BlueCompare for Hospitals Frequently Asked Questions



Print




The 2016 BlueQ Scorecard reports were distributed to the medical/surgical general acute care hospitals in November 2016. The BlueQ Ribbon results will be published to Provider Finder in January 2016. Additions to the 2016 BlueQ Scorecard include:

  • Added the CMS Surgical Complication measures "A Wound That Splits Open After Surgery on the Abdomen or Pelvis" and "Accidental Cuts and Tears From Medical Treatment” to the CMS Outcome Indicators section.
  • Added the CMS Healthcare-Associated Infections (HAI) measures "Surgical Site Infections from Colon Surgery" and "Surgical Site Infections from Abdominal Hysterectomy" to the Outcome Indicators section.
  • Deleted the Heart Attack measures "Patients Given Aspirin at Discharge" and "Patients Given Prescription for a Statin at Discharge" since they are no longer reported by CMS.
  • Deleted the Heart Failure measures "Patients Given ACE Inhibitor or ARB for Left Ventricular Systolic Dysfunction (LVSD)" and "Patients Given Discharge Instructions" since they are no longer reported by CMS.

The BlueQ Ribbon is a value assigned based on the BlueQ Hospital Scorecard performance and is determined by comparing a hospital’s performance on publicly available measures within a geographic region. BlueQ Ribbons are displayed in Provider Finder. Ribbon values are dark blue, light blue and clear. If a hospital cannot be scored for a BlueQ Ribbon, then a Not Enough Data icon will be assigned. A hospital also has the option to not display their BlueQ Ribbon and in that case, an icon indicating an Opt Out is present in Provider Finder.


The Affordability Scale is based on a comparison of participating general acute care hospitals’ costs for inpatient and outpatient services. The allowed amount per inpatient admission and outpatient services as determined by Blue Cross and Blue Shield of Texas (BCBSTX) is based upon taking a year's worth of commercial PPO claims for that provider and repricing it against their most current contract. This is then compared to the National Unadjusted Medicare Rate to obtain a percent of Medicare reimbursement rate. The costs BCBSTX uses for analysis include all services provided by the hospital during an inpatient stay, such as labs, X-rays, and medications, as well as the room and board charges and all services provided in the outpatient setting. The analysis includes claims and membership for BCBSTX patients. A hospital’s Affordability Scale may not reflect its performance for all hospital patients.


A hospital may not have a BlueQ Ribbon if:

  • The hospital did not have sufficient data at the time of measurement
  • The hospital is not a medical/surgical general acute care facility.

Medical/Surgical general acute care hospitals are evaluated on an annual basis, with BlueQ reports, BlueQ Ribbons and Affordability Scale information communicated annually in the Fall. BlueCompare results are posted to Provider Finder around the beginning of the following year.


In order to be evaluated for an Affordability Scale, a medical/surgical general acute care hospital must have data available to measure affordability for an inpatient and/or outpatient admission. An Affordability symbol is not displayed for general acute care hospitals that do not have sufficient data for assessment.


Hospitals or facilities that are not classified as a medical/surgical general acute care hospital on BCBSTX Provider Finder did not receive a report. Examples include pediatric hospitals, rehabilitation facilities, and psychiatric hospitals.


According to Leapfrog's website and the Hospital Quality and Safety Survey FAQs, hospitals that should report to Leapfrog include acute care and short term general acute care hospitals. Leapfrog does not specify the number of beds a hospital must have to report survey results.


According to the Leapfrog website, hospitals should have submitted a 2015 survey by June 30, 2016 to be included in Leapfrog’s first release of the 2014 survey results. Those results were released in late July and fully replaced the 2014 survey results. BCBSTX sourced results for the 2015 BlueQ report from Leapfrog’s website as of September 2016.


Yes, a medical/surgical general acute care hospital can choose to opt out of the BlueQ Ribbon display in Provider Finder. The opt out form, included in the Blue Compare distirbution, must be completed and submitted. Opting Out is available for the BlueQ Ribbon only, not the affordability Scale.


The national, state, and hospital rates shown on the BlueQ scorecard are averages provided by CMS and HCAHPS. The number of points a hospital earns for a measure is based on the percentile in which the hospital rate falls. In some cases, a hospital's rate for a particular measure can be higher than the state or national average, but still not be in the percentile to qualify for the maximum number of points.