PCHQR Program Tools and Resources

Hospital Contact Change Form

• Hospital Contact Change Form

Measure Exception Form

Some hospitals may not have locations that meet the National Healthcare Safety Network (NHSN) criteria for CLABSI or CAUTI reporting and some hospitals may perform so few procedures requiring surveillance under the SSI measure that the data may not be meaningful for Care Compare or sufficiently reliable to be utilized for quality reporting purposes in a program year.

Reporting will not be required for these measures if the PPS-Exempt Cancer Hospital (PCH) performed less than a combined total of 10 colon and abdominal hysterectomy procedures in the calendar year prior to the reporting year. To indicate a measure is not being reported, a Measure Exception Form should be completed and submitted prior to the First Quarter data submission deadline for the applicable program year.

• Measure Exception Form

Extraordinary Circumstances Exceptions (ECE) Request Form 

Hospitals may request an exception from various quality reporting requirements due to extraordinary circumstances beyond the control of the facility. Such circumstances may include, but are not limited to, natural disasters (such as a severe hurricane or flood) or systemic problems with CMS data collection systems that directly affected the ability of facilities to submit data.

Hospitals must submit an ECE Request Form, with all required sections completed within 90 calendar days of the extraordinary circumstance. The hospital may request consideration for an exception of the requirement to submit quality data for one or more quarters.

• Extraordinary Circumstances Exceptions (ECE) Request Form_