MN DEPARTMENT OF HEALTH
PROVIDER PEER GROUPING (PPG)
ADVISORY GROUP
REVIEW QUALITY MEASUREMENTS:
CONDITION SPECIFIC & TOTAL CARE
COMBINING COST & QUALITY
MEASUREMENTS
ANN ROBINOW
MEETING 6: JULY 27, 2009
Introduction
Comments and changes to meeting summary?
Review of questions or comments since last meeting.
Report Technical Panel responses since last meeting.
Meeting tomorrow.
Questions for Technical Panel
How to track and assign patients who have switched providers
while having the same condition, particularly for patients who
had a bad outcome from the initial provider?
How much incremental value do additional structural or
process measures add to assessing quality?
Recommendation for a pneumonia process measure.
Can ACS measures selected for conditions be rolled up and
utilized to measure Total Care physician quality?
How can overall composite quality scores be made
comparable if some providers’ cell sizes are too small for
individual quality component measures?
Condition Specific Quality : Summary
Condition
Measure
Weighting
Guidelines
Pneumonia
#2 Rate of hospital re-admission for bacterial pneumonia
Equal
Pneumonia
#3 Rate of hospital ER visits for pneumonia post discharge
Equal
Pneumonia
Process Measure (Tech Panel)
Equal
Diabetes
#1 Optimal diabetes care (D5 composite)
Equal
Diabetes
#7 Rate of hospital admissions for short-term complications
Equal
Diabetes
#9 Rate of hospital admissions for uncontrolled
Equal
Diabetes
#11 Rate of hospital ER visits for diabetes
Equal
Asthma
#1 Use of appropriate medications for people with asthma
Equal
Asthma
#4 Rate of hospital ER visits for asthma
Equal
Asthma
#3 Rate of hospital re-admissions for asthma
Equal
Asthma
#2 Rate of hospital admissions for adult asthma
Equal
Condition Specific Quality : Summary
Condition
Measure
Weighting
Guidelines
CAD
#1 Optimal vascular care (5 measure composite)
Equal
CAD
#2 Rate of hospital admissions for CAD
Equal
Heart Failure
#6 Rate of hospital admissions for congestive heart failure
Equal
Heart Failure
#8 Rate of hospital ER visits for heart failure
Equal
Heart Failure
#5 30-day mortality after hospital discharge
Equal
Total Knee
No adequate measures to use for public reporting
Equal
Total Care Quality: Summary
PPG Advisory Meeting Schedule
MEETING
DATE
TIME
Meeting 1
Thursday, June 11
Introduction/Background
Meeting 2
Friday, June 26
Defining Parameters
Meeting 3
Friday, July 10
Cost Measure for Conditions
Meeting 4
Friday, July 17
Quality Measures for Conditions
Cost Measure for Total Care
Meeting 5
Wednesday, July 22
Quality Measure for Total Care
Combining Cost & Quality
Meeting 6
Monday, July 27
Combining Cost & Quality
Meeting 7
Wednesday, September 2
Information Needs by Audience
Meeting 8
Friday, September 11
Revisit Outstanding Issues
Meeting 9
Wednesday, September 30
Final Review
Context For Today’s Discussion
High Level Steps in Peer Grouping
Combining
Cost & Quality
Questions for Today’s Meeting: Combining
Cost & Quality Measures
1.
How to design a composite value measure that highlights
value in both cost & quality versus value created
primarily by only one component?
2.
What structure should be used for a composite value
measure?
3.
If weighting, how should components be weighted?
4.
If setting a threshold, what should the threshold be?
Composite Quality & Cost Measure:
Why?
Considerations for Combining Measures
1.
Quality & Cost measures must be on same directional scale if adding together.
Intuitively, they are opposite.
2.
Cost measures are generally less controversial than quality measures due to a lack
of true outcome measures.
3.
Quality score is composite (of composite)—no clear science for combining into single
score.
4.
Combining Quality & Cost in some proportion, even an equal proportion, requires a
value judgment.
5.
Quality and cost not on same scale—e.g. what does it mean to be twice as high on
quality?
Method must be able to measure a continuum to identify the bottom 10%.
6.
Comparing Value: Current Efforts
Scatter Plot Example
Chris Tompkins Article Summary of Measuring
Outcomes & Efficiency
Goal to combine measures is to reward providers with differential
value (quality + cost).
Outlines a two step process.
1.
2.
Cohort providers based on having similar or equal total quality scores.
Compare costs to a benchmark or average only within each cohort.
Adapted Example:
Provider
Cohort
1
Cohort
2
Cohort
3
Quality
Score
Cost per
Patient
Cost Benchmark
Cost Ratio to
Benchmark
A
87%
300
300
300/300 =1.00
B
87%
400
300
400/300 = 1.33
C
87%
500
300
500/300 = 1.67
D
80%
600
300
600/300 = 2.00
E
65%
250
250
250/250 = 1.00
F
65%
400
250
400/250 =1.60
Steps In Combining Cost & Quality
Combining Cost and Quality: Structure
Options
Scoring with Scattergram
Scoring with Scattergram (v2)
Putting It Together: Value Summary
Scoring Methodology
• Continuum relative to average
• Assigned category score
• Threshold binary score
Quality
How to Combine?
•Ratio
•Weighted Sum
•Cohorting w/Ratio
•Two stage w/Sum
•Percentile /Scatter
Weighting
Guidelines
between Cost
& Quality
Cost
Condition
Specific
Total Care
PPG Advisory Meeting Schedule
MEETING
DATE
TIME
Meeting 1
Thursday, June 11
Introduction/Background
Meeting 2
Friday, June 26
Defining Parameters
Meeting 3
Friday, July 10
Cost Measure for Conditions
Meeting 4
Friday, July 17
Quality Measures for Conditions
Cost Measure for Total Care
Meeting 5
Wednesday, July 22
f/u Quality Measures for Conditions
Quality Measure for Total Care
Combining Cost & Quality
Meeting 6
Monday, July 27
Combining Cost & Quality
AUGUST RECESS
(Draft Report to be distributed in August)
Meeting 7
Wednesday, September 2
Information Needs by Audience
Meeting 8
Friday, September 11
Revisit Outstanding Issues
Meeting 9
Wednesday, September 30
Final Review