What CMS’s latest proposal means for your eCQMs, equity measures, and Star Ratings
CMS has released the 2026 Outpatient Prospective Payment System (OPPS) Proposed Rule. While it’s packed with regulatory detail, one theme is clear: streamlining manual work and raising expectations around emergency care and safety.
This rule touches multiple CMS programs (OQR, ASCQR, REHQR, and the Overall Hospital Star Rating), and it’s another step forward in CMS’s push for digital-first, outcomes-focused measurement.
Let’s break down the biggest changes and what they could mean for your hospital’s compliance, performance, and public reputation.
2026 Payment Rate Change
CMS proposes a payment rate increase with a Hospital Outpatient Department (HOPD) fee schedule of $91.747. But here’s the catch: hospitals that don’t meet OQR reporting requirements will see a 2% payment reduction ($89.958 conversion factor).
Translation: Hospitals that miss quality reporting requirements leave real money on the table. Not sure how the penalty works?
Here’s a quick explainer on the OQR penalty.
Major Updates to the OQR Program
New eCQM: Emergency Care Access & Timeliness (ECAT)
CMS proposes adding a comprehensive emergency care eCQM, which would eventually replace several abstracted measures. Voluntary reporting begins in 2027, with mandatory reporting in 2028.
The ECAT measure tracks:
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ED wait time > 1 hour
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Patients leaving without evaluation
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ED boarding > 4 hours
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ED length of stay > 8 hours
This shift aligns with CMS’s digital measurement goals and signals the sunset of manual abstraction for key ED measures.
Proposed Measure Removals
CMS plans to remove:
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COVID-19 Vaccination Coverage (HCP)
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Hospital Commitment to Health Equity (HCHE)
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Social Drivers of Health (SDOH-01 & 02)
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Median ED Arrival to Departure Time
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Left Without Being Seen
Important note: You still need to report on these in 2025. Removals would begin affecting payment years 2026–2029, depending on the measure.
Other Key Changes
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Excessive Radiation eCQM becomes voluntary permanently
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Extraordinary Circumstances Exception (ECE) request window reduced from 90 to 30 days
Updates for REHs & ASCs
EHQR
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REHs may now choose to report the ECAT eCQM annually or continue with quarterly abstracted measures.
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Similar removal timelines for equity and SDOH measures
ASCQR
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Adds the Information Transfer PRO-PM, a patient-reported outcome on discharge clarity
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Voluntary 2027–2028, mandatory 2029+
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Removes COVID, equity, and SDOH measures
A Closer Look at the ECAT eCQM
CMS is zeroing in on the growing emergency care access crisis — and using this measure to capture system-wide performance, digitally.
Scoring structure:
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Denominator: All ED encounters (any age, all payers)
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Numerator: Encounters with any of the four negative outcomes listed above
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Standardization: Z-score calculation adjusted by ED volume bands (e.g., 20,000 visits per band)
Hospitals will be compared to peers with similar ED volumes. Positive z-score = worse performance.
Changes to Hospital Star Ratings
CMS is moving forward with its two-stage plan to address safety performance in star ratings:
Stage 1 (2026 Star Ratings)
Hospitals in the lowest quartile of Safety of Care (with ≥3 safety measures) will be capped at 4 stars. Already finalized.
Stage 2 (2027+ Star Ratings)
Hospitals in the lowest safety quartile will be downgraded by one star, no exceptions.
CMS estimates 459 hospitals could be affected (16%).
There's still time to influence your 2027 rating. Focus on current safety measures, especially Hospital Harm eCQMs.
Current Safety Measures:
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HAI-1 to HAI-6
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PSI 90
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COMP-HIP-KNEE
Hospital Harm eCQMs CMS is watching:
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Hypoglycemia, Hyperglycemia, Opioid Events, Pressure Injury
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Acute Kidney Injury, Falls with Injury, Post-Respiratory Failure
Well-Being & Nutrition: A Future Focus
CMS is soliciting input on new potential measures, such as:
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Life satisfaction and overall well-being
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Complementary health strategies
- Nutrition, physical activity, and sleep
CMS continues to expand its view of “quality” to include holistic health and patient experience.
What This Means for Hospitals
This rule continues CMS’s shift toward digital efficiency, emergency care reform, and patient safety accountability.
Key Takeaways:
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Less manual abstraction, more eCQMs
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Emergency care is now a quality focal point
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Low safety scores could cost you a star and your reputation
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Digital infrastructure matters more than ever
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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