Provider Peer Grouping
Monthly Updates
July 8, 2013
Mat Spaan
Planning Director, Health Economics Program
This morning’s discussion
• Miscellaneous Updates
– Helpdesk
– CMS Qualified Entity Certification for Medicare Data Entry Program
• Advisory Committee Meeting Update
• Hospital Updates
– Ongoing validation efforts
– Progress Update: Summary Report
– Round Two updates and methodological revisions
• Clinic Updates
– Provider Linkage
– Attribution
– Quality measure set
• Updated Anticipated Timeline
Miscellaneous Updates
• Helpdesk closed on May 31, 2013
– Please direct all further questions, comments or concerns
directly to the state @ [email protected]
• CMS Qualified Entity Certification for Medicare Data
Entry Program (QECP)
– Process allows more timely acquisition of CMS data
– Anticipate submission of Phase 1 materials by 7/12/2013
– Anticipate receiving CMS data by early 2014
Advisory Committee Meeting
• PPG Advisory Committee met on June 27, 2013
• Patient Experience
• Will be part of quality composite for PPS hospitals
• 20% weighting in composite score
• Continuing conversations with committee regarding weighting
• Creation of a 3rd Peer Group
• Continue to examine impact of case-mix adjustment and other
methods that may make cost comparisons between facilities more
balanced
• http://www.health.state.mn.us/healthreform/peer/advisoryco
mmittee.html
Upcoming AC/RRT Topics
Advisory Committee
Topic
Hospital Report: # / Typology of Peer Groups
Mode
Meeting
Timing
June 27, 2013
Clinic Report: # / Typology of Peer Groups
Meeting
late July, 2013
Clinic Report: Confidential Report Template
Meeting
Hospital Report: Public Report Display
Meeting
August - October,
2013
before December
2013
Rapid Response Team
Topic
Clinic Report: Attribution of patients to clinics
Timing
late June, 2013
Hospital Report: Outliers
Mode
Memo
only
Meeting
Hospital Report: Quality Benchmarking
Meeting
July / August, 2013
Clinic Report: Quality Measurement Methodology
Meeting
Aug / Sept, 2013
Clinic Report: Outliers & Risk Adjustment
Meeting
October, 2013
Clinic Report: High cost services and Exclusions
Memo
only
Memo
only
October, 2013
Clinic Report: (1) Cost Standardization, (2) Categories of
Service, (3) Benchmarking
July, 2013
January, 2014
Hospital Updates
• Ongoing discussion with hospitals
– Validation & appeals
• Development of summary report (July 2013)
– Analysis of practice patterns variation of cost and quality
– Highlighting of certain metrics, e.g., readmission/ patient experience
– On track to be submitted this month
• Analysis for round two & methodological revisions
–
–
–
–
Quality compositing
Risk adjustment (functional form)
Outlier treatment (RRT meeting topic)
Treatment of teaching hospitals and uncompensated costs (as
discussed in AC meeting)
Clinic Updates
• Finalized attribution methodology
–
–
–
–
Single attribution
50% threshold
Tiebreaker method: based on costs (small proportion of cases)
Results will be communicated to RRT for input on round 2 of
attribution
• Finalized quality measure set for testing with report template
– Inclusion of claims-based quality measures
– Patient experience
• Newer measure
• Ongoing discussion on inclusion in composite – MDH leaning
towards leaving out of composite
Updated Timeline
Acti vi ty
2013
Ja n
Feb
Ma r
(SQRMS data 10/1/1909/30/11 DOS; CMS data
7/1/11-6/30/12 DOS)*
Ma y
Jun
Jul
2014
Aug
Sep
Oct
Nov
Dec
Ja n
Feb
CY2008-11
Commerci a l &
Medi ca i d
CY2008-10
Medi ca re Da ta
Cos t Da ta Ava i l a bi l i ty
Qua l i ty Da ta Ava i l a bi l i ty
Apr
Ma r
Apr
Ma y
Jun
Jul
Aug
Sep
Oct
Nov
Dec
CY2008-2012 Al l
Pa yers
CMS Readmit(c), HF Readmit (c) - 7/1
Depression Measure (c), HEDIS (c),
AHRQ (h), MNCM (c), HIT (c) - 8/1
CDC (h), UMN (h) - 9/1
Patient Experience (c) - 10/15
Ho spital
Co mpare
(h)
HIT (h)
A SC (h)
M NCM (c )
Hospital Analysis
conf. rel ea s e
Fi rs t round (s econd
i tera ti on)
(CY 2009 Commerci a l &
Medi ca i d; CY 2008
Medi ca re cos t da ta )
report
rel ea s e
hos pi ta l revi ew & va l i da ti on.
s umma ry report devel opment,
rel ea s ed l a te June.
confi denti a l rel ea s e
Second round
(Fed FY2011 Commerci a l
& Medi ca i d cos t da ta ;
Fed FY 2010 Medi ca re
cos t da ta )
a s s es s method i mprovements ,
s ens i ti vi ty tes ts compa ri ng
model opti ons , crea te da ta
fi l es , perform a ttri buti on,
ca l cul a te cos ts , conduct
benchma rki ng, etc.
hos pi ta l revi ew & res pond to
i nqui ri es
publ i c
report
confi denti a l rel ea s e
a s s es s method i mprovements ,
s ens i ti vi ty tes ts compa ri ng
model opti ons , crea te da ta
fi l es , perform a ttri buti on,
ca l cul a te cos ts , conduct
benchma rki ng, etc.
Thi rd round**
(Fed FY2012 a l l pa yers )
Clinic Analysis
Fi rs t round
(Fed FY2011 Commerci a l
& Medi ca i d cos t da ta ;
Fed FY 2010 Medi ca re
cos t da ta )
hos pi ta l revi ew & res pond to
i nqui ri es
publ i c
report
confi denti a l rel ea s e
s ens i ti vi ty tes ts compa ri ng model opti ons , crea te da ta fi l es ,
perform a ttri buti on, ca l cul a te cos ts , conduct benchma rki ng, etc.
cl i ni c revi ew & res pond to
i nqui ri es
confi denti a l rel ea s e
Second round**
(Fed FY2012 a l l cos t
da ta )
*Except 30-da y morta l i ty a va i l a bl e 3/1/08-6/1/11 DOS; CMS-PGP mea s ures 1/1/11-12/31/11 DOS
**As s umes CMS da ta a va i l a bl e for i ncl us i on i n MN APCD by December 2013
a s s es s method i mprovements ,
s ens i ti vi ty tes ts compa ri ng
model opti ons , crea te da ta
fi l es , perform a ttri buti on,
ca l cul a te cos ts , conduct
benchma rki ng, etc.
cl i ni c revi ew & res pond to
i nqui ri es
publ i c
report
Next call
August 12, 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:
Stefan Gildemeister at [email protected]
Kevan Edwards at [email protected]
Mat Spaan at [email protected]