Quality Based Reimbursement (QBR)

Overview

The Health Services Cost Review Commission (HSCRC) Quality-Based Reimbursement (QBR) program is a payment model implemented in Maryland, USA, aimed at improving the quality and efficiency of healthcare services provided by hospitals. The program is part of Maryland’s unique all-payer hospital payment system.

Here’s an overview of how the program typically operates:

1. Quality Metrics: Hospitals participating in the program are assessed based on various quality metrics related to patient outcomes, safety, and efficiency. These metrics often include measures such as readmission rates, patient satisfaction scores, infection rates, and adherence to best practices for specific conditions or procedures.
2. Financial Incentives: Hospitals that perform well on these quality metrics are rewarded with financial incentives, such as higher reimbursement rates for services provided. Conversely, hospitals that perform poorly may face penalties, including lower reimbursement rates or financial disincentives.
3. Data Reporting and Monitoring: Participating hospitals are required to regularly report data on the specified quality metrics to the HSCRC or another designated agency. This data is used to monitor hospital performance and calculate incentive payments or penalties.
4. Continuous Improvement: The QBR program is designed to encourage continuous improvement in healthcare quality and efficiency. Hospitals are expected to use the feedback provided through the program to identify areas for improvement and implement strategies to enhance the quality of care they provide.
5. Collaboration and Support: The HSCRC and other stakeholders often provide support and resources to help hospitals improve their performance on quality metrics. This may include educational programs, technical assistance, and opportunities for hospitals to learn from each other’s best practices.

Overall, the HSCRC QBR program is intended to align financial incentives with the delivery of high-quality, cost-effective healthcare services, ultimately improving patient outcomes and reducing healthcare costs. For more information on the QBR policy, please visit the following HSCRC website page.

The CRISP Reporting Services Portal hosts a few types of reports built for users to understand hospital performance under the HSCRC’s Quality Based Reimbursement (QBR) Program.

The Sections below is a brief description of each type.

QBR Scoring

The QBR Scoring Report is a document that provides hospitals with detailed information about their performance in the QBR program. This report typically includes

• • Performance Metrics:  The report outlines the specific quality metrics used to evaluate hospital performance, such as readmission rates, patient satisfaction scores, infection rates, and adherence to best practices for various conditions or procedures. Hospitals can see how they scored on each metric and where they stand compared to benchmarks or other participating hospitals.
  • Score Calculation: The report explains how scores are calculated for each quality metric, including any adjustments or risk stratification methods used to account for differences in patient populations or hospital characteristics.
  • Performance Trends: Hospitals can track their performance over time by reviewing historical data included in the report. This allows them to identify trends, track improvements, or address areas of concern.
  • Benchmarking: The report may include comparisons to benchmarks or performance targets set by the HSCRC or other relevant organizations. This helps hospitals understand how their performance compares to industry standards or goals.
  • Financial Implications: Hospitals can see the financial implications of their performance in the QBR program, including any incentive payments or penalties they may receive based on their scores. This information helps hospitals understand the financial impact of their quality performance and may incentivize improvements.
  • Actionable Insights: The report may provide hospitals with actionable insights and recommendations for quality improvement based on their performance data. This could include suggestions for targeted interventions, areas for further investigation, or opportunities for collaboration with other healthcare providers.

QBR Inpatient Mortality Reports

Inpatient Mortality Reports are documents that provide detailed information on mortality rates for patients admitted to hospital. Here’s what is included in an HSCRC Inpatient Mortality Report:

• Mortality Rates: The report typically includes data on inpatient mortality rates for various conditions, procedures, or patient populations. This data allows hospitals to assess their performance in terms of patient outcomes and identify areas for improvement.
• Risk Adjustment: In order to provide a fair comparison of mortality rates across hospitals, the report may include risk adjustment methodologies. These methods take into account factors such as patient demographics, severity of illness, and comorbidities to adjust for differences in patient populations and ensure a more accurate assessment of hospital performance.
• Trends Over Time: Hospitals can track changes in their mortality rates over time by comparing current data to historical trends. This longitudinal analysis helps hospitals identify improvements or areas of concern and assess the impact of quality improvement initiatives.
• Benchmarking: The report may include comparisons of each hospital’s mortality rates to benchmarks or performance targets established by the HSCRC or other relevant organizations. Benchmarking allows hospitals to understand how their performance compares to industry standards and identify opportunities for improvement.
• Root Cause Analysis: In some cases, the report may include information on the underlying causes of patient mortality, such as complications during surgery, medication errors, or healthcare-associated infections. This data can help hospitals identify specific areas for quality improvement and implement targeted interventions to prevent future adverse events.

QBR 30-Day All-Cause Mortality Reports

These reports are similar to the Inpatient Mortality Reports, however, the purpose is to capture mortality which occurs after a hospital discharge. The HSCRC staff Staff believes that expansion to a 30-day measure in the payment program better captures and incentivizes the quality of care delivered by a hospital, expanding beyond the wall of the hospital.

QBR PSI-90 Reports

PSI-90 (Patient Safety Indicator-90) Reports provide detailed information on patient safety outcomes in Maryland hospitals. These reports focus specifically on the PSI-90 metric, which is a composite measure of patient safety developed by the Agency for Healthcare Research and Quality (AHRQ).

The PSI-90 is a composite measure that combines several patient safety indicators, such as postoperative sepsis, accidental puncture or laceration, and bloodstream infections acquired in the hospital. It provides a comprehensive overview of patient safety outcomes within a hospital.

QBR Follow Up After Discharge Reports

Using data from MD Medicare and Medicaid, the Follow-Up After Discharge Reports provide detailed information on patient outcomes and follow-up care after discharge from hospitals in Maryland. These reports are part of the broader QBR program aimed at improving healthcare quality and patient outcomes. The reports contain data on the extent to which hospitals conduct follow-up care with patients with specific conditions after they have been discharged. This may include scheduled appointments, phone calls, home visits, or other forms of follow-up care aimed at ensuring patients’ well-being and preventing readmissions. he reports may assess how effectively hospitals coordinate transitions of care between inpatient and outpatient settings. This includes communication with primary care providers, medication reconciliation, and continuity of care to ensure a smooth transition for patients after discharge.

QBR TFU – Patient Adversity Index and Disparity Gap Report

TFU (Total Facility Utilization) – Patient Adversity Index and Disparity Gap Report provides detailed information on patient outcomes, facility utilization, and healthcare disparities in Maryland hospitals. This report focuses on assessing and addressing disparities in healthcare access, quality, and outcomes among different patient populations.

Patient Adversity Index is a composite measure that incorporates various socioeconomic, demographic, and clinical factors to assess the level of adversity or vulnerability experienced by patients. Factors may include income level, education, insurance status, race/ethnicity, housing stability, and comorbidities. The index helps identify patients who may face barriers to accessing healthcare or achieving optimal health outcomes.

The report analyzes disparities in healthcare utilization, quality, and outcomes among different patient populations, as measured by the Patient Adversity Index. It examines differences in hospital admissions, readmission rates, mortality rates, length of stay, resource utilization, and other metrics between advantaged and disadvantaged patient groups.

Similar to other quality metrics, the data in the Disparity Gap Report may be risk-adjusted to account for differences in patient populations and hospital characteristics. This ensures that hospitals are evaluated fairly and accurately based on their performance in addressing healthcare disparities.