and mental health diagnoses (with and without).
Here’s an executive summary to help explain the measure internally.
2026 Proposed Changes: Hospital Quality Star Rating
In the 2025 OPPS Proposed Rule, CMS suggested a few methods for re-calculating the Hospital Star Rating. They explained that some hospitals were performing poorly in the safety category and still receiving a 5-star rating. So, they presented a couple of options and got feedback from interested parties. This year, they landed on one option and have proposed a two-stage approach.
Stage 1 (2026 Star Rating)
Hospitals in the lowest quartile of Safety of Care (with at least three safety measures) will be capped at 4 out of 5 stars. Your 2026 Star Ratings are already set in stone at this point. CMS said it will affect around 14 hospitals.
Stage 2 (2027 Star Rating and beyond)
Any hospital in the lowest quartile of Safety of Care will have their star rating reduced by one star (minimum of 1 star). You still have a chance to affect this one. They will use data up until the end of 2025 for your 2027 star rating. Stage 2 would impact 459 hospitals (16% of those in the lowest safety quartile). So, work those safety measures now! That means improving the ones currently in use (see below) and getting your Hospital Harm eCQMs up and running.
2025 Safety Star Measures
- COMP-HIP-KNEE
- HAI-1
- HAI-2
- HAI-3
- HAI-4
- HAI-5
- HAI-6
- PSI 90
Hospital Harm (Safety) eCQMs (may be included in future star ratings)
- HH-Hypoglycemia
- HH-Hyperglycemia
- HH-Opioid Related Adverse Events
- HH-Pressure Injury
- HH-Acute Kidney Injury
- HH-Falls with Injury
- HH-Post-Respiratory Failure
Well-Being and Nutrition: Request for Information
CMS is seeking input on future measures related to well-being and nutrition across all three programs. They're particularly interested in:
- Tools assessing overall health, happiness, and life satisfaction
- Measures for complementary and integrative health
- Nutritional status assessments
- Physical activity and sleep measures
What This Means for Hospitals
The 2026 proposed rule represents a significant streamlining effort by CMS, removing measures that created high administrative burden while increasing eCQMs that can capture more comprehensive data with less manual effort.
Key takeaways:
- Reduced Administrative Burden: Removal of multiple manual reporting measures
- Emergency Care Focus: New emphasis on comprehensive emergency care measurement
- Patient Safety Priority: Star rating changes will significantly impact hospitals with poor safety performance
- Technology Advancement: Continued movement toward eCQMs and automated data collection
Through these comprehensive updates, CMS continues to emphasize meaningful measurement, patient safety, and a digital-first approach to quality reporting.
How Medisolv Helps
We’re closely monitoring the ECAT rollout and supporting hospitals with eCQM readiness strategies. Our quality solutions include many of the new and proposed measures, and our Advisory Services team partners with hospitals to assess performance gaps.
Whether it’s Star Ratings prep or ED measure planning, we’re here to help you navigate what’s coming.
Want help digesting how this rule affects your hospital’s current reporting or future strategy?
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