Provider Peer Grouping
Monthly Updates
September 12, 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:
Physician Clinic Analysis
Physician Clinic
Total Care Analysis
• PPG Total Care analysis will include
clinics that offer primary care
• MDH has developed an index to assess
the extent to which physician clinics offer
primary care
Primary Care Service Index
A PCSI value is based on:
• An individual provider’s practice location(s)
• An individual provider’s NPI number and
self-selected taxonomy codes
• An individual provider’s priority rating for
each type of care provided
• A physician’s priority rating of the clinic
practice location
Use of Primary Care
Service Index
• MDH will use a clinic’s PCSI score as one
criterion to determine whether a clinic
should be included in Total Care peer
grouping
• MDH will also use a component of the
PCSI score to allocate costs across clinics
for providers affiliated with multiple clinics
Use of Primary Care
Service Index
• Claims are linked to individual patients and
providers rather than to clinic locations
• When individual providers are affiliated
with more than one clinic location in
physician clinic registry, the PCSI provides
a basis for allocating costs across the
multiple clinics
Use of Primary Care
Service Index
• MDH considered using the PCSI to adjust
for differences in types of services offered
by various clinics
• Based on feedback from stakeholders,
MDH will instead rely solely on ACG risk
adjustment for severity of illness
Progress Update
Hospital Total Care Reports
• MDH will release Hospital Total Care
reports on September 27 by email and
mail
• MDH will send advance communication to
hospitals this week via email
Communication with Hospitals
• MDH will host a webinar on September 29
to explain PPG information to hospitals
• MDH will also host 3 regional meetings in
the Twin Cities, Rochester, and Duluth on
October 4-5
Timeline for
Physician Clinic Analysis
• Volume of data for physician clinic
analysis is greater than for hospitals
• MDH is improving its research
environment to allow for faster processing
of data
• MDH will provide more concrete updates
on timing in the future
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 2010
– Explored characteristics of reliable data
– Discussed ways of assessing reliability
• Reliability Workgroup provided helpful
feedback on hospital analysis and will be
asked for similar input on clinic analysis
For more information, see
www.health.state.mn.us/
healthreform/peer/index.html
Next call
Monday, October 10, 2011
7:30 am