Provider Peer Grouping
Monthly Updates
June 13, 2011
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)
Methodological Update:
Construction of the
Composite Quality Measure
Total Care
Composite Quality Measure
• Physician clinics and hospitals will receive
a composite quality score
– Performance on individual quality measures
will first be aggregated into “subcomposites”
of similar types of measures
– Subcomposite categories are combined to
form the composite quality measure
Aggregating Measures
Into Subcomposites
• Providers will earn points on each measure
based on their performance
• We will use a point system that uses emerging
CMS approaches to combine individual
measures into subcomposites
Earning Points on Measures
• Points will be measured on a 0-10 scale
– Provider must perform at least at the “achievement threshold”
(30th percentile) of performance to earn any points on a measure
– Provider receives 10 points if rate is above “benchmark” (mean
of top decile of performance)
– Provider receives 1-9 points otherwise:
9*((rate-threshold)/benchmark-threshold)] +.5
“Topped Out” Measures
• Measures for which performance is almost
uniformly very high are referred to as
“topped out” measures
• These are more prevalent among hospital
than physician clinic measures
• We are still evaluating how to treat topped
out measures within the point system
Physician Clinic Measures
• Three subcomposites and 19 measures
• Subcomposite categories
• Chronic Disease (60%)
• Acute (20%)
• Preventive (20%)
Physician Clinic Measures
• Quality measures include data submitted
directly from clinics on components of
optimal diabetes and optimal vascular care
• Quality measures also include HEDIS
measures:
• Six calculated at clinic level
• Five calculated at medical group level
Hospital Measures
• Four subcomposites and 33 measures
• Subcomposites
– Inpatient Complications (20%)
– Process of Care (30%)
– Mortality (30%)
– Readmission (20%)
Minimum Case Size
Requirements
• Requirements for minimum numbers of
patients vary by measure set
• PPG will rely on existing community
standards for minimum numbers of
patients necessary for each measure set
Treatment of Missing Data
• Consistent with PPG Advisory Group
recommendations, providers must have at
least one measure per subcomposite in
order to be included in peer grouping.
• Providers that do not meet this threshold
will not be included in peer grouping.
Treatment of Missing Data
• No missing results will be imputed for physician
clinics or prospective payment system hospitals
• Results may be imputed on individual measures
for Critical Access Hospitals that have some
data for a particular measure, but less than the
minimum N
– CAH’s own results will count in proportion to the
number of patients for which it has data
– Balance of CAH’s score will be the statewide average
for CAHs on that measure
Patient Experience
• Patient experience data is not uniformly
available for physician clinics and
hospitals
• Where patient experience data is available
based on CAHPS tools, it will be reported
along with composite quality score
– Patient experience will not be part of
composite quality score
Reporting of Quality Results
• Results will be displayed at the composite,
subcomposite, and individual measure
results for providers and consumers
Progress Update
Provider Report Design
• Mathematica tested design of hospital
provider reports with a range of hospitals
in late May
• Hospital reports are slated to be
disseminated to providers later this
summer
Stakeholder Involvement
Stakeholder Involvement:
Rapid Response Team
• MDH convened this group to provide input on
critical issues
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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
Stakeholder Involvement:
Reliability Workgroup
• MDH convened first meeting of this group
in December
– Explored characteristics of reliable data
– Discussed ways of assessing reliability
• Next meeting will occur on June 23 and
will focus on hospital analysis
For more information, see
www.health.state.mn.us/
healthreform/peer/index.html
Next call
Monday, July 11, 2011
7:30 am