Quality Based Reimbursement (QBR)

Overview and Background

Maryland’s Quality-Based Rei​mbursement (QBR) program, in place since July 2009, uses similar measures to the federal Medicare Value-Based Purchasing (VBP) program, in place since October 2012. Because of Maryland’s long-standing Medicare waiver for its all-payer hospital rate-setting system and the implementation of the QBR program, the C​enters for Medicare & Medicaid Services (CMS) has given Maryland various special considerations, including annual exemption from the Medicare VBP program. The QBR program incentivizes quality improvement across a wide variety of quality measurement domains, including:

  • Person and Community Engagement
  • Clinical Care
  • Patient Safety

Current Quality-Based Reimbursement (QBR) Program

On January 1, 2014 the State of Maryland entered into a new All-Payer Model demonstration contract with the Center for Medicare and Medicaid Innovation (CMMI).  Among other provisions of the Model, the Centers for Medicare & Medicaid Services (CMS) will waive the VBP program requirements for Maryland hospitals, provided that the Maryland program "submits an annual report to the Secretary that provides satisfactory evidence that a similar program in the State for Regulated Maryland Hospitals achieves or surpasses the measured results in terms of patient health outcomes and cost savings.” The State must apply annually for this exemption from the national VBP program. The exemption from the CMS VBP program grants Maryland the continued flexibility to adapt its quality-based payment programs to focus on areas specific to Maryland hospitals. This exemption additionally enables Maryland to maintain its all-payer approach to quality-based payments to hospitals and continue to align the all-payer QBR program with the operational realities of the all-payer rate setting system. Maryland’s QBR program, like the fe​deral VBP program, holds 2% of hospital revenue at risk based on performance, and measures performance in clinical care, patient safety, and person and community engagement (previously “experience of care”) domains (see rate year (RY) policies for domain weighting).  Hospital performance is scored, as is done with VBP, by comparing performance period results for each measure to historical performance, and by using a threshold and benchmark to calculate points earned by each hospital; both improvement and points are calculated for each measure, and the better of the two scores are used to calculate each hospital’s total score for the program.

The HSCRC established the following guiding principles for the QBR through stakeholder input from the Performance Measurement Work Group:​

  • The measurements used for performance linked with payment must include all patients, regardless of payer.
  • The measurements must be fair to hospitals.
  • The measurements used should be generally consistent with the CMS VBP measures to support Maryland's annual waiver from the VBP.
  • The approach must include the ability to track progress.

​Key QBR Policy Documents

Rate Year 2024

​Communications and Memos ​ ​
Document TitleDate
​Final PolicyRY24 Final QBR Recommendation 
Nov 10, 2021
Memo​sRY24 QBR Memo
Feb 25, 2022

​Rate Year 2023

​Communications and Memos ​ ​
Document Title Date
​Final Policy RY23 Final QBR Policy Recommendation
Feb 22, 2021
Memo​s RY23 QBR Memo
Feb 22, 2021
Data Workbooks​​ ​ ​
​Calculation Sheet

Base Period Workbook​

Rate Year 2022

​Communications and Memos ​ ​
Document Title Date
​Final Policy RY 2022 QBR Final Approved QBR Policy
Dec 17, 2019
Memo​s RY 2022 QBR Memo (Updated)

Feb 28, 2020
Data Workbooks​​ ​ ​
​Calculation Sheet RY 2022 QBR Calculation Sheet 
Mar 11, 2020
Base Period Workbook​ RY 2022 QBR Base Period Workbook  ​May 14, 2020
​​Revenue Adjustment RY 2022 QBR Scaling​ ​Jun 30, 2021

Rate Year 2021

​Communications and Memos ​ ​
Document Title Date
​Final Policy RY 2021 Final Approved QBR Policy
Jan 4, 2019
Memo​s RY 2021 QBR Memo (UPDATED)

Mar 05, 2019
Sep 09, 2019
Data Workbooks​​ ​ ​
​Calculation Sheet RY 2021 QBR Calculation Sheet  (UPDATED)
​Mar 11, 2020
​Revenue Adjustments RY 2021 QBR Scaling - Prelim ​June 12, 2020

Rate Year 2020

​Communications and Memos ​ ​
Document Title Date
​Final Policy RY 2020 Final Approved QBR Policy
Dec 13. 2017
Memo​s RY 2020 QBR Memo (UPDATED)
RY 2020 QBR Revenue Adjustments
​Mar 01, 2018
Sep 09, 2019
Data Workbooks​​ ​ ​
​Calculation Sheet RY 2020 QBR Calculation Sheet (UPDATED)
​Apr 11, 2018
​Performance Period Data*
​Revenue Adjustments RY 2020 Final QBR Scaling
​Sep 09, 2019
* Designated hospital employees can access mid-year data through the CRISP Reporting Services (CRS) Portal. For non-hospital interested parties, this data is available upon request, please contact HSCRC Quality at hscrc.quality@maryland.gov.

Rate Year 2019

​Communications and Memos ​ ​
Document Title Date
​Final Policy FINAL Recommendation - QBR - RY 2018 and 201.pdf​ ​Feb 08, 2017
Memo​s RY 2019 QBR Memo Updated 06-02-2017.pdf
RY 2019 QBR Results and Revenue Adjustments.pdf
RY 2019 QBR Memo.pdf
​Jun 02, 2017
Sep 26, 2018
May 22, 2017
Data Workbooks​​ ​ ​
​Performance Period Data*
​Calculation Sheet RY2019 QBR Calculation Sheet (UPDATED)
​Sep 27, 2017
* Designated hospital employees can access mid-year data through the CRISP Reporting Services (CRS) Portal. For non-hospital interested parties, this data is available upon request, please contact HSCRC Quality at hscrc.quality@maryland.gov.

​Rate Year 2018

​Communications and Memos ​ ​
Document Title Date
​Final Policy FINAL Recommendation - QBR - RY 2018 and 2019.pdf

RY 2018 Original Final Recommendation QBR.pdf
​Feb 08,2017

Oct 14, 2015
Memo​s RY 2018 QBR Program Results and Revenue Adjustments

2017-06-01 REVISED RY 2018 QBR Memo.pdf

2017-03-27 QBR Memo RY 2018 Revisions.pdf

Dec 08, 2017

​Jun 01, 2017

Mar 31, 2017

Feb 19, 2016
Data Workbooks​​ ​ ​
​Performance Period Data RY 2018 Safety Data.xlsx ​Jun 01, 2017
​Rate Year Scales
​Calculation Sheet RY 2018 QBR Calculation Sheet (UPDATED) ​Aug 04, 2017


QBR Workgroup Information

For information regarding the QBR development workgroups, please visit the Archived Quality Initiatives​ page.

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