PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program
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.
- FY 2013 IPPS/LTCH Final Rule (77 FR pages 53555 through 53567) CMS hereby finalized five quality measures (two healthcare-acquired infection (HAI), and three cancer-specific treatment (CST) measures) for the fiscal year (FY) 2014 program and subsequent years.
- FY 2014 IPPS/LTCH PPS Final Rule (78 FR pages 50837 through 50853)
CMS hereby finalized one additional new HAI quality measure (Surgical Site Infection, [SSI]) for the FY 2015 program and subsequent years. In addition, CMS finalized 12 new quality measures, including five Clinical Process Oncology Care Measures (OCM), six Surgical Care Improvement Project (SCIP) measures, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) for the FY 2016 program and subsequent years. CMS did not remove or replace any of the previously finalized measures from the PCHQR Program for FY 2015 and FY 2016.
- FY 2015 IPPS/LTCH PPS Final Rule (79 FR pages 50277 through 50286)
CMS hereby finalized one new Clinical Effectiveness measure (External Beam Radiotherapy for Bone Metastases [EBRT]) for the FY 2017 program and subsequent years. CMS did not remove or replace any of the previously finalized measures from the PCHQR Program for the FY 2017 program and subsequent years.
- FY 2016 IPPS/LTCH Final Rule (80 FR pages 49713 through 49723)
CMS hereby finalized two new outcome measures, Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infection (CDI), as well as one process measure, Healthcare Personnel Vaccination (HCP), for the FY 2018 program and subsequent years. SCIP measures were removed as of October 1, 2016, with the last data reported being from Quarter 3, 2015.
- FY 2017 IPPS/LTCH Final Rule (81 FR pages 57182 through 57193) CMS hereby finalized one new Claims-Based Outcome Measure, “Admissions and Emergency Department (ED) Visits for Patients Receiving Outpatient Chemotherapy.” Additionally, an existing OCM, “Oncology Radiation Dose Limits to Normal Tissues” (National Quality Forum, [NQF] #0382), was updated to expand the patient cohort to include patients receiving 3D conformal radiation for breast and rectal cancer. This applies to patients being treated in calendar year 2017 and applies to the FY 2019 Program and subsequent years.
- 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.
- 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 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.
Refer to the Federal Register for other official Medicare Final Rule publications.