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Provider Peer Grouping

January 24, 2012

House Health & Human Services Reform Committee

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20 25 30 35 40 45 50 55 60 65 70$6,000

$6,500

$7,000

$7,500

$8,000

$8,500

$9,000

$9,500

$10,000

$10,500

$11,000

$11,500

WY

WV

WI

WA

VT

VA UT

TX

TN

SD

SC

RI

PA

OR

OK

OH

NY

NV

NM

NJ

NH

NE

ND

NC

MT

MS

MO

MN

MI

ME

MD

MA

LA

KY

KS

INIL

ID

IA

HI

GA

FL

DECT

CO

CAAZ

AR

AL

AK

Value Comparison by State (updated 11/11)

Overall Quality Meter (2010 - B)

Pric

e-A

djus

ted

Med

icar

e $/

Ben

(200

8-A

)

Nat'l Avg.

Sources: A - Dartmouth Inst. for Health Policy,B - 2010 NHQR State Snapshots

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MDH has made efforts to address some of providers’ concerns

MHA expected an open, stakeholder-driven process with transparent formula for PPG

MHA appreciates department’s responsiveness to flaws with initial report sent to hospitals• Incomplete data• Old data (2008-09)• Hospitals with low volumes had skewed scores• Misleading methodology that forced the appearance

of variation in qualityE.g., Hospital A had 99% and received 10 points

Hospital B had 96.3% and received 1 point

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MDH acknowledges that it is unable or unwilling to resolve some concerns

2010 data will be reported in 2013“Agedness of data is becoming an increasing liability to how well PPG can be actionable for consumers” MDH slide presentation, slide 24, Jan. 10, 2012

Hospitals’ performance on many quality measures is almost identical, yet MDH must force variation as PPG is currently designed

Risk adjustments fail to account for some significant differences between hospital services

Trauma Inpatient psychiatryMedical education Neonatal ICU

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State’s intended uses of PPG reportspresume usability, reliability

Public reporting (currently required by statute) Health plans must use PPG results for at least one of

their commercial products (currently required by statute)

Incorporate into Health Insurance Exchange website

Even though MDH acknowledgesthat PPG data are not actionable

by consumers

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MHA’s suggested solutions

Amend statute to … • Allow providers to verify the data used to measure

their cost of care and quality of care • Require any displayed differences in quality to be

based on statistically significant differences in scores on relevant measures

• Delay or remove requirement that health plans use PPG results in insurance plan design

• Establish a stakeholder board to oversee PPG process and ensure reliability of results before publication

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Alternative directions for Provider Peer Grouping

Make ongoing efforts reliable, usable & fair• Data must be accurate •Data must be more current• Providers need to be allowed to verify data MDH uses• Displayed differences in quality must be relevant and statistically significant

If PPG can’t be improved, do we need a different approach?

Take a different direction