Quality Improvement | Process Measures (QBR)
Complications: Maryland Hospital Acquired Conditions (MHAC)
This initiative, which commenced July 1, 2009, links payments to hospital performance on a set of 49 Maryland Hospital Acquired Conditions (MHACs) across all-payers and patients in the State. MHACs were derived from a list of 64 Potentially Preventable Complications (PPC) developed by 3M Health Information Systems based on their clinically appropriateness and significant cost implications when they occur. PPCs are complications that are unlikely to be a consequence of the natural progression of an underlying illness. PPC are not present when the patient is first admitted and, thus, are associated with the care during the hospitalization.
Examples of PPCs include urinary tract Infection, septicemia (infection in the blood), and iatrogenic pneumothrax (collapsed lung).
During fiscal year 2008, 49 MHACs were included in the program and these complications were present in approximately 53,000 of the State’s total 800,000 inpatient cases and represented approximately $500 million in potentially preventable hospital payments. From FY 2009 to FY 2010, we saw a 12% decrease in measured complication rates with associated costs of $62M. This may, in part, be attributable to hospital coding changes in addition to the rewards and penalties that were applied to hospital payment rates.
The MHAC methodology provides a system of payment incentives based on a hospital’s actual number of complications versus a statewide target rate for each of the selected MHAC categories. Under this approach, hospitals face strong financial incentives to reduce complication rates. They will also be armed with a sophisticated data analysis tool that will enable them to systematically help achieve this collective goal of reducing complications.
Key Features of the MHAC Initiative:
For full details of the MHAC Initiative, click on the links below under Policy Papers, Press Releases, Quality Reports and Analyses.
Policy Papers and Press Releases
Final Staff Recommendation on QBR and MHAC Scaling Magnitudes and Standard for Expected Values for the FY 2014 and FY 2015 Updates to Hospital RatesFY 2009
Final Staff Recommendation on QBR and MHAC Magnitudes and Scaling for the FY 2013 Update to Hospital Rates
Quality Reports and Analyses
Rate Year FY 2015
Final MHAC Detailed Tables FY 2013 Q3-Q4 FY 2014 Q1-Q2 with RY 15 PPC Regress
Final MHAC Detailed Improvement PPC Rates for select PPCs, Rate Year 2015, FY2013 Q3 Q4
& FY2014 Q1 Q2 vs. FY 2012
Final MHAC Detailed Tables FY 2013 Q3 with RY 15 PPC Regress
Final MHAC Detailed Tables FY-2013-Q3-Q4 with RY 15 PPC Regress
Final MHAC Detailed Tables FY-2013-Q3-Q4-FY-2014-Q1 with RY 15 PPC Regress
Final MHAC Detailed Improvement PPC Rates for select PPCs, Rate Year 2015, FY2013Q3 vs. FY 2012
Final MHAC Detailed Improvement PPC Rates for select PPCs, Rate Year 2015, FY2013Q3Q4 vs. FY 2012
Final MHAC Detailed Improvement PPC Rates for select PPCs, Rate Year 2015, FY2013Q3Q4 & FY2014Q1 vs. FY 2012
Detailed Baseline (FY2012) PPC Rates for Rate Year 2015 by Hospital and Select PPC
Standardization Factors for RY 2015
MD PPC Marginal Charge Estimation for Rate Year 2015
MHAC Regression Results for Rate Year 2015
PPC Norms for Rate Year 2015
Baseline Improvement for Rate Year 2015
Rate Year FY 2014
Rate Year 2013
Rate Year 2012
MHAC FY2011 Data Detailed AnalysisRate Year 2011
MHAC Scaling Results to be used in FY2012
Total PPC Cases and Costs by PPC in Maryland, FY 2011
Changes in PPC Cases and Costs from FY2010 to FY2011, Maryland
Estimate of the Marginal Additional Cost of PPCs, Base Year FY2010
Total PPC Cases and Costs by PPC in Maryland, FY 2010
Changes in PPC Cases and Costs from FY2009 to FY2010, Maryland
Total PPC Cases and Cost by Hospital, FY 2010
Hospital Infection Related PPC Rates, FY 2010
MHAC FY 2010 Data Detailed Analysis
MHAC Scaling Results
Estimate of the Marginal Additional Cost of PPC, Base Year FY 2009
Rate Year 2010
Please click here to email questions or inquiries about HSCRC’s Quality Improvement Initiatives or contact Dianne Feeney by telephone at 410-764-2605.