Minnesota Department of Health
Provider Peer Grouping Advisory Committee
June 27, 2013 2-4pm
Meeting Minutes
Members Present:
MDH Staff Present:
Peter Benner (AFSCME – retired)
Diane Rydrych
Allie Coronis (Allina Hospitals & Clinics)
Stefan Gildemeister
William Davis (Winona Health)
Kevan Edwards
Bryan Dowd (University of Minnesota)
Mat Spaan
Mark Hudson (Department of Human Services)
Denise McCabe
Patrick Irvine (Independent)
Chelsea Georgesen
Susan Knudson (HealthPartners)
Carrie Coleman, Facilitator
Larry Lee (Blue Cross Blue Shield)
David Luehr (Integrity Health Network)
Linda Ridlehuber (MN Association of Community Health Centers)
Todd Sandberg (Sibley Medical Center)
Bob Stevens (Ridgeview Medical Center)
Beth McMullen (MN Business Partnership)
I. Welcome and overview
Carrie Coleman, Facilitator, and Diane Rydrych, Director of the Health Policy Division,
welcomed the group and thanked them for their participation. Dr. Bob Stevens, Advisory
Committee Chair, also offered his welcome and thanks.

Overview of committee goals – Ms. Coleman explained that overarching policy
decisions will be brought to the Advisory Committee, while more technical
methodological questions will be brought to the Rapid Response Team. More consumer
and provider input are especially being sought on the committee.

Timeline for upcoming reports – Stefan Gildemeister, Director for the Health
Economics Program, walked the group through the timeline for future public release of
hospital information, as well as the first iteration of confidential clinic reports.

Overview: Issues and Resolutions – Mr. Gildemeister walked the group through an
outline of upcoming issues that will be brought to the AC and RRT.

Staff Update: Modifications of Peer Grouping Models – Ms. Coleman directed the
committee members’ attention to a one-page description of planned changes to the
hospital peer grouping methodology and data.
II. Today’s Topic – Issue 1: Patient Experience Measures and Quality Compositing for
Total Care Hospital Reports
The committee agreed with the MDH staff recommendation that patient experience measures
from the HCAHPS be included in the quality composite of the next PPG report and be
initially weighted at 20 percent. Some concern that patient experience may not be directly
correlated with outcomes, or that results could be a mixed-bag (Lee). Patient experience is
part of an overall quality picture, and may be useful as an accountability tool (MDH Staff).
Dr. Dowd added that patient experience compositing is not an exact science, and some
members expressed their opinions that 20 percent weighting was not particularly
conservative (McMullen, Dowd). Other members expressed that they were happy with 20
percent weighting, which is still less than the 30 percent that CMS uses (Knudson, Sandberg,
Luehr). Committee members also commented that it would be important to finalize how this
information is presented to consumers, and whether or not the weighting would be
transparent in the results display (McMullen, Benner). A final consideration was whether or
not to include patient experience measures for Critical Access Hospitals, which are only
required to report on HCAHPS to SQRMs if they have more than 500 discharges per year
(about half of the CAHs currently report). The committee recommended displaying the
patient experience information for the CAHs that have it, but not including it the quality
composite score until there is complete and consistent data.
III. Today’s Topic – Issue 2: Possible Addition of a Third Hospital Peer Group to Hospital
Provider Peer Grouping Analysis
The committee would like to better understand how case mix differences are accounted for in
the risk adjustment strategy. Several members suggested sending this issue to the RRT for
further methodological help; however, one member commented that it likely won’t produce
any new results as it has been discussed there before (Knudson). There is a difference of
opinion between MDH staff and some advisory committee members about whether
additional case-mix adjustment is beneficial. Need to be careful about how much cost
variation is taken away in the risk adjustment, because this information may be meaningful to
consumers (MDH Staff). Another discussion was what kind of information was useful and
understandable to consumers. For example, Medicaid members are not as concerned with
costs, but would be more interested in seeing comparability between facilities based on
coverage levels (Hudson). Some Advisory committee members recommended pursuing
condition-specific cost reporting, which may be more valuable to users (Hudson, Luehr).
There was no consensus on the resolution to this issue, and the committee requested
revisiting it again after additional information has been presented to them. The committee
chair requested a graphical representation of costs associated with teaching status compared
to other PPS hospitals (Stevens). The committee requested updated definitions and
summaries of what went into the cost and clinical adjustments so that committee members
are all on the same page for the next discussion.
IV. Public Comment –
Mark Sonneborn – Minnesota Hospital Association:
 Currently under Medicare Value-based Purchasing (VBP) 1% of Medicare payment is
withheld if certain quality thresholds are not met. Next year there will be an efficiency
measure added, which is essentially a peer grouping measure. It is confusing for hospitals
to do both VBP and PPG, although VBP is reimbursement-based and PPG is consumerbased. Should consider if PPG is really a consumer-friendly format.
 PPG’s condition-specific reports should be included on the timeline.
 Will APR-DRG level charge data given to hospitals be made public?
Nancy Garrett – Hennepin County Medical Center:
 Looking at the CMS VBP method, HCMC is one of the most efficient hospitals –
however, under the PPG method they look completely different, which hurts their
credibility.