Provider Peer Grouping
Monthly Updates
September 13, 2010
Katie Burns
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
risk-adjusted 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)
Patient Attribution
• Patient attribution is the method by which
patients will be linked to physician clinics or
medical groups
• When a patient receives care from multiple
providers, what provider has responsibility for
that patient?
Patient Attribution
• This presentation relates only to the cost
component of the peer grouping analysis
• MDH will clarify how patients are attributed
for quality measures at a later date
Patient Attribution
• Peer grouping will be based on multiple
proportional rule:
– All clinics involved in treating the patient are
attributed some portion of that patient’s costs
– How much is determined by each clinic’s
proportion of Evaluation and Management
(E&M) visits
Patient Attribution
• This approach will keep a variety of patients,
including those who seek care from several
providers, in analysis
– Other methods rely on a minimum threshold of care,
which may exclude patients who are likely sicker and of
significant interest for peer grouping purposes
– Greater number of patients will increase reliability of
analysis
Patient Attribution
• Total care analysis will only include
primary care clinics as a reported unit of
analysis
– A portion of costs associated with specialty
care will be attributed back to primary care
– Condition-specific analysis will include all
relevant providers
Example One: Attribution for Total
Cost of Care
Clinic 1
(Primary care)
Clinic 2
(Primary
care)
Clinic 3
(Specialty only
clinic)
Clinic 4
(Specialty only
clinic)
Total
Total Cost of
Care Provided
$1,000
$3,000
$6,000
$10,000
$20,000
% of E&M
visits
10%
40%
30%
20%
100%
Costs
Attributed to
Provider
$2,000
$8,000
$0
$0
$10,000
Patient Attribution
• All costs from hospital stays, pharmacy,
and other ancillary services will be
attributed back to primary care clinic
• See example on next slide
Example Two: Attribution for Total
Cost of Care
[1]
Clinic 1
(Primary care)
Clinic 2
(Primary care)
Hospital[1]
Pharmacy
Total
Total Cost of
Care Provided
$1,000
$3,000
$15,000
$1,000
$20,000
% of E&M
visits
10%
90%
0
0
$100%
Costs
Attributed to
Provider
$2,000
$18,000
$0
$0
$20,000
This example refers only to the total care physician clinic/medical group analysis. If this example applied to the total care hospital
analysis and the hospital costs noted here are all inpatient hospital costs, 100% of those costs would attributed to the admitting hospital.
Stakeholder Involvement:
Rapid Response Team
• MDH convened this group to provide input on
critical issues
–
–
–
–
–
Approach for specific condition analysis
Methodology for attributing patients to providers
Benchmarking and determination of peer groups
Risk adjustment
Design and weighting of individual quality measures
into composite quality score
– Design of composite cost and quality measure
Stakeholder Communications and
Input Additional Opportunities
• Monthly call
• Workgroup on reliability thresholds to be
convened in late Fall
• Soliciting feedback from providers about mock
provider reports
Next call
Monday, October 11, 2010
7:30-8:30 am