Thank you for your inquiry on CMS1028v2 (Severe Obstetric Complications). A facility’s risk-adjusted rate may be higher or lower than the observed rate depending upon their case mix, since the risk-adjusted rate represents the hospital’s relative performance compared to other hospitals with the same case mix. The CY 2024 PC-07 FAQ posted on QualityNet contains additional information about risk-adjustment and how it is calculated for this measure ( https://qualitynet.cms.gov/inpatient/measures/ecqm/resources#tab2 ). The goal of risk adjustment is to account for patient-level factors that are clinically relevant, have strong relationships with the outcome, and are outside of the control of the reporting entity, without obscuring important quality differences. Risk factors can increase (or decrease) the likelihood that a patient experiences a certain outcome. Risk adjustment for case mix differences among hospitals is based on the clinical status of the patient and other patient characteristics at the time of admission. Only conditions or comorbidities that convey information about the patient at the time of the admission are included in risk adjustment, determined by present on admission indicators. Complications that arise during the hospitalization are not used in risk adjustment. The risk variables included in the final risk model can be found on QualitiyNet. In particular, the FAQ document may prove to be of value to you.