Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Protecting, maintaining and improving the health of all Minnesotans Date: September 22, 2010 To: Provider Peer Grouping Rapid Response Team members From: Katie Burns, Health Economics Program Subject: Third issue for your consideration Thank you for participating in the Rapid Response Team. In preparation for our third meeting, I wanted to distribute the attached memo from Mathematica Policy Research, Inc. It describes the next issue for which we would like your input: 1) Should all hospitals be included in one peer group or should separate peer groups be created for certain types of hospitals? We will review the memo at our meeting this afternoon to ensure you have an opportunity to clarify your understanding of the issues and to ask questions. Response deadline: We will need your feedback on these issues by Tuesday, September 28 at 4:00 pm. Responses may be provided via email to [email protected]. MEMORANDUM 955 Massachusetts Avenue, Suite 801 Cambridge, MA 02139 Telephone (617) 491-7900 Fax (617) 491-8044 www.mathematica-mpr.com TO: Katie Burns, MDH FROM: Jeffrey Ballou, Mary Laschober, and Nyna Williams, Mathematica SUBJECT: Recommendations for Peer Groups for Total Care and Condition-Specific Care DATE: 9/21/2010 Overview and Summary of Recommendations This memo focuses on peer groups for hospitals. It also explains our considerations in determining peer groups for physician clinics/medical groups in the future. We present a set of options, discuss the relative advantages of each, and make a recommendation based on our judgment regarding which option represents the most methodologically sound approach. While this memo focuses on peer groups for hospitals, many of the issues raised here also apply to determining appropriate peer groups for physician clinics/medical groups. In making explicit comparisons among providers, it is important to ensure meaningful comparisons are being drawn. The Provider Peer Grouping Advisory Group recommended keeping all hospitals in a single peer group and all physician clinics/medical groups in a single peer group. Whether it is possible to build meaningful peer groups as inclusive as these hinges on our ability to adequately adjust for differences in severity of illness among patient populations and for differences in the types of services provided to patients. Guided by the principles that peer groups should be more rather than less inclusive for ease of consumer use and to promote high standards of care across all types of hospitals, we recommend grouping all hospitals other than critical access hospitals (CAHs) into a single peer group, with CAHs included in a separate peer group.1 We are not making a specific recommendation at this point with respect to peer groups for physician clinics/medical groups, but instead, outline our considerations in determining physician clinic peer groups in the future. 1 In year two, when more quality metrics are available for pediatric services, we may also consider peer grouping separately for pediatric and adult care. An Affirmative Action/Equal Opportunity Employer MEMO TO: Katie Burns FROM: Jeffrey Ballou, Mary Laschober, and Nyna Williams DATE: 9/21/2010 PAGE: 2 1. Should a Hospital’s Peer Group for the Total Care and Condition-Specific Measures Include All Other Hospitals or Only Other Hospitals of the Same Type? A single all-hospital peer group would be the most simple for consumers to understand and would place a clear focus on providing high quality care efficiently, regardless of facility type, while type-specific peer groups would result in more meaningful comparisons in the presence of imperfections (real or perceived) in the process of adjusting for differences related to severity and service mix. Relative Advantages of a Single Peer Group. Including all hospitals in the same peer group would make it easiest for consumers to compare hospitals. It would also emphasize the importance of delivering high quality care efficiently, regardless of facility type, and highlight any unwarranted variation in quality or resource use across hospital types. In addition, the large size of a single all-hospital peer group should increase the precision of the benchmarks. Relative Advantages of Type-Specific Peer Groups. Patterns of resource use might differ meaningfully across different types of hospitals—such as rural versus urban hospitals—for reasons unrelated to the efficiency of care delivery. If risk adjustment models cannot control adequately for important differences across hospitals in the populations treated, higher cost facilities might be incorrectly judged as inefficient when compared to all other hospitals. Moreover, comparing a facility to similar institutions might have greater face validity with hospital administrators who believe (correctly or not) that their patients’ cost or quality measures were not adequately risk-adjusted. Adjustments related to differing service mixes across facilities may also not adequately adjust for differences between rural and urban hospitals. Finally, legal restrictions for certain types of hospitals could also distort patterns of resource use in ways unrelated to the efficiency of care. For example, CAHs’ patterns of treatment and resource use will likely differ from those of other hospitals because of the length-of-stay restrictions on CAH acute care admissions. Also noteworthy is that participation in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is voluntary for Minnesota hospitals with fewer than 500 admissions per year. These smaller hospitals are most often CAHs. That many CAHs in Minnesota choose not to report these data is an additional argument for peer grouping CAHs and non-CAHs separately, provided that the number of CAHs is sufficiently large to accommodate the computation of reliable CAH-specific benchmarks. Recommendation: Because a primary objective of peer grouping hospitals is to encourage facilities of all types to provide high quality care, we recommend including all non-CAHs in a single peer group when evaluating performance for total care. Because CAHs are subject to length-of-stay restrictions and reimbursed differently from other acute care hospitals, their costs are likely to differ in meaningful ways from those of non-CAHs. In our opinion, adjustments related to severity of illness and service mix do not adequately account for fundamental differences between these types of hospitals. Consequently, we recommend that CAHs be included in a separate peer group for total care analyses. MEMO TO: Katie Burns FROM: Jeffrey Ballou, Mary Laschober, and Nyna Williams DATE: 9/21/2010 PAGE: 3 For the analyses of condition-specific care, CAHs would be compared with all other CAHs, (similarly for non-CAHs) for pneumonia. When analyzing total knee replacement, the peer group would consist of all orthopedists regardless of whether they are affiliated with a CAH or a nonCAH, with performance measured at the hospital level. Similarly, in the future, if there are other specific conditions for which care is provided in similar ways at all hospitals, we may consider including CAHs and non CAHs in the same peer group for these specific conditions. 2. Considerations in Determining Peer Groups for Physician Clinics/Medical Groups MDH and Mathematica are still determining whether the unit of analysis for the physician total care and specific condition analysis will be physician clinics or medical groups. Consistent with the Provider Peer Grouping Advisory Group’s recommendations, our goal is to peer group at the clinic rather than the medical group level, as information at this level is most informative to consumers. Whether or not we can peer group at the clinic level depends on whether available data can support this unit of analysis. Regardless of whether peer grouping occurs at the clinic or medical group level, it is also our goal to have as inclusive a peer group for physicians as possible. In order to have one peer group for physician clinics or medical groups, it will be necessary to adequately adjust for differences in severity of illness of patient populations as well as for differences in the types of services offered to patients. We will provide an update to stakeholders on this important issue after we have conducted some related analysis of the data. Summary In summary, we recommend that peer groups for hospital reporting include one peer group for CAHs and one peer group for all other non-pediatric hospitals. cc: Provider Peer Grouping Project Team