Quality Initiatives


The Maryland Health Services Cost Review Commission (HSCRC) runs several quality-based measurement and payment initiatives. These initiatives are important policy tools for providing strong incentives for hospitals to improve their quality performance over time. These initiatives hold a portion of hospital revenue at-risk directly related to specified performance benchmarks.

The HSCRC currently runs a series of quality initiatives to ensure that hospitals improve quality in line with targets set in the Maryland All-Payer Model agreement with the Center for Medicare and Medicaid Innovation (CMMI), which runs from 20​14-2018. Quality programs provide financial incentives for hospitals to improve or maintain high quality performance on selected quality of care measures. Quality measures are typically classified into three categories: structural (such as patient to provider ratios or use of electronic health records), process (such as percentage of patients receiving preventive services), and outcome (for example, rate of complications). Where possible, the HSCRC works to employ the use of outcome measures.

Maryland Quality Initiatives

The overall mission of the HSCRC Quality Initiatives is to help create a health care environment where Maryland hospitals provide efficient, high quality patient care, and support overall healthcare delivery system improvements in the state. The overarching goals of the HSCRC Quality Initiatives are to:

  • Work with Maryland hospitals to enhance the quality of patient care by providing financial support and rewards/incentives consistent with evidence-based health services research and improved patient outcomes;
  • Utilize a broad set of quality measures that appropriately reflect the delivery of quality health care services provided at Maryland hospitals;
  • Collect data to support accurate and reliable quality measures;
  • Better understand the relationship between quality and cost; and
  • Become a model for enhancing health care quality in the hospital setting while remaining consistent with broader healthcare delivery quality initiatives.

The HSCRC Quality team designs, implements, and manages statewide all-payer hospital reimbursement adjustments based upon hospital performance on a comprehensive set of quality metrics. The Quality team works with stakeholders, consumer advocates, and subject-matter experts to maintain the integrity of the quality initiatives, most notably through the Performance Measurement Work Group. To date, HSCRC has engaged in a multi-pronged approach to quality improvement, including:

  1. Maryland Hospital Acquired Conditions (MHAC) Initiative – MHAC aims to reduce the number of Potentially Preventable Complications (PPCs) through individual hospital and statewide rewards and penalties. PPCs are post-admission complications that may result from hospital care and treatment. 
  2. Potentially Avoidable Utilization (PAU) Savings Program – Hospitals can receive savings for reducing potentially avoidable utilization, including readmissions, preventable admissions, and preventable observation stays.
  3. Quality-Based Reimbursement (QBR) Program – The QBR program incentivizes quality improvement on a wide variety of quality measures, including measures of Person and Community Engagement, Clinical Care, and Safety.
  4. Readmissions Reduction Incentive Program (RRIP). RRIP was implemented to reduce preventable 30-day hospital readmissions in the All-Payer Model and is closely aligned with federal readmissions programs. Hospitals can receive rewards or be assessed penalties based on readmission rates. 
The HSCRC also implements a maximum revenue guardrail policy to limit the amount one hospital can be penalized in a single year under the quality policies.

Quality Webinars

Webinar Title ​Webinar Slides and Recording ​Date
RY 2021 Quality Policies​ ​Ry 2021 Quality Policies Webinar Slides
RY 2021 Quality Webinar Recording*
*Please register with name and e-mail to listen to recording​
​Jun 28, 2019
RY 2020 Quality Policies​ RY2020 
RY 2020 Quality Policies Webinar Slides
RY 2020 Quality Webinar Recording*
*Please register with name and e-mail to listen to recording
​Jun 19, 2018
RY 2019 Quality Policies​ RY 2019 Quality Policies Webinar Slides (UPDATED)
RY 2019 Quality Webinar Recording
RY 2019 QBR Program Results and Revenue Adjustments
* Please register with name and e-mail to listen to recording
​Jul 14, 2017
RY 2018 Quality Policies​ RY 2018 Quality Policies Webinar Slides ​Jul 29, 2016

Previous Quality Initiatives

For information regarding previous quality initiatives, please refer to the Archived Quality Initiatives Page​.

Please e-mail questions or inquiries about HSCRC’s Quality Initiatives to hscrc.quality@maryland.gov or contact Dianne Feeney by telephone at 410-764-2605.