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 that is provided to Medicare beneficiaries. A major part of the program supports improvement 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 specific quality measures related to the PCHQR Program to the Centers for Medicare & Medicaid Services (CMS). Mandated reporting began with the Fiscal Year (FY) 2014 payment determination year. Participating facilities must comply with the program requirements set forth in the FY 2013 IPPS/LTCH Final Rule, including public reporting of the measure rates on Hospital Compare.
PCHQR Program Eligibility
Eligible hospitals are described in section 1886(d)(1)(B)(v) of the Social Security Act. PPS-Exempt Cancer Hospitals are excluded from payment under the Inpatient Prospective Payment System (IPPS). CMS has designated 11 hospitals as PPS-Exempt (Medicare PPS-Excluded Cancer Hospitals).
Final Rules for Hospital Inpatient PPS/Long Term Care Hospitals (LTCHs)
Information regarding the PCHQR Program can be found in the following Final Rule (FR) publications:
- FY 2019 IPPS/LTCH PPS Final Rule (83 FR 41609 through 41624)
- 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 PCHQR Program measure set.
- Four OCMs (NQF #0382, 0384, 0389, and 0390) were removed for patients being treated in calendar year 2019. This applies to FY 2021 Program and subsequent years.
- One new Claims-Based Outcome measure (30-Day Unplanned Readmissions for Cancer Patients, NQF #3188) which applies to FY 2021 program and subsequent years.
- FY 2018 IPPS/LTCH PPS Final Rule (82 FR 38411 through 38425)
- The three Cancer-Specific Treatment measures were removed from the Program beginning with diagnoses occurring as of January 1, 2018.
- Four new end-of-life claims-based measures (NQF #0210, #0213, #0215, and #0216) were added to the Program for the FY 2020 program year and subsequent years.
- FY 2017 IPPS/LTCH PPS Final Rule (81 FR 57182 through 57193)
- The new claims based outcome measure, Admissions and Emergency Department (ED) Visits for Patients Receiving Outpatient Chemotherapy, was finalized for the FY 2019 program and subsequent years.
- The diagnosis cohort for Oncology: Radiation Dose Limits to Normal Tissues (National Quality Forum, NQF #0382) was expanded to include patients receiving 3D conformal radiation therapy for breast or rectal cancer, in addition to patients receiving 3D conformal radiation therapy for lung or pancreatic cancer. This is effective January 1, 2017, and applies to FY 2019 program and subsequent years.
- FY 2016 IPPS/LTCH PPS Final Rule (80 FR 49713 through 49723)
- Two new outcome measures, Methicillin-resistant Staphylococcus aureus (MRSA), and Clostridium difficile infection (CDI) and one process measure, Healthcare Personnel Vaccination (HCP), were finalized for the FY 2018 program and subsequent years.
- Surgical Care Improvement Project (SCIP) measures will be removed as of October 1, 2016.
- FY 2015 IPPS/LTCH PPS Final Rule (79 FR 50277 through 50286)
- One new clinical effectiveness measure (EBRT) was finalized for the FY 2017 program and subsequent years.
- No previously finalized measures were removed or replaced or the FY 2017 program and subsequent years.
- FY 2014 IPPS/LTCH PPS Final Rule (78 FR 50837 through 50853)
- One new HAI quality measure (surgical site infection) was finalized for the FY 2015 program and subsequent years.
- 12 new quality measures (including five clinical process oncology care measures, six SCIP measures, and Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS]) for the FY 2016 program and subsequent years were finalized.
- No previously finalized measures were removed or replaced for the FY 2015 and FY 2016 program and subsequent years.
- FY 2013 IPPS/LTCH Final Rule (77 FR 53555 through 53567)
- Five quality measures (two hospital-acquired infection [HAI], and three Cancer Specific Treatment [CST] measures) were finalized for the FY 2014 program and subsequent years.
Refer to the Federal Register for other official Medicare Final Rule publications.
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