Provider Peer Grouping
Monthly Updates
August 12, 2013
Mat Spaan
Planning Director, Health Economics Program
This morning’s discussion
• Upcoming Rapid Response Team Topics
– Hospital Cost and Quality Methodology, Clinic Attribution,
and Clinic Cost and Quality Methodology
• Advisory Committee Updates
• Additional Updates
–
–
–
–
Hospital Analysis, Round 2
Clinic Analysis, Round 1
Potentially Preventable Readmissions Measurement
CMS Qualified Entity Certification for Medicare Data Entry
Program (QECP)
• Updated Report Timelines
Upcoming RRT Discussion Topics
Rapid Response Team
Topic
Communication
Timing
Memos &
Conference Call
September, 2013
Memo only
November 2013
Memo & Conference
Call
November, 2013
Clinic Report: Total Cost (Part 2), including Cost Memo & Conference
measure calculation and Standardization
Call
December, 2013
Hospital Report: Total Cost, including Outliers,
Cost Transformation, Risk Adjustment, & Case
Mix Adjustment
Hospital Report: Quality Methods, including
Benchmarking and Compositing
Clinic Report: Attribution of patients to clinics
Clinic Report: Total Cost (Part 1) including
Outliers, Risk Adjustments and Exclusions
Clinic Report: (1) Categories of Service, (2)
Benchmarking
Clinic Report: Quality Methodology
Memo only
January, 2014
Memo & Conference
Call
February, 2014
Advisory Committee
• Next meeting planned for September 2013
– The number and typography of peer groups for
the Clinic analysis
– Confidential report content and design for Clinic
reports
• Future meeting will address the public report
display for Hospital Round 2
Additional Updates
• Hospital Analysis, Round 2:
– Continued testing and evaluation of methodology adjustments
•
•
•
•
Quality compositing
Risk adjustment (functional form)
Outlier treatment
Treatment of teaching hospitals and uncompensated costs
• Clinic Analysis, Round 1:
– Exploring reporting at both individual clinic level and the overall
medical group level
• Potentially Preventable Readmissions Measurement:
– Completed testing of 3M’s PPR Grouping Software. Presenting results
to RARE Campaign workgroup in August.
Additional Updates
• CMS Qualified Entity Certification for Medicare
Data Entry Program (QECP)
– MDH now a Certified Qualified Entity
– Allows us to publically report on providers using
Medicare data
– Certifies our methodology on cost and quality
measures
Updated Timeline
Activity
Data Availability
2013
Jan
Feb
Mar
Apr
May
Jun
Jul
2014
Aug
Sep
Oct
Nov
Dec
Jan
CY2008-11
Commercial &
Medicaid
CY2008-10
Medicare Data
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
CY2008-2012 All
Payers
Hospital Analysis
confidential release
Second round
(Fed FY2011 Commercial
& Medicaid cost data;
Fed FY 2010 Medicare
cost data)
assess method improvements, sensitivity tests
comparing model options, create data files, perform
attribution, calculate costs, conduct benchmarking, etc.
hospital review & respond to
inquiries
public
report
confidential release
assess method improvements,
sensitivity tests comparing
model options, create data
files, perform attribution,
calculate costs, conduct
benchmarking, etc.
Third round**
(Fed FY2012 all payers)
Clinic Analysis
First round
(Fed FY2011 Commercial
& Medicaid cost data;
Fed FY 2010 Medicare
cost data)
hospital review & respond to
inquiries
public
report
confidential release
sensitivity tests comparing model options, create data files,
perform attribution, calculate costs, conduct benchmarking, etc.
clinic review & respond to
inquiries
confidential release
Second round**
(Fed FY2012 all cost
data)
**Assumes CMS data available for inclusion in MN APCD by December 2013
assess method improvements,
sensitivity tests comparing
model options, create data
files, perform attribution,
calculate costs, conduct
benchmarking, etc.
clinic review & respond to
inquiries
public
report
Updated Timeline – Timing of Quality Data
Activity
Hospital Quality
Measures *
Clinic Quality
Measures*
Jan
Feb Mar Apr May
Jun
2013
Jul Aug
Sep
Oct
Nov
Dec Jan Feb Mar Apr May Jun
DOS
20112012
Claimsbased:
DOS 20092011;
SQRMS:
2011-2012
2014
Jul Aug
Sep
Oct
Nov
Dec
DOS
20122013
2014 SQRMS
Measure Set
Released
Claimsbased:
DOS 20102012;
SQRMS:
2012-2013
2015
SQRMS
Measure
Set
Released
Hospital Analysis
confidential release
Second round
report development
pub.
hospital review & respond to
rep
inquiries
ort
confidential release
Third round
Clinic Analysis
First round
report development
report development
hospital review & respond to pub.
inquiries
report
confidential release
clinic review &
respond to inquiries
confidential release
Second round**
*DOS vary by measure but generally include data from 2011-2012 for hospitals and 2009-2011 for clinics in 2013
report development
clinic review & respond to
inquiries
pub.
report
Next call
September 9, 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]