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New report seeks to better understand the cost of care at Minnesota medical groups

New report seeks to better understand the cost of care at Minnesota medical groups

A new report from MN Community Measurement (MNCM) highlights the significant variation of costs across medical groups in Minnesota and examines the drivers that impact and influence health care costs.

“The continued rise of health care costs and the burden this places on families, businesses and the community makes it critical for medical groups and the community to work together,” said Jim Chase, MNCM President. “This is our endeavor in this new report.”

The 2016 Cost & Utilization Report features analysis and comparative data on medical group performance in Total Cost of Care (TCOC), which includes all costs associated with treating commercially-insured patients, including professional, facility inpatient and outpatient, pharmacy, lab, radiology, behavioral health and ancillary costs. MNCM posted total cost results in the fall on New in this report is information that breaks out the total cost into price and utilization.

This report shows the variation or difference in total cost by medical group. Further, the report shows how much of the variation was due to the amount medical groups were paid relative to others and how much was due to the utilization or use of services. The report also contains more detailed utilization measures such as the rate of admissions, emergency room visits, office visits and pharmacy use, using the same patients and time period as TCOC.

For example, the 2016 Cost & Utilization Report shows that depending on where you go for care:

  • A strep test can range from $8 to $101
  • Total Cost of Care can range from $365 to $914 per month on a risk adjusted basis
  • Amount of resource use for a patient ranges from 22 percent below average to 33percent above average, after accounting for patient risk
  • Emergency room use (utilization of ER as a health care service) ranges from 37 percent less than expected to 104 percent more than expected, after accounting for patient illness

A goal of the 2016 Cost & Utilization Report is to help medical groups better identify opportunities to reduce costs for their patients. The report helps evaluate the categories of care that are driving the majority of providers’ costs and the medical groups can then take actions to reduce their costs and provide more efficient care. The report helps consumers make informed decisions on where to receive care. Further, the report can be used by health plans, employers, and policy makers, all of whom have a stake in addressing the challenges of rising health care costs.

The 2016 Cost & Utilization Report includes a suite of measures which encompasses 119 separate measures of cost and utilization to give a comprehensive view of the drivers of health care costs.

The 2016 Cost & Utilization Report provides insight into individual procedure costs (Average Cost per Procedure chapter), statewide and regional views into total cost of care (TCOC chapter), along with newly published perspective on the resources used (Resource Use and Price Index chapter) and the utilization of health care (Utilization Ratios chapter). When possible, this report displays information on these measures statewide, regionally, and by medical group for ease of analysis.

Reviewed and considered as a whole or individually by chapter, these measures provide unique insight into tracking, comparing and taking actions to manage and reduce health care costs.

The results of these measures are based on 2015 health insurance claims of more than 1.5 million commercially-insured patients enrolled with four Minnesota health plans: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica and PreferredOne.

View the current, and previous MNCM cost of care reports here.


Become a MNCM Sponsoring Member Today

As your organization looks at its end of the year giving and the selects organizations to support and partners with, we hope you’ll keep MN Community Measurement (MNCM) in mind. By joining MNCM as a Sponsoring Member, your organization will help further the improvement of health through measurement and public reporting.

MNCM began with an idea to report on diabetes performance at a handful of medical groups and has transformed into the primary trusted source for health data sharing and measurement in Minnesota and nationally.

Accelerating the improvement of health and catalyzing our community requires foresight. In the coming year, MNCM will continue to convene key stakeholders to evaluate, discuss and achieve consensus on a variety of measurement and reporting initiatives on quality, cost, patient experience and health equity. At the same time, MNCM committee members, board members and staff are seeking additional alignment of national and local measurements.

Join MNCM today! Become a Sponsoring Member today.

Your annual contribution will support this critical work, as well as provide you with:

  • Notification of applicable board and committee openings
  • Opportunities to network with MNCM leaders and other members who are passionate about health and health care quality
  • Notification of measurement development workgroup participation and other feedback opportunities
  • Discounted rates on our annual one-day seminar
  • Recognition on and access to member-only webinars

With the help of Sponsoring Members like you, we will continue to bring individuals and organizations together to improve the health of our community.

And since MNCM is a 501(c)(3) non-profit, your organizations contribution may be tax deductible!

For more information, please contact Brian Strub at or 612-454-4827.


Planning for the Future: MACRA and MIPS

Today, MN Community Measurement (MNCM) assists the community with local reporting requirements as well as several federal requirements involving PQRS, meaningful use attestation and NCQA requirements.

One certainty for the New Year, is that MNCM will remain a trusted partner and will help providers meet their requirements. More to come in 2017, so stay tuned!

To learn more information about what is on the horizon for 2017, contact


Sign up Today – Make MNCM your PQRS Partner

MN Community Measurement has been – and continues to be – a trusted PQRS partner, ensuring seamless PQRS submissions for medical groups of a wide variety of sizes. Whether your medical group is returning or new to the process, contact MNