Medicare Beneficiary Quality Improvement Project (MBQIP)
The Medicare Beneficiary Quality Improvement Project (MBQIP) is a quality improvement activity under the Medicare Rural Hospital Flexibility (Flex) grant program. The goal of MBQIP is to improve the quality of care provided in small, rural Critical Access Hospitals (CAHs). This is being done by increasing the voluntary quality data reporting by CAHs, and then driving quality improvement activities based on the data. This project provides an opportunity for individual hospitals to look at their own data, measure their outcomes against other CAHs and partner with other hospitals in the state around quality improvement initiatives to improve outcomes and provide the highest quality care to each and every one of their patients.
These resources address the challenges of defining and reporting rural-relevant quality measurements and adopting proven clinical delivery models that drive quality and performance-based value. They also provide an overview of the goals, expectations, and measures for MBQIP.
Questions about MBQIP?
CAH Administrators and other personnel: Flex Coordinators are a great resource for information about MBQIP or the Flex Program. The State Contact Information and Flex Profile pages include contact information for each state's Flex Coordinator.
Flex Coordinators: Please send MBQIP questions to the Federal Office of Rural Health Policy, Health Resources and Services Administration program mailbox firstname.lastname@example.org.
These resources provide an overview that helps to explain the purpose of MBQIP, steps for CAHs to complete and benefits of participation.
Care transitions refer to the movement of patients from one health care provider or setting to another. For people living with serious and complex illnesses, transitions in setting of care are prone to errors. For example, one in five patients discharged from the hospital to home experience an adverse event within three weeks of discharge. An adverse event is defined as an injury resulting from medical management rather than the underlying disease. The most common adverse events are medication related; they often can be avoided or mitigated. The current rate for hospital readmissions among Medicare beneficiaries within 30 days of discharge is nearly 20%, contributing to lower patient satisfaction and rising health care costs.
Data Reporting and Use
These resources provide information about how to submit data to MBQIP and how that data can be utilized to improve health care.
Emergency Department Transfer Communications
While emergency care is important in all hospitals, the emergency department is particularly important in rural hospitals where the distance to urban medical centers makes the effective triage, stabilization, and transfer of patients essential. Communication problems are a major contributing factor to adverse healthcare events in hospitals, accounting for 65% of sentinel events tracked by The Joint Commission. In addition, research indicates that deficits exist in the transfer of patient information between hospitals and community primary care physicians, and between hospitals and long-term care facilities. For example, when a patient arrives at an emergency department needing time-sensitive care that includes transfer to a tertiary care center, the rural hospital’s ability to quickly assess, arrange, and get the patient out the door with the necessary and appropriate information can be of life or death importance.
Data indicating how well a rural hospital serves this important stabilize-and-transfer care transition role is not currently widely available. This measure allows hospitals to collect information on emergency department transfer communication, and use the data to improve quality of care, safety and outcomes for patients transferred from their emergency department.
The intent of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) initiative is to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care. While many hospitals have collected information on patient satisfaction, prior to HCAHPS there was no national standard for collecting or publicly reporting patients' perspectives of care information that would enable valid comparisons to be made across all hospitals. In order to make "apples to apples" comparisons to support consumer choice, it was necessary to introduce a standard measurement approach: the HCAHPS survey. HCAHPS is a core set of questions that can be combined with a broader, customized set of hospital-specific items. HCAHPS survey items complement the data hospitals currently collect to support improvements in internal customer services and quality related activities.
The Hospital Inpatient Quality Reporting (IQR) Program is intended to equip consumers with quality of care information to make more informed decisions about health care options. It is also intended to encourage hospitals and clinicians to improve the quality of inpatient care provided to all patients. The hospital quality of care information gathered through the program is available to consumers on the Hospital Compare website. The Hospital IQR Program requires "sub-section (d)" hospitals to submit data for specific quality measures for health conditions common among Medicare beneficiaries, which typically result in hospitalization. For MBQIP, a rural-relevant subset of Heart Failure and Pneumonia inpatient measures were selected for CAHs to voluntarily report.
The Hospital Outpatient Quality Reporting (OQR) Program is a quality data reporting program for outpatient hospital services implemented byCenters for Medicare and Medicaid Services (CMS). CMS focuses on reporting measure data that have high impact and support national priorities for improved quality and efficiency of care for Medicare beneficiaries. For MBQIP, a rural-relevant subset of outpatient measures were selected for CAHs to voluntarily report.
Patients and their families are essential partners in the effort to improve the quality and safety of health care. Their participation as active members of their own health care team is an essential component of making care safer and reducing readmission.
Robust efforts to engage patients and families in their care are woven throughout all aspects of the Partnership for Patients to achieve system-wide adoption of patient and family engagement best practices.
A 2008 study demonstrated measurable benefits to providing patient-centered care with a positive impact on patient satisfaction, length of stay and cost per case. By improving communication with patients, via providers at the bedside or institutionally through committees focused on systemic changes in patient care, patient outcomes can and will improve.
Making Care Safer. Ten years after publication of the Institute of Medicine’s report To Err Is Human, researchers identified rates of medical harm—that is, injuries to patients associated with their care—in excess of 25 events per 100 admissions. A recent study by the Office of the Inspector General (OIG) found that 13 percent of hospitalized Medicare beneficiaries experience adverse events resulting in prolonged hospital stay, permanent harm, life-sustaining intervention, or death. Almost half of those events are considered preventable.
Pharmacist Review of Medication Orders
Adverse drug events account for 34.2 percent of all hospital acquired conditions (Partnership for Patients, 2010). Additionally, each hospital patient can expect to be subjected to, on average, more than one medication error per day (IOM, 2006). The goal of the MBQIP Phase 3 Pharmacist Verification of Medication Orders within 24 hours is to increase the level of pharmacist oversight of the medication administration process at critical access hospitals, resulting in fewer errors, better medication management, and improved patient outcomes. The measure was designed to be non-burdensome, providing a simple numerator/denominator percent value derived from a report generated by the hospital’s order entry software.
- Numerator: Number of electronically entered medication orders for an inpatient admitted to a CAH (acute or swing-bed), verified by a pharmacist or directly entered by a pharmacist within 24 hours.
- Denominator: Total number of electronically entered medication orders for an inpatient admitted to CAH (acute or swing-bed) during the reporting period.
- Technical Assistance and Services Center (TASC)
- Advisory Committee
- Flex Program
- Medicare Beneficiary Quality Improvement Project (MBQIP)
- Rural Health Virtual Training Gateway
- Small Rural Hospital Improvement Grant Program (SHIP)
- State Contact Information & Flex Profiles
- Resource Library
- Health Education and Learning Program (HELP) Webinars
- Performance Management Group (PMG) Calls
- Rural Hospital Performance Improvement (RHPI) Project
- Rural HIT Network Development (RHITND)
The Federal Office of Rural Health Policy periodically publishes the MBQIP Monthly newsletter which highlights current information about the Medicare Beneficiary Quality Improvement Project (MBQIP) for Flex Coordinators and associated staff.
Latest Issue: August 2014 [PDF - 326 KB]
MBQIP Data Reports
The Flex Monitoring Team (FMT) periodically publishes MBQIP data reports, which provide nationwide data on the measures of the Medicare Beneficiary Quality Improvement Project (MBQIP) for Flex Coordinators and associated staff.