Provider Peer Grouping
Monthly Updates
April 8, 2013
Stefan Gildemeister
Director, Health Economics Program
This morning’s discussion
• Hospital report update
– Distribution
– Summary brief
• Clinic report update
– Quality compositing
– HEDIS measures
– Risk adjustment
– Attribution
• Hospital data validation efforts
• Advisory group work
• Updated timeline
Hospital report update
Release and distribution plan
Hospital Reports
Report release update
• Release detail
– Electronic copy and paper report submitted to 99 hospitals on March
26, 2013
– Summary data tables (3) sent first week of April electronically
– Two webinars/meeting held on April 2nd and April 3rd
– Developing cost methods manual
– Working on summary report
• This is a confidential release – Further methodology
refinement based on stakeholder and community feedback
will take place for future iterations.
Modifications: Data
• Performed analysis on updated data set and with enhanced
provider attribution
– increased number of claims by about 15 percent overall
• Fixed grouper problem related to Diagnostic Related Groups
– Accurate distinction between medical and surgical cases
– Assignment of certain DRGs to MDC 0
• Assigned Medicare Advantage claims to Medicare, instead to
commercial claims
• Validated against Minnesota Hospital Discharge Data
• Developed agreement with CMS and process for
expedited reporting of Medicare data
5
Methods Modification: Quality Composites
• Concern regarding original method of quality composting based on
provider relative ranking
• Distribution of quality measurement scores in MN Hospitals are tightly
clustered
• Using a scoring method based on relative comparison creates artificially
large differences in composited scoring when raw measurement scores
are tightly distributed
• Revised method assigns points based on the range of scores regardless of
a provider’s relative ranking within that range
• Providers with similar scores on a measure now receive approximately the
same number of points for that measure
6
Methods Modification: Risk Adjustment
• Evaluated performance of four alternative risk adjustment
models
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•
•
•
ACGs
ADGs
APR-DRGs
Hybrid model using aspects of ACG/APR-DRG
• Evaluated performance of two cost outlier truncation models:
• Globally using 95th 98th 99th and 99.5 percentile of cost
• MDC specific using 95th 98th 99th and 99.5 percentile cost
• Identified and removed certain rare, high-cost cases from the
analysis to reduce potential bias
• Burns
• Transplants
• Neonatal care
7
Clinic report update
Methodology
Clinic report update
Clinic report methodology
• Quality compositing
– Number of domains
– How to weight each domain, i.e.,
absolute, relative or a
combination
• Claims & other quality measures
– Which measures to chose claims
vs. SQRMS measures vs. HEDIS
– Convert to clinic-based
discussion using administrative
data
• Which measures can be
converted
• Attribution decisions
– Multiple proportionate
attribution vs. single clinic
attribution
– Assessing use of 30/40/50
percent attribution model
• Risk adjustment
– What risk adjusters
– How much historical data
– How to handle continuity of
eligibility
Advisory Committee(s)/Group(s)
• Various advisory bodies to PPG
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–
–
–
Advisory Committee
RRT
Reliability workgroup
Validation workgroup
• How to best leverage stakeholder input w/o overburdening
our colleagues
– Technical issues
– Higher-level policy issues
– Making adequate progress
• Advisory Committee: finalizing meeting date in March
Updated Timeline
• Hospital PPG:
– summary report: May 2013
– v.2, public release: December 2013
• Clinic:
– v.1, confidential release: Sept/Oct 2013
– summary report: January 2013
– v.2, public release: Spring 2014
Next Steps for Hospitals
• Review of reports & results
– Questions, requests for additional information, and written comments can
be directed to Mathematica
– Appeals based on concerns about accuracy of data can be directed to
MDH
• Developing a summary report in May – no individual hospital will be
identified in the analysis
• Performing PPG analysis for public reporting with more updated
data and additional input on methodology
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–
–
–
Comments from your confidential review
Alignment with any relevant national developments
PPG stakeholder/advisory groups
Initial R&D plans: quality compositing & outlier management
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Next Steps for PPG Overall
• Continue to work with CMS on speeding up/simplifying data
submission
• Developing a public display option
– Technical infrastructure
– How to best communicate to consumers
• Developing clinic PPG
– Much methodological work on quality compositing and cost analysis
(attribution, standardization, risk adjustment, etc.)
– Initial confidential report to hear feedback and comments from clinics
and health system
– Development of a summary report – what can we learn from this
analysis in aggregate
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Next call
May 13, 2013
7:30am
Resources
Additional information on PPG is available online:
www.health.state.mn.us/healthreform/peer/
Information on Minnesota’s health care market can also be found online:
www.health.state.mn.us/healtheconomics
Questions may be sent to:
Stefan Gildemeister at Stefan.Gildemeister@state.mn.us or 651-201-3554