Medicare Beneficiary Quality Improvement Project (MBQIP): Enhancing Care in Critical Access Hospitals

As the healthcare industry shifts toward a value-based system, critical access hospitals (CAHs) must participate in public quality reporting programs to demonstrate high-quality, patient-centered care. The Medicare Beneficiary Quality Improvement Project (MBQIP) is a key initiative under the Federal Office of Rural Health Policy’s (FORHP) Medicare Rural Hospital Flexibility (Flex) grant program, designed to help CAHs measure and improve care quality.

CAHs serve as vital healthcare access points for rural populations, yet financial constraints, staffing shortages, and limited access to technology create significant barriers to delivering high-quality care. Lower Medicare reimbursement rates further complicate quality improvement efforts, making it difficult for rural hospitals to sustain essential programs. 

CAHs serve as vital healthcare access points for rural populations, yet financial constraints and staffing shortages create significant barriers to delivering high-quality care. In just the past year, the percentage of America’s rural hospitals operating in the red jumped from 43 to 50 percent,¹ putting even more pressure on these facilities to sustain essential programs. Lower Medicare reimbursement rates further complicate quality improvement efforts, underscoring the need for sustainable strategies that enhance care quality while ensuring financial viability.

While MBQIP cannot directly resolve reimbursement limitations or workforce shortages, it provides CAHs with a structured framework to measure care quality, benchmark progress, and demonstrate value-based improvements. Participation in MBQIP can also help hospitals secure additional funding and policy support, easing financial pressures while improving patient outcomes.

But how exactly does MBQIP help CAHs improve care and remain financially sustainable? Understanding its structure, purpose, and impact is key to recognizing why participation is more than just a recommendation—it’s a necessity.

What is the Medicare Beneficiary Quality Improvement Project (MBQIP)?

Medicare Beneficiary Quality Improvement Project is a federal quality improvement initiative that helps critical access hospitals measure and enhance care quality. By voluntarily participating, CAHs gain access to structured quality metrics, benchmarking tools, and improvement initiatives that support compliance with evolving healthcare regulations.

Through MBQIP, hospitals can:

• Report standardized quality data to demonstrate care effectiveness.

• Benchmark performance against other CAHs to identify strengths and areas for improvement.

• Engage in quality improvement initiatives that enhance patient safety and operational efficiency.

Given the national push toward value-based reimbursement models, MBQIP participation is crucial. Hospitals actively engaging in the program are better positioned to secure funding, avoid penalties, and maintain long-term viability in an increasingly competitive healthcare landscape.

MBQIP: Key performance measures and reporting guidelines

To effectively track and improve healthcare quality, Medicare Beneficiary Quality Improvement Project requires CAHs to report on standardized performance measures. These MBQIP core measures focus on four key areas: 

1. Patient safety/Inpatient: Influenza vaccination coverage among healthcare personnel, and antibiotic stewardship

2. Patient engagement: Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

3. Care transitions: Emergency Department Transfer Communication (EDTC)

4. Outpatient: Outpatient and emergency department timeliness

To help CAHs easily access and explore key MBQIP performance areas, we’ve compiled a free, downloadable MBQIP Measures Examples PDF, which outlines a sample of core quality measures used in MBQIP reporting.

MBQIP Measures Examples PDF

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1. Patient safety/Inpatient

Ensuring patient safety is critical for reducing preventable infections, improving recovery outcomes, and meeting national quality standards. MBQIP supports CAHs in strengthening infection prevention and responsible medication use with two key patient safety initiatives:

• Influenza vaccination coverage among healthcare personnel (HCP/IMM-3) reduces the spread of hospital-acquired infections, protecting patients and staff from severe illness. Higher vaccination rates lead to fewer flu-related complications, hospitalizations, and staff absences.²

• Antibiotic stewardship programs, monitored through the CDC National Healthcare Safety Network (NHSN), help hospitals combat antimicrobial resistance, prevent unnecessary antibiotic use, and reduce complications like Clostridioides difficile (C. diff) infections.³

By prioritizing infection prevention and responsible medication management, hospitals can improve patient safety, reduce costs associated with prolonged hospital stays, and align with national healthcare quality goals.

2. Patient engagement

A positive patient experience is directly linked to better health outcomes—when patients feel informed, respected, and supported, they are more likely to follow treatment plans and engage in their care.

• The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey evaluates hospital communication and support, measuring provider communication, hospital responsiveness, discharge planning, and overall care experience.²

• Higher patient engagement scores lead to fewer readmissions, improved treatment adherence, and stronger community trust in healthcare services.³

Since HCAHPS scores influence hospital reimbursement, investing in patient-centered care isn’t just about meeting a metric—it’s about building a reputation for high-quality, compassionate care.

3. Care transitions

For rural hospitals, safe and efficient patient transfers are critical—patients often require specialized care at larger facilities, and communication gaps can lead to medical errors, delays, and poor health outcomes.

• The Emergency Department Transfer Communication (EDTC) measure ensures that essential patient information—such as medications, allergies, provider notes, and test results—is accurately shared with the receiving hospital.²

• Stronger transfer protocols result in fewer medical errors, improve continuity of care, and enhance patient safety—especially for time-sensitive conditions like strokes and heart attacks.³

By optimizing care transitions, CAHs can reduce avoidable complications, improve coordination with larger hospitals, and ensure patients receive timely, appropriate treatment.

