CMS is making it pretty clear where hospital quality reporting is headed next. More Hospital Harm measures, more digital quality measurement, and more pressure on hospitals to prove performance through data.
The proposed changes to the IQR Program give an early look at that shift. From new eCQM requirements and claims measure updates to future-focused concepts like the Sepsis Hybrid dQM, there’s a lot packed into this year’s proposed rule.
To make it easier to follow, we broke down the proposed IQR program changes into short video clips from our recent webinar, paired with quick summaries beneath each section. Whether you want the fast highlights or a deeper understanding of what’s changing, you can explore the topics most relevant to your organization and what they could mean for 2027 and beyond. Check it out.
CMS is doubling down on digital quality measurement and Hospital Harm measures are moving from optional to mandatory faster than many hospitals expect. Watch the short overview, then read on for the specifics.
Beginning with the 2028 reporting year, CMS is proposing two new eCQMs:
CMS is also proposing to remove:
Another major update is the Malnutrition Care Score measure becoming mandatory in 2028. Previously known as the Global Malnutrition Composite Score, the measure would move from optional to required reporting.
CMS is proposing that Hospital Harm eCQMs become mandatory after two years of self-selected reporting.
That means:
This gives hospitals a short runway to activate, validate, and improve these measures before they become required and publicly visible.
CMS has also hinted that Hospital Harm measures could eventually replace PSI-90 as the industry’s primary patient safety composite measure.
Why it matters: If Hospital Harm measures eventually replace PSI-90, the impact would stretch far beyond IQR reporting. PSI-90 currently influences Hospital Star Ratings, HACRP, Care Compare, Leapfrog Safety Grades.
These measures are quickly becoming more than just reporting requirements. They are becoming public indicators of hospital safety and quality performance.
Now is the time to validate workflows and tighten data quality before these measures carry financial consequences. IIf your hospital is still building confidence in its eCQM data, Medisolv’s ENCOR for Electronic Hospital Measures and eCQM Optimization & Validation Advisory Services can help your team improve measure accuracy, close workflow gaps, and get ahead of what’s coming.
CMS is also making some important changes to claims-based measures within the IQR Program, especially around expanding quality measurement to include Medicare Advantage patients.
CMS is proposing three major updates across several existing claims measures:
These updates would apply to several familiar mortality and Excess Days in Acute Care (EDAC) measures tied to:
CMS is also proposing a brand-new measure:
This new measure would track acute care utilization after diabetes hospitalizations for Medicare fee-for-service and Medicare Advantage patients age 65 and older.
CMS wants these measures to better reflect today’s patient population as Medicare Advantage enrollment continues to grow.
There’s also some behind-the-scenes measure shifting happening between programs. Some updated mortality measures are temporarily being placed into the IQR Program before eventually moving into the Hospital Value-Based Purchasing (HVBP) Program, which is why hospitals will see overlapping timelines and transition periods over the next few years.
Why it matters: These updates continue CMS’s push toward broader population measurement, greater public transparency, and stronger focus on outcomes and utilization after hospitalization. Hospitals may also begin seeing shifts in quality performance and benchmarking as Medicare Advantage patients become part of these calculations.
Keeping up with constantly changing claims measures and reporting methodologies is becoming increasingly difficult for hospital quality teams.
Medisolv’s Advanced Quality Improvement (AQI) Support helps hospitals strengthen reporting accuracy, monitor performance trends, validate data, and stay ahead of changing CMS requirements so teams can focus less on chasing measure changes and more on improving outcomes.
CMS is continuing to hint at where hospital quality reporting may be headed next, especially around maternal health, emergency department performance, public transparency, and digital quality measurement.
One proposed update would require hospitals participating in a Perinatal Quality Improvement Collaborative to report the actual name of the collaborative instead of simply attesting “yes” that they participate.
CMS is also considering changes to the “Birthing-Friendly” hospital designation. Instead of a simple designation, CMS is exploring a more public scoring approach using maternal eCQMs like:
Hospitals could eventually be grouped by delivery volume and assigned a rating from zero to three hearts, similar to Hospital Star Ratings.
CMS is also evaluating future-focused quality measures, like the Sepsis Hybrid dQM.
The Sepsis Hybrid dQM would move away from traditional QRDA submissions and instead use FHIR-based data exchange through the CDC NHSN Link API to electronically submit labs, vitals, and other clinical data elements.
CMS is clearly continuing its shift toward more digitally driven quality measurement and more publicly visible performance scoring. Measures tied to maternal care, emergency department throughput, and patient safety are becoming increasingly connected to hospital reputation, public reporting, and eventually reimbursement.
Why it matters: These future-focused proposals offer an early look at where CMS may be headed over the next several years. Hospitals should expect continued movement toward:
Teams that start strengthening data capture, interoperability workflows, and digital quality reporting processes now will be in a much stronger position as CMS continues expanding digital quality measurement across its programs.
Solutions like Medisolv’s QualityIQ help hospitals bring quality data across programs into one unified view so teams can monitor performance trends, identify risks earlier, and stay ahead of evolving CMS requirements.
The proposed IQR changes may not all happen overnight, but they do give hospitals an early look at where reporting requirements are headed.
Between expanding Hospital Harm measures, changing claims methodologies, and future-focused reporting concepts, quality teams will likely need stronger workflows, cleaner data, and closer collaboration with IT moving forward.
The hospitals that start preparing now will be in a much better position when these changes eventually move from “proposed” to required.
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Take Control of Hospital Quality Reporting Regulatory reporting is only getting more complex, and the cost of missing a single requirement can be significant. As measure updates continue across CMS programs, hospitals need a better way to stay ahead. Medisolv’s Hospital Quality Reporting Package gives your team one comprehensive solution to manage every requirement across programs, measure types, and deadlines. By bringing everything together in one unified system, Medisolv helps you simplify reporting, reduce risk, and gain a clearer view of performance across your organization. From setup to submission, our experts help ensure nothing falls through the cracks, so your team can spend less time chasing requirements and more time focusing on care improvement. Request a demo to see how Medisolv’s Hospital Quality Reporting Package can help your hospital stay compliant and prepared. |