Download Slides for May 9, 2011, conference call (PDF: 172KB/24 pages)

Provider Peer Grouping
Monthly Updates
May 9, 2011
Katie Burns
What is Provider Peer Grouping?
• A system for publicly comparing provider
performance on cost and quality
– …a uniform method of calculating providers' relative
cost of care, defined as a measure of health care
spending including resource use and unit prices, and
relative quality of care… (M.S.§62U.04, Subd. 2)
– a combined measure that incorporates both provider
risk-adjusted cost of care and quality of care…
(M.S.§62U.04, Subd. 3)
What Types of Provider Peer
Grouping Needs to be Developed?
1. Total Care
2. Care for Specific Conditions
The commissioner shall develop a peer grouping system
for providers based on a combined measure that
incorporates both provider risk-adjusted cost of care and
quality of care, and for specific conditions…
(M.S.§62U.04, Subd. 3)
Hospital Total Care Analysis
Attributing Hospital Admissions
• The first step in calculating the total care
cost measure for each hospital is
attribution of inpatient admissions
− This serves as the denominator for the cost per
admission measure
• Generally, attributed admissions consist of
all inpatient stays that occur at a hospital
over a defined time period
Treatment of Readmissions
• Hospital stays that occur at the same or
another hospital within 30 days after a
patient’s discharge are treated differently if
the patient is initially admitted due to:
– pneumonia
– congestive heart failure
– heart attack
– total knee replacement
Treatment of Readmissions
• An initial admission related to one of these
conditions and procedure is attributed
together with the first readmission
following it within 30 days of discharge
• The combined costs of the initial
admission and the first readmission are
assigned to the initial hospital
Categorizing Admissions
• All admissions for each hospital are
classified into one of three categories:
1) Initial admission for AMI, CHF, pneumonia, or total knee
replacement
2) First readmission within 30 days of discharge from an initial
admission
3) Admission for any other condition or procedure that is neither an
initial admission for AMI, CHF, pneumonia, or total knee
replacement nor a readmission for one of these three conditions
or one procedure
Hospital Admissions
• There were 434,148 admissions in
Minnesota during the measurement period
Hospital Admissions
By Payer Type
Distribution of Admissions
Sample
Size
All Hospitals
131
Number of
Discharges
434,148
Percentiles
Percentage
of Total
Number of
Discharges
Mean
100
3,314
10th
25th
50th
(Median)
75th
90th
154
310
889
2,893
11,102
Admissions that may Trigger
“Readmission” Attribution
Principle Diagnosis/Procedure
AMI, CHF,
pneumonia, or
total knee
replacement
All Admissions
AMI
CHF
Pneumonia
Total Knee
Replacement
Number of
Admissions
6,438
10,567
13,380
11,306
41,691
434,148
Percentage
of All
Admissions
1.5
2.4
3.1
2.6
9.6
100
Summary of
Admission Classifications
Initial Admissions
All Other
Admissions
AMI
CHF
Pneumonia
Total
Attributed
Admissions
First
Readmission
Total
Admissions
11,213
429,991
4,157
434,148
647
40,555
560
41,115
10,566
389,436
3,597
393,033
Total Knee
Replacement
All Hospitals
Number of
Admissions
391,897
5,254
9,259
12,368
CAHs
Number of
Admissions
35,532
187
1,472
2717
PPS Hospitals
Number of
Admissions
356,365
5,067
7,787
9,651
Calculating Cost Measures
• Two cost measures are calculated
– Actual costs (reflect resource use and unit price)
– Standardized costs (reflect resource use only)
• Cost per admission
− Calculated separately for CAH and
other hospitals and within payer type
Standardized Cost of Admission
• Hospital costs are standardized using AllPatient Refined-Diagnosis Related Groups
(APR-DRGs) and length of stay
• The standardized cost of an admission is
the cost per day of stays within a particular
DRG at a particular hospital type paid by a
particular payer type multiplied by length
of stay of that admission
Classifying Hospital Stays
• Each hospital stay is classified by payer
type and hospital type
• Each stay is then classified into an APRDRG and one of four severity levels for
each APR-DRG
–
–
–
–
1: minor
2: moderate
3: major
4: extreme severity of illness or risk of mortality
Calculating Actual and
Standardized Costs
• Standardized cost per day for each stay is
calculated as the sum of costs divided by
the sum of lengths of stay across all stays
within a DRG-severity cell for a hospital
type and payer type
Progress Update
Provider Report Design
• Mathematica will interview quality and
financial leadership from 12 hospitals in
late May
– Recruiting for participants to occur shortly
• Testing of physician clinic reports will
occur in the summer
Stakeholder Involvement
Stakeholder Involvement:
Rapid Response Team
• MDH convened this group to provide input on
critical issues
–
–
–
–
–
Approach for specific condition analysis
Methodology for attributing patients to providers
Benchmarking and determination of peer groups
Risk adjustment
Design and weighting of individual quality measures
into composite quality score
Stakeholder Involvement:
Reliability Workgroup
• MDH convened first meeting of this group
in December
– Explored characteristics of reliable data
– Discussed ways of assessing reliability
• Next meeting will focus on data and
options related to hospital analysis this
spring
For more information, see
www.health.state.mn.us/
healthreform/peer/index.html
Next call
Monday, June 13, 2011
7:30 am