Version 1.2 Revised 7/20/2025

Quality Measures Included in the Quality Incentive Calculations

The following quality measures are included in Ohio's Quality Incentive Payment calculations:

  • Catheter Inserted/Left in Bladder (L)

  • Falls with Major Injury (L)

  • UTI (L)

  • Pressure Ulcers (L)

How is the Quality Incentive Payment Calculated?

Marlyland’s P4P is calculated based on real time QM Scores calculated by DatAlign for chs.care for the current quarter to simulate how current performance would impact reimbursement. 

Points Assignment

Points for Maryland’s P4P program range from 0-5 and are calculated using the following method:

  1. Calculate the “cut”-

(1 - Maximum Value to Receive Full Points) × 100

  1. Calculate the P4P Score -

    1. Round the QM Score to the nearest integer

    2. Subtract the rounded score from 100

    3. This is the P4P Score

  2. Calculate the points -

    1. If the P4P Score is less than the cut 0 points are awarded for this QM

    2. If the P4P Score = 100 the facility is awarded full points (5 points) for this QM

    3. If the P4P Score is less than 100 and greater than the cut the following formula is used to obtain the points awarded:

       5 × ((P4P Score - cut)/(100-cut))


From Points to Dollars and Cents

The Quality Incentive Payment is calculated using the following formula:

Per diem Quality Payment rate × Points × Number of Medicaid days in the period

  • Per diem Quality Payment rate: $0.111

  • Number of Medicaid days in the period: The sum of the days of care in the period for patients whose primary payer is Medicaid.

Note: Maryland’s P4P program awards payments per Medicaid day based on overall points from a variety of domains, including MDS QMs, with 100 points as the maximum points. However, the per diem award for a facility with that amount of points is unavailable. The payment also fluctuates per facility as it is determined on a percentage of a pool and a facility’s individual daily rate, which is only finalized at a time that we are unaware of. We took the average points and corresponding P4P per diem payment for FY 2025 published by the State of Maryland for the purpose of these calculations, which were 62.712 points and $7.02 per diem. Based on these data points, the average per diem payment per point was $0.110941839.

As noted, there is fluctuation, with the highest per diem per point amount equal to $0.1312262142 and the lowest per diem per point amount equal to $0.0968060487 

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References


Version 1.2 Revised 7/20/2025