Provider Peer Grouping
Monthly Updates
November 21, 2011
Stefan Gildemeister
Interim Director, Health Economics Program
What is Provider Peer Grouping?
• A system for publicly comparing provider
performance on cost and quality
– …a uniform method of calculating providers' relative cost of
care, defined as a measure of health care spending
including resource use and unit prices, and relative quality
of care… (M.S.§62U.04, Subd. 2)
– a combined measure that incorporates both provider riskadjusted cost of care and quality of care… (M.S.§62U.04,
Subd. 3)
What Types of Provider Peer Grouping
Needs to be Developed?
1. Total Care
2. Care for Specific Conditions
The commissioner shall develop a peer grouping system for
providers based on a combined measure that incorporates
both provider risk-adjusted cost of care and quality of care,
and for specific conditions… (M.S.§62U.04, Subd. 3)
Stakeholder Involvement
• Provider Peer Grouping Advisory Group
• Rapid Response Team
• Reliability Workgroup
• Monthly Conference Calls
Methodological Update:
Hospital Total Care
Analysis
Hospital Total Care Reports
• MDH released Hospital Total Care reports on
September 27 by email and mail
• MDH hosted a webinar on September 29 to explain
PPG information to hospitals
• MDH also hosted 3 regional meetings in the Twin
Cities, Rochester, and Duluth on October 4-5
• MDH invited input from hospitals via these forums as
well as an electronic feedback process
• October 21st communication to hospitals
Cost Composite Modifications
• Issue: Missing discharges
• Solution: Improved data set
– More current data set
• Public program and commercial claims for the full 2009
calendar year
• Medicare claims still for calendar year 2008
– More complete accounting of Minnesota hospital claims
Cost Composite Modifications
• Issue: Surgical case allocation
• Solution: Corrected grouping software
Cost Composite Modifications
• Issue: Medicaid and Medicare managed care
discharges reported as Commercial
• Solution: Improved managed care claim allocation
– Payer type will be more representative of hospitals’ patient
population
Cost Composite Modifications
• Potential Risk Adjustment Changes
– Hospital characteristics
• Burns
• Transplants
• Neonatal care
– Outlier payments
– ACG look-back period
Quality Composite Modification
• Topped-Out Measures
– Measures for which performance is almost uniformly very
high are referred to as “topped out” measures
– These measures will continue to be included in this
iteration of the hospital total care analysis
– MDH is exploring alternate ways to handle these measures
which do not penalize high performers who are slightly
below the highest performers
Progress Update
Timeline for
Modified Hospital Reports
• MDH will continue to communicate with hospitals on its
progress
• Modified reports will be disseminated in early 2012
• Hospitals will have an opportunity to confidentially review
their results for 30 days
• Hospitals will also be able to review and comment on the
proposed online mechanism for public reporting
– Details have not been finalized
Timeline for
Physician Clinic Analysis
• Volume of data for physician clinic analysis is greater than for
hospitals
• MDH has improved its research environment to allow for
faster processing of data
• MDH will continue to provide more concrete updates on
timing in the future
For more information, see
www.health.state.mn.us/
healthreform/peer/index.html
Questions can be sent to
Stefan Gildemeister at
Stefan.Gildemeister@state.mn.us or
651-201-3554
Next call
Monday, December 12, 2011
7:30 am