Provider Peer Grouping
Monthly Updates
January 13, 2014
Stefan Gildemeister
Director, Health Economics Program
This Morning’s Discussion
• Updates
• Upcoming Activities for Rapid Response Team
& Advisory Committee
• Revised Report Timelines
Hospital Report Updates
• Finalized add-on payment methodology by
coordinating required data with DHS and
developing:
– data query to provide data table with add-on payments on claim
by claim basis
– matching strategy for cross-walking DHS data file with APCD
– algorithm for:
• calculating of a claim-level payment value which includes add-on
amounts
• removing DHS add-on payments from overall hospital
reimbursement
Hospital Report Updates
• Finalized quality measure set
– Removed measures that are no longer used by CMS,
including some that are topped-out
• Tested impact of MN vs. national AP-DRG weights on
risk adjustment & price standardization
– Because of marginal improvement, we are maintaining
choice of national weights
• Pre-data validation efforts underway
• Continue work on readmissions (more discussions
w/RARE workgroup)
Clinic Report Updates
• Nearing finalization of programming attribution method
• Conducted analyses on how to pursue standardized cost
calculations in all-payer setting
• Tested clinic report template with providers; some
preliminary feedback includes:
–
–
–
–
Consider comparing clinics based on geography and clinic type
Ensure quality measures reflect current practices
Better clarify purpose and frequency of the report
Consider finer breakdowns of payer groups
Data Aggregator RFP Updates
• MDH currently in negotiations with highestscoring vendor
• MDH will communicate final details including
implications for data submitters following
contract execution … soon!
• Next contract will include efforts to:
– Consider X12 recommendations
– Implement ICD-10 data submission
– More interactive relationship w/data submitters
QECP Updates
• Participated in Qualified Entity Certification
Program (QECP) December site visit
• Currently participating in Phase 2 which
includes review and certification of data
security infrastructure
• CMS has presented itself as flexible and
collaborative … and interested in Minnesota’s
work
Advisory Committee and RRT Updates
• RRT Updates
– MDH response to last discussion summarizing
forthcoming: finalized methodology to remove add-on
payments for Medicaid FFS from hospital total costs is
forthcoming
– Next memo will be sent in January and will cover
attribution of patients to clinics
• AC Updates
– Requested material is under development
– Next meeting will take place in early spring 2014 – there
are a couple of possible topics
Upcoming RRT Discussions
Topic
Communication
Timing
Memo only
January 2014
Memo & Conference
Call
Early Spring 2014
Clinic Report: Total Cost (Part 2), including Cost Memo & Conference
measure calculation and Standardization
Call
Early Spring 2014
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
Spring 2014
Memo & Conference
Call
Late Spring 2014
2014 Updated Timeline
• Hospital:
– V. 2, confidential release: Spring 2014
– V. 2, public release: Summer 2014
• Clinic:
– V. 1, confidential release: Summer 2014
• Analytic RFP
– Five-year contract end period is approaching;
MDH is considering appropriate timing for
releasing RFP for hospital v.3 and clinic v.2
Spring 2014,
RRT & AC meetings
Jan 2014, RRT
Memo Only
2014
Jan
Summer 2014,
Clinic Report, v. 1
Feb
Mar
April
Today
Spring 2014, HR
v.2 confidential
release
conduct cost &
quality analysis
confidential review by hospitals of
HR.2
implement clinic/medical
group attribution
calculate clinic-based
quality measures
perform cost
analysis
confidential review by clinics of
CR.1
May
June
July
Aug
Sept
Summer 2014,
HR v.2 public
reporting
Nov
Timeline Delays
• Contractual Matters:
– Expiration of and procurement for current data aggregator
vendor
– Ongoing revisions to analytic vendor contract issues
• Some staff turn-over
• Medicare data submissions
• Method development
– Incorporated stakeholder feedback to develop add-on
payment methodology
– Pursued a number of solutions to analytic challenges that
are characteristic of an all-payer environment
Next call
February 10, 2014
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]
Ellen Wolter at [email protected]