Minnesota Department of Health’s
Health Care Quality Report
November 17, 2010
Katie Burns
2008 State Health Reform Law
and Quality Measurement
• Minnesota Statutes, § 62U.02, Subd.1 and 3
• The commissioner of health shall develop a
standardized set of measures by which to assess
the quality of health care services offered by health
care providers…
• The commissioner shall establish standards for
measuring health outcomes, establish a system for
risk adjusting quality measures, and issue annual
public reports on provider quality…
Recognizing Key Partners
• MDH has a 4-year, $3 million contract with
MN Community Measurement (MNCM) as
lead member of consortium including
MMA, MHA, Stratis Health, and the
University of Minnesota
• MNCM acting as data collector for
physician clinics under contract with MDH
Statewide Quality Reporting and
Measurement System Requirements
• MDH adopted the first set of administrative rules
establishing the Statewide Quality Reporting and
Measurement System in December 2009.
– Clinics must register through web-based process annually
– Clinics and hospitals must submit data needed to calculate
each applicable clinical quality measure and perform risk
adjustment
– Clinics and hospitals must complete annual Health
Information Technology survey
– Cooperate in data validation activities and maintain
documentation for two years
MDH Quality Report:
Physician Clinics
• Two measures for which data was
submitted directly by physician clinics for
2009 dates of service
– Optimal diabetes care
– Optimal vascular care
• 11 HEDIS measures based on 2008 dates
of service
HEDIS Measures
•
•
•
•
•
•
•
Appropriate Testing for
Children with a Sore Throat
Appropriate Treatment for
Children with a Cold
Breast Cancer Screening
Cervical Cancer Screening
Chlamydia Screening
Use of Appropriate
Medications for Asthma
Avoidance of Antibiotic
Treatment of Adults with
Bronchitis
•
•
•
•
Colorectal Cancer Screening
Controlling High Blood
Pressure
Cancer Screening Combined
Childhood Immunization
Status
HEDIS Measures
• MDH used results previously calculated
and reported for medical groups and
linked them to each clinic associated with
that medical group
• Only clinics that are part of a medical
group with an existing HEDIS measure
result have data reported for HEDIS
measures
MDH Quality Report: Hospitals
• 43 measures included in report
–
–
–
–
9 related to heart attacks
6 related to heart failure
6 related to surgical care
11 related to medical complications and infection
prevention
– 11 related to other conditions
• Pneumonia
• Hip fracture treatment
• Childbirth
MDH Quality Report: Hospitals
• These measures are a combination of:
– Centers for Medicare and Medicaid Services
(CMS) Hospital Compare measures
– Appropriate Care Measures
– Agency for Healthcare Research and Quality
(AHRQ) measures calculated from discharge
data
– Healthcare Associated Infection measures
• Dates of service vary according to measure
set
Organization of the Report
• Statewide report is divided into four regions
–
–
–
–
Region One: Northwest and West Central
Region Two: Northeast and Central
Region Three: Twin Cities Metro
Region Four: Southwest, Southeast and South Central
• Each regional report includes information on
physician clinic and hospital measures for
providers located in those regions
Organization of the Report
• Separate sections on physician clinic and
hospital measures
• Measures are described in easy to
understand language with information
explaining whether a higher or lower rate
is better
Organization of the Report
• Physician clinics are listed alphabetically
under the city in which they are located.
Cities are presented in alphabetical order.
• Hospitals are presented in alphabetical
order with a reference to city name as
needed.
Organization of the Report
• Information is presented in a simple format
for use by multiple audiences, including
providers and consumers
• Risk-adjusted rates are reported in the
front of the document along with statewide
averages for most measures
Organization of the Report
• More detailed information is available in
appendices
– More data elements
– Description of data sources and data
collection procedures and
– Description of methodology
Additional Data Elements
in Appendices
• Physician clinics
• Risk adjusted rates and confidence intervals;
• Distribution of patient population according to primary
payer type;
• Total population or sample-based reporting;
• Unadjusted rates and confidence intervals
• Hospitals: available data elements vary
according to measure set
Physician Clinics
Included in the Report
• All physician clinics that registered through MN
Community Measurement and with specialties
relevant to optimal diabetes and optimal
vascular care measures are included in the
report
• Other physician clinics also included if MDH
determined they had relevant specialties
Reporting Thresholds
• Physician clinic results were reported if
data was available for at least 30 patients
for most measures (minimum of 60 for four
“hybrid” HEDIS measures)
• Hospital results were reported if data was
available for at least 25 patients
“Small Numbers”
and Data Not Reported
• If numbers of observations did not meet
these thresholds, MDH included a footnote
for each provider noting that “sufficient
data not available”
• If physician clinic did not submit data for
clinical measures, MDH included a
footnote noting “data not reported”
What is Risk Adjustment?
“Risk adjustment means a process that adjusts the
analysis of quality measurement by accounting for
those patient-population characteristics that may
independently affect results of a given measure
and are not randomly distributed across all
providers submitting quality measures. Risk
adjustment characteristics include severity of
illness, patient demographics, or payer mix.”
-- Minnesota Rules,
Chapter 4654.0200, Subpart 17
MDH Quality Report
• Results are risk adjusted, consistent with
Minnesota Statutes 62U.02
– Physician clinic patient populations are
adjusted to reflect a statewide average payer
mix
– Hospital measure results are adjusted to
account for demographic characteristics,
severity of illness and risk of mortality where
necessary
Risk Adjustment
for Physician Clinics
Effect of Risk Adjustment
On Physician Clinic Results
Differences between Risk Adjusted and Unadjusted Rates
Absolute
Minimum
Absolute
Maximum
Middle 80 percent range
difference
Median difference
Optimal Diabetes Care
0%
17%
0 - 2%
1%
Optimal Vascular Care
0%
10%
0 - 2%
1%
High Blood Pressure
0%
20%
0 - 9%
2%
Asthma
0%
12%
0 - 3%
0%
Cold (Upper Respiratory Infection)
0%
8%
0 - 2%
1%
Sore Throat (Pharyngitis)
0%
21%
0 - 2%
1%
Bronchitis
0%
6%
0 - 2%
0%
Breast Cancer Screening
0%
32%
0 - 2%
1%
Cervical Cancer Screening
0%
13%
0 - 2%
1%
Colorectal Cancer Screening
0%
44%
0 - 6%
1%
Cancer Screening Combined
0%
18%
0 - 8%
1%
Chlamydia Screening
0%
9%
0 - 4%
1%
Childhood Immunizations
0%
11%
0 - 3%
1%
MEASURE
Risk Adjustment for Hospitals
• CMS Hospital Compare “Process of Care”,
Appropriate Care and two Healthcare
Associated Infection measures do not
require risk adjustment
– Measures examine whether a recommended
care practice was followed when a patient
received care rather than a patient outcome in
which patient characteristics influence results
Risk Adjustment for Hospitals
• AHRQ measure results are adjusted on
basis of severity of illness
• Information explains whether hospital
results are “better, same, or worse” than
expected compared to other similar
hospitals
Quality Reporting
and Health Reform
• Results included in this report are a critical
building block of provider peer grouping,
which will compare providers on a
combined measure of risk-adjusted cost
and quality
Release Schedule For Public Report
• Physician clinics received a link via email to the
report on Tuesday, November 16
• Webinars providing an overview of report are
being held today Wednesday, November 17
• MDH will post its quality report on the MDH
website on Thursday, November 18
If you need more information,
please contact:
Katie Burns
651.201.3562
or [email protected]