Quality and Safety in Nursing/Measurement of Effectiveness: Metrics

Medicare Beneficiary Quality Improvement Project (MBQIP)

Introduction The Office of Rural Health Policy (ORHP) created the Medicare Beneficiary Quality Improvement Project (MBQIP) in 2008 as a Flex Grant Program activity within the core area of quality improvement. “The primary goal of this project is for Critical Access Hospitals (CAHs) to implement quality improvement initiatives to improve their patient care and operations” (National Rural Health Resource Center, 2013).

Body Hospital Compare was created through the efforts of Medicare and the Hospital Quality Alliance. This is a national website that promotes reporting of hospital quality of care. Hospital Compare has evolved to include mandatory reporting measures that link reimbursement to quality outcomes. Critical Access Hospitals are not included in the reimbursement at this time. CAHs can report to Hospital Compare for the purpose of benchmarking and best practices, but the challenge is that Hospital Compare only reports the study if the numbers are statistically significant. This happens to be rare for most CAHs as the patient numbers are much lower, thus the purpose of creating MBQIP.

MBQIP takes a proactive approach to ensure CAHs are well-prepared to meet future quality requirements, as quality reporting and demonstrating value through providing cost efficient quality care is where the health care environment is currently headed. “The passage of meaningful use and the Affordable Care Act heightened national attention on quality activities and reporting. In the environment of meaningful use, pay for performance, bundled payments, and accountable care organizations (ACO), CAHs may soon be compared with their urban counterparts to ensure public confidence in their quality health services” (National Rural Health Resource Center, 2013). Paul Moore, D.PH., Senior Health Policy Advisor, believes CAHs will not be exempt from linking reimbursements to quality outcomes where CAHs represent 25% of hospitals. He states “If we don’t take ownership of our own quality, others will do it for us with their own interpretation.”

MBQIP uses Flex funding to support Critical Access Hospitals with technical assistance and national benchmarks to improve health care outcomes. Those CAHs who volunteer to participate are requested to report a specific set of annual measures determined by ORHP and engage in quality improvement projects to benefit patient care.

The following are benefits for participating in MBQIP established by the National Rural Health Resource Center. • Engage in quality improvement initiatives • Improves patient care across a broad population • Improves hospital services, administration and operations • Allows for clear benchmarking and the identification of best practice CAHs • Receive technical assistance regarding cutting edge quality improvement tools and models • Prepare CAHs for the future where CAHs will likely have to report measures • Fulfills the Quality Improvement portion of the Flex Grant

There are three yearly phases with specific reporting measures that have been established. Phase I started in September 2011.

Phase I (Begin September 2011) • Pneumonia: Hospital compare CMS Core Measure (participate in all sub-measures); AND • Congestive Heart Failure: Hospital Compare CMS Core Measure (participate in all sub-measures) Phase II (Begin September 2012) • Outpatient 1-7: Hospital Compare CMS Measure (all sub-measures that apply); AND • Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Phase III (Begin September 2013) • Pharmacist CPOE/Verification of Medication Orders Within 24 hours; AND • Outpatient Emergency Department Transfer Communication • *Reporting tool for Phase 3 Measures is yet to be determined

Conclusion Currently 71% of CAHs publically report inpatient measures to Hospital Compare, only 35% of CAHs report to HCAHPS. 753 CAHs have committed to participate in MBQIP as of 10/12/2011. ORHP and its partners are charged with increasing current CAH Hospital Compare participation rates, and CAH dedication to QI initiatives. While participation in the project is voluntary, MBQIP seeks to increase attention on quality health care to all CAH Medicare beneficiaries, both inpatient and outpatient. This project puts patients first by focusing on Critical Access Hospital improvements to health care services, processes, and administration. For more information on MBQIP, the three yearly phases, or how to participate, please visit http://www.ruralcenter.org/tasc/resources/medicare-beneficiary-quality-improvement-project-mbqip.

References National Rural Health Resource Center. (2013). Medicare beneficiary quality improvement project (MBQIP). Retrieved from: http://www.ruralcenter.org/tasc/resources/medicare-beneficiary-quality-improvement-project-mbqip Centers for Medicare and Medicaid Services. (2013). Hospital compare. Retrieved from: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalCompare.html Moore, P. (2011). Medicare beneficiary quality improvement project. Retrieved from: http://www.hrsa.gov/ruralhealth/about/video/index.html