Provider Peer Grouping
Monthly Updates
May 13, 2013
Stefan Gildemeister
Director, Health Economics Program
This morning’s discussion
• Hospital report update
– Questions & comments
• Clinic report update
– Preparation of data file & initial analysis
• Hospital data validation efforts
• Advisory committee work
• Updated timeline
Hospital report update
Release and distribution plan
Hospital Reports
Report release update
• Release dates
– Confidential release took place end March
– Two webinars held in April
– Detailed summary data released in early April
– Methods manual scheduled for release in May
• Preparation of next round of analysis underway
– Updating data
– Considering methods improvement in quality compositing
– Later: testing alternative models in outlier treatment and
other potential refinements
Hospital reports
Questions from Various Discussions
• Number of occasions for feedback and questions
– Initial webinar, PPG helpdesk, direct discussions & webinar on May 7th
• Summary of questions
– Why has our hospital not received a report?
– We don’t use APR-DRGs; can we validate w/MS-DRGs?
– We have many out-of-state patients, does PPG include non-MN
residents?
– Patient experience is important in evaluating provider quality; will it
be included in the next report?
– Where can we obtain additional technical information on risk
adjustment?
– We have a mental health unit; shouldn’t those costs be excluded?
– www.health.state.mn.us/healthreform/peer/hospitaltotalcare.html.
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
• HEDIS measures
– Available at medical group level
– 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
Clinic report update
Clinic data validation
• Clinic validation
– Number of visits/encounters
– Distribution by
• payer,
• product type,
• demographics and cost
• Challenges
–
–
–
–
Attribution methodology
Lack of benchmarking data set
Volume of data
Confidentiality protections of data
• Partnership with clinics and health systems one-on-one and in
technical workgroup(s)
Ongoing hospital report data validation efforts
Advisory Committee(s)/Group(s)
• Various advisory bodies to PPG
–
–
–
–
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: planning for meeting dates in June/July
Updated Timeline
• Hospital PPG:
– Summary report: June 2013
– v.2,
• Confidential release in August, 2013
• Public release: Dec 2013
• Clinic:
– v.1, confidential release: Sept/Oct 2013
– summary report: December 2013/Jan 2014
– v.2, public release: Spring 2014
Cost Data Used In Hospital (v.2) and Clinic (v.1) Analysis
Dates of Service by Federal Fiscal Year
Medicare
2008
J
F M A M
J
J
2009
A
S
O
N
D
J
F
M A M
J
F
M A M
J
J
2010
A
S
O
N
D
J
F
M A M
A
S
O
N
D
J
F
M A M
J
J
A
S
O
N
D
A
S
O
N
D
Commercial/State Programs
2009
Key:
Yellow is the look-back period
Green is the observation period
Red is 30-day period following a readmission
J
J
2010
J
J
2011
J
F
M A M
J
J
A
S
O
N
D
Next call
June 10, 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:
PPG Helpdesk at [email protected]
Stefan Gildemeister at [email protected] or 651-201-3554