Health Care Management Links
Provider Peer Grouping Recommendations
Upon passing the 2008 Health Care Reform law, the Provider Peer Grouping Advisory Group was created to provide advice and recommendations on how to appropriately compare providers on a combined measure of risk-adjusted cost and quality for a provider’s patient population as a whole, and separately for select specific health conditions. Based on the work of the Advisory Group (appointed by the Commissioner of Health), a report has been compiled of their recommendations. This report is attached for your use and review.
In summary, the Advisory Group recommends the following six specific conditions for peer grouping in 2010: diabetes, coronary artery disease, pneumonia, asthma, congestive heart failure, and total knee replacement. These conditions were selected because they impact a cross section of patient and payer populations, they have high variability in cost among providers, they address both chronic and acute conditions, and include a major hospital component and/or a major specialty physician component.
The Advisory Group had its greatest struggles discussing how cost and quality should be
combined into a single value measure due to the majority of the members’ disagreement with
the principle of the task. The Advisory Group offers recommended attributes for a methodology
to translate value into a single score, but prefers displaying the components of value separately and letting users determine where value lays for them.
The Advisory Group reviewed alternatives and made recommendations on the nine core methodological issues as outlined in Minnesota Statutes 62U.04:
- Provider attribution of costs and quality
- Appropriate adjustment for outlier or catastrophic cases
- Appropriate risk adjustment to reflect differences in the demographics and health status across provider patient populations, using generally accepted and transparent risk adjustment methodologies
- Specific types of providers that should be included in the calculation
- Specific types of services that should be included in the calculation
- Appropriate adjustment for variation in payment rates
- Appropriate provider level for analysis
- Payer mix adjustments, including variation across providers in the percentage of revenue received from government programs
- Other factors that the commissioner determines are needed to ensure validity and comparability of the analysis
Finally, the Advisory Group strongly recommends the Commissioner and the Legislature expand the encounter and pricing database for uses beyond provider peer grouping. During the Advisory Group’s discussions, it became apparent how valuable and informative the database could be in helping Minnesota better understand its population’s health care use. Minnesota will now possess a unique source of information that can help inform multiple State departments, agencies, researchers, and enable the Legislature make better policy decisions and help Minnesota achieve its Health Reform goals.
Click here for the report.
Kathy Bryant’s Top Four Challenges in Beckers ASC Online:
| ASC Association | The ASC Association is a nonprofit association representing the interests of ambulatory surgery centers (ASCs) throughout the nation. It represents all aspects of the industry including the physicians, nurses, administrative staff, and owners.
| The Joint Commission |
| The Dartmouth Atlas of Health Care |
| Center for Studying Health System Change |
| American Academy of Orthopedic Surgeons |
| American Podiatric Medical Association |
| Association of periOperative Registered Nurses |
| Association of American Physicians and Surgeons |
| Physician Hospitals of America |
| Association for Professionals in Infection Control & Epidemiology |
| American Medical Association |
| Accreditation Association for Ambulatory Health Care |
| American Association for Accreditation of Ambulatory Surgery Facilities |
l Medicare National 2009 ASC Rates and HOPD Rates l