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 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. Adoption of 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.
    • FY 2021 IPPS/LTCH PPS Final Rule CMS hereby finalized refinement of two existing National Healthcare Safety Network (NHSN) measures, Catheter-Associated Urinary Tract Infection (CAUTI) and Central Line-Associated Bloodstream Infection (CLABSI), to incorporate an updated methodology developed by the Centers for Disease Control and Prevention that uses updated HAI baseline data that is risk-adjusted to stratify results by patient location. Public reporting of the updated versions of the CLABSI and CAUTI measures to begin October 2022. Data collection of the updated versions of CAUTI and CLABSI to begin CY 2021 (January 1–December 31, 2021).
    • FY 2020 IPPS/LTCH PPS Final Rule (84 FR 42509 through 42524) CMS hereby finalized adoption of one new claims-based outcome measure, Surgical Treatment Complications for Localized Prostate Cancer, beginning with FY 2022 program year. Removal of the Clinical Effectiveness measure, EBRT, for patient encounters occurring as of January 1, 2020. Refinement of the HCAHPS Survey by removing pain management questions being with October 1, 2019 discharges. Begin public reporting of the Admissions and ED Visits for Patients Receiving Outpatient Chemotherapy measure and HAI measures (CDI, MRSA, SSI-colon and abdominal hysterectomy, and HCP) as soon as feasible. Conduct national confidential reporting of the 4 EOL (NQF #0210, 0213, 0215, AND 0216) and 30-Day Unplanned Readmissions for Cancer Patients (NQF #3188) measures.
    • FY 2019 IPPS/LTCH Final Rule (83 FR 41609 through 41624) CMS hereby finalized the removal of four OCMs (NQF #0382, 0384, 0389, and 0390) which applies to patients treated in calendar year 2019, and applies to FY 2021 program and subsequent years. One new claims-based outcome measure, “30-Day Unplanned Readmissions for Cancer Patients (NQF #3188). Addition of new measure removal factor 8, “the costs associated with the measure outweigh the benefit of its continued use in the program,” to consider when evaluating potential measures for removal from the program measure set.
    • FY 2018 IPPS/LTCH Final Rule (82 FR 38411 through 38425) CMS hereby finalized the removal of three Cancer-Specific Treatment measures from the Program beginning with diagnoses occurring as of January 1, 2018 and added four new end-of-life claims-based measures (NQF #0210, #0213, #0215, and #0216) for the FY 2020 program year and subsequent years.

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