Overview
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 2014-2018. 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:
- 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.
- Potentially Avoidable Utilization (PAU) Savings Program - Hospitals can receive savings for reducing potentially avoidable utilization, including readmissions, preventable admissions, and preventable observation stays.
- 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.
- 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.
- Digital Quality Measures Reporting - CRISP and Medisolv are working in partnership to support the HSCRC in collecting hospital-reported digital quality measures, with initial effort focused first on Electronic Clinical Quality Measures (eCQMs) and subsquently on hybrid quality measures. A few hospitals started optional submission of the 2021 eCQM measures in Spring of 2022. In calendar year (CY) 2022, HSCRC required Maryland hospitals to submit on a quarterly basis 4 eCQMs. For CY 2023, hospitals are required to submit 6 eCQMs. All eCQM data is being submitted in the Quality Reporting Document Architecture (QRDA) I format to Medisolv ENCOR portal via CRISP Portal. While these measures align with federal IQR measures, it does not replace IQR Reporting requirements for Maryland hospitals.
For additional information about Maryland's work in this area, please refer below to the memoranda distributed to Maryland hospitals. The detailed reporting and submission information may be found on the
CRISP website.
Quality Data Collection and Reporting Exceptions Process
Maryland hospitals may request an exception with respect to the reporting of required quality data -including electronic Clinical Quality Measure (eCQM) data-
when there are extraordinary circumstances beyond the control of the hospital. Please refer to the Maryland Hospital Extraordinary Circumstances Exception (ECE) Policy for additional information.
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.
Previous Quality Initiatives
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.
