PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program

Overview

The Prospective Payment System (PPS)-Exempt Cancer Hospital Quality Reporting (PCHQR) Program was developed as mandated by Section 3005 of the Affordable Care Act (Public Law 111-148).

The PCHQR program is intended to equip consumers with quality-of-care information to make more informed decisions about healthcare options. It is also intended to encourage hospitals and clinicians to improve the quality of inpatient care provided to Medicare beneficiaries by ensuring that providers are aware of and reporting on best practices for their respective facilities and type of care.

To meet the PCHQR Program requirements, PPS-Exempt Cancer Hospitals (PCHs) are required to submit all quality measures to the Centers for Medicare & Medicaid Services (CMS), beginning with the Fiscal Year (FY) 2014 payment determination year. Participating facilities must comply with the program requirements set forth, including public reporting of the measure rates.

PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program Eligibility

Eligible hospitals are described in section 1886(d)(1)(B)(v) and referred to as a Prospective Payment System (PPS)-Exempt Cancer Hospitals, or PCHs. These hospitals are excluded from payment under the Inpatient Prospective Payment System. The Centers for Medicare & Medicaid Services (CMS) has designated 11 hospitals as PPS-Exempt Cancer Hospitals, or Medicare PPS-Excluded Cancer Hospitals.

Final Rules for Hospital Inpatient Prospective Payment Systems

Information regarding the PCHQR Program can be found in the following Inpatient Prospective Payment System and Long-Term Care Hospitals Prospective Payment System (IPPS/LTCH) Final Rule (FR) publications. (Previous Year Rules)

• FY 2024 IPPS/LTCH PPS Final Rule (88 FR 59203 through 59232) CMS hereby finalized the adoption of three health equity measures: Facility Commitment to Health Equity, Screening for Social Drivers of Health, and Screen Positive Rate for Social Drivers of Health. Adopted the Documentation of Goals of Care Discussion Among Cancer Patients measure. Modified the COVID-19 Vaccination Among Healthcare Personnel measure (88 FR 59137 through 59144). Finalized public display of the Surgical Treatment Complications for Localized Prostate Cancer measure. Modified the data submission and reporting requirements for the Hospital Consumer Assessment of Healthcare Providers and Systems  Survey measure.

•  FY 2023 IPPS/LTCH PPS Final Rule (87 FR 49311 through 49314) CMS herby finalized the public display of the timelines for the 30-Day Unplanned Readmissions for Cancer Patients and four EOL measures. Adopted and codified a patient safety exception into the measure removal policy. Acknowledged comments received on the Request for Information regarding the potential future adoption of two digital NHSN measures: the NHSN Healthcare-Associated Clostridioides difficile Infection Outcome measure and NHSN Hospital-Onset Bacteremia & Fungemia Outcome measure.
• FY 2022 IPPS/LTCH PPS Final Rule (86 FR 45426 through 45437) CMS hereby finalized removal of the Oncology: Plan of Care for Pain – Medical Oncology and Radiation Oncology measure beginning with FY 2024 program year. Adopted the COVID-19 Vaccination Among Healthcare Personnel measure beginning with the FY 2023 program year and subsequent years. Finalized updating terminology for the PCHQR Program by replacing “QualityNet Administrator” with “QualityNet Security Official”. Finalized codification of existing PCHQR Program policies at 42 CFR 412.23 (f)(3) and CFR 412.24.

Refer to the Federal Register for other official Medicare Final Rule publications.