4. Outpatient

Timely care in the emergency department is a key factor in patient survival and recovery. Delays in treatment can lead to worsening conditions, increased hospital admissions, and even preventable deaths.

• MBQIP emergency care measures track how quickly patients receive treatment and whether they leave without being seen due to excessive wait times.²

• Hospitals with faster ED response times tend to see lower mortality rates, fewer complications, and higher patient satisfaction scores.³

Because rural hospitals often operate with limited staff and resources, improving ED efficiency isn’t just about meeting benchmarks—it’s about delivering lifesaving care when every second counts.

How MBQIP enhances rural healthcare quality

Data-driven quality improvement

By tracking performance trends and using peer comparisons, MBQIP helps CAHs identify care gaps and implement evidence-based improvements. Hospitals gain access to:

• Quality improvement toolkits that outline best practices.

• Benchmarking data to compare performance with similar hospitals.

• Actionable insights for enhancing patient care and safety.

Financial sustainability and reimbursement opportunities

MBQIP participation supports CAHs in maintaining Medicare compliance while securing financial incentives through:

• State Flex Programs, which reward hospitals for quality reporting.

• Value-based reimbursement models, where higher performance leads to increased funding opportunities.

• Avoidance of financial penalties, ensuring hospitals remain competitive in an evolving healthcare landscape.

For many CAHs, sustainable quality improvement requires not only clinical focus but also thoughtful financial strategy. One such strategy is Method 2 billing, which allows hospitals to submit a single outpatient claim for both professional and facility services. While not directly tied to MBQIP, Method 2 can support CAHs participating in quality initiatives by improving revenue cycle visibility, reducing billing complexity, and streamlining data capture for outpatient services—all of which can free up resources to focus on care quality.

Better patient outcomes and experience

Hospitals adhering to MBQIP standards can:

• Reduce emergency department wait times and enhance care coordination.

• Minimize preventable complications, such as hospital-acquired infections.

• Improve patient satisfaction through better communication and follow-up care.

Compliance and competitive advantage

As Medicare and Medicaid policies shift toward value-based care, MBQIP prepares CAHs to:

• Meet federal reporting and performance requirements.

• Maintain long-term viability by adapting to new healthcare models.

• Attract more patients, funding, and partnerships through demonstrated quality performance.

Expanding access: Digital strategies for rural healthcare improvement

While MBQIP provides a framework for measuring and improving care quality, rural hospitals still face significant barriers in delivering patient-centered care, particularly in low-acuity conditions like musculoskeletal (MSK) disorders, chronic disease management, and post-acute care.

Long wait times for therapy and low patient engagement rates further complicate access to essential services. Research from the Journal of Rehabilitation Medicine found that among patients referred for MSK conditions, only 24 percent accessed physical therapy services after referral.⁴ This suggests that a significant portion of patients do not follow through with recommended therapy, which may lead to prolonged symptoms and increased healthcare costs.

To address these challenges, hybrid and remote care models have emerged as cost-effective strategies. Hybrid care solutions, such as Medbridge Pathways, can help critical access hospitals and health systems bridge these gaps by integrating virtual tools into patient care workflows. These solutions allow hospitals to:

• Increase care accessibility by offering virtual consultations for non-emergency conditions.

• Reduce costs by managing patients remotely, minimizing hospital visits while ensuring timely intervention.

• Enhance patient engagement and satisfaction through automated tools that provide education, follow-ups, and remote monitoring.

As rural hospitals navigate financial and logistical constraints, the integration of hybrid care models represents more than just a convenience—it’s a necessary evolution in how care is delivered. The ability to extend services beyond hospital walls, proactively engage patients, and optimize limited resources could redefine healthcare access in rural communities.

While MBQIP provides the structure and benchmarks for improving care quality, many Critical Access Hospitals benefit from additional support to build internal capacity, interpret metrics, and sustain ongoing improvement. That’s where Rural Quality Improvement Technical Assistance (RQITA) comes in. Funded by the Federal Office of Rural Health Policy, RQITA offers tailored coaching, data tools, and peer learning networks designed specifically for rural providers.

Sustaining quality care in rural communities

As healthcare continues shifting toward value-based care, CAHs must adapt by leveraging data-driven quality initiatives, financial incentives, and digital solutions to enhance patient outcomes. By leveraging MBQIP’s data-driven approach, rural hospitals can enhance care standards, strengthen accountability, and position themselves for long-term sustainability. However, sustaining these improvements requires ongoing commitment to quality reporting and strategic adoption of innovative care models.

Expanding access through hybrid and remote care solutions is already helping CAHs overcome geographic and financial barriers while improving patient outcomes and optimizing resources. Many rural hospitals are successfully integrating digital tools—such as Medbridge Pathways—to enhance patient engagement, reduce delays in care, and improve long-term outcomes. By integrating MBQIP standards with emerging healthcare technologies, CAHs can continue delivering high-quality, patient-centered care to the communities that rely on them most.

References

1. https://www.chartis.com/insights/unrelenting-pressure-pushes-rural-safety-net-uncharted-territory

2. https://www.ruralcenter.org/sites/default/files/2023-02/MBQIP-Measures.pdf

3. https://mbqip.com/

4. https://doi.org/10.1093/fampra/cmaa104