Provider Peer Grouping
Monthly Updates
November 19, 2012
Stefan Gildemeister
Director, Health Economics Program
This morning’s discussion
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Advisory Committee
― Sept. 7 & Oct. 16 debrief
― Next meeting plug (Nov. 19, 2012, 1-4pm, Snelling Office Pk)
Hospital report data validation efforts
– Data table templates
– Definitions: readmissions and exclusions
Rapid Response Team (RRT)
– risk adjustment discussion
Public reporting on quality
Hospital & clinic analysis update
PPG preliminary timeline
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PPG Advisory Committee:
Sept. 7th and Oct. 16th
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PPG Advisory Committee
Recommendation on Issue 1:
Timeliness of Data
– Most recent quality data used (regardless of concurrent
cost data availability)
– Do not maintain goal for a single combined measure of
relative value
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PPG Advisory Committee
Issue 3: Defining the Unit of Analysis –
Provider Definitions
Draft Recommendations
― Define hospitals by distinct practice location
― Clinic unit of analysis is deferred for now
PPG Advisory Committee
Issue 4: Quality Compositing:
Quality Measurement Compositing
―Final decision on compositing for hospital version 2
and clinic version 1 was delayed pending further
discussion by the Advisory Group
― Discussion on November 19th
― Requests to MDH for add’l information
― Responses available on PPG webpages:
www.health.state.mn.us/healthreform/peer/advisorycommittee.html
PPG Advisory Committee
Issue 4: Quality Compositing:
Absolute v. Relative Scoring
• Final decision tradeoffs between absolute & relative
scoring was delaying pending further discussion by
the Advisory Group
– Discussion on November 19th
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PPG Advisory Committee
Public Comment:
• National Groups developing composite measures for use
(AHRQ)
• Caution when applying weights to measures
• Should measures be included in the composite if few
hospitals had them?
• Are these the “right” measures to evaluate the overall quality
of providers.
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PPG Advisory Committee
Next meeting:
The next PPG Advisory Committee will be held on
Monday, November 19, 1-4pm
MDH Snelling Office Park - Red River Room
1645 Energy Park Drive, Saint Paul
All meetings of the Advisory Committee will be open to the public.
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Hospital report data validation
efforts
Definitions and summary files
Hospital report data validation
Activities
• Ongoing discussions w/hospitals and health systems
• Responding to questions on methods
– Attributing readmissions
– Exclusion criteria
• Obtaining feedback on templates that will hold
granular data
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Hospital report data validation
• Cost summary table
– APR-DRG level cost
information for all APRDRGs
– MDC summary
information
Hospital report data validation
• Enhanced summary file
– Demographic, clinical
and cost data
– APR-DRG level
information for all APRDRGs
– MDC summary
information
Rapid Response Team (RRT)
Risk Adjustment
RRT Discussions
• Choice of risk adjuster (APR-DRG, ACGs,
combination)
• Method of selecting outliers and truncation
points
• Risk adjustment model to consider claims for
admissions only or historical utilization
• Excluding certain rare, high-cost conditions
• Effect of capped public program admissions
Public reporting on quality
design, display and dissemination
Public reporting on quality
Progress Update
• Public reporting of quality through Statewide Quality
Reporting & Measurement (and PPG results) a state
requirement
• MDH published an initial report in 2010
– www.health.state.mn.us/healthreform/measurement/report/index.html
– MDH is currently working with the MnHIX on a display of quality
measures that are part of SQRMS
• Consumer testing of a prototype with a range of display
options later in 2012
– MnHIx and MDH will work with a variety of advisory bodies and consumer
testing strategies to obtain feedback
Hospital & Clinic Analysis
Progress Report
Progress Update
• Version 1 of hospital total care analysis will
conclude after decisions on risk adjustment –
confidential reporting will commence
• Data aggregation for version 2 hospital analysis
and version 1 of clinic analysis is being finalized
– Parallel analysis began in November
– Feedback from Advisory Committee will inform work
– RRT and Reliability workgroups will contribute
Preliminary Timeline, PPG 2012 to 2014
Preliminary Timeline, Provider Peer Grouping Analysis
Oct., 2012
2012
Activity
Oct
Nov
Hospital Analysis
First round, second
iteration
2013
Dec
Jan
Feb
Mar
Apr
May
Jun
2014
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
…
confidential release
completion
hospital review & respond to inquiries
confidential release
Second round
(2010 cost data)
create data files, perform attribution, cal-culate
public
hospital review & respond to inquiries
costs, conduct benchmarking, etc.
reportg.
Clinic Analysis
First round
(2010 cost data)
confidential release
create data files, perform attribution, calculate costs, conduct benchmarking,
perform quality compositing, etc.
clinic review & respond to
inquiries
confidential release
Second round
(2011 cost data)
create data files, perform attribution, cal-culate
public
hospital review & respond to inquiries
CMS data
costs, conduct benchmarking, etc.
reportg.
2012 data
Data validation
includes CMS data
Throughout with providers, using enhanced summary files. Validation workgroup beginning its activities in Spring 2013.
Preliminary timeline assumes interaction with Advisory Committee, Rapid Response Team, and Reliability Workgroup, as indicated. It also assumes that data delivery will be complete and on time and that CMS'
compressed data delivery schedule can be executed successfully.
Next call
Monday, December 10, 2012
7:30 a.m.
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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
[email protected] or 651-201-3554
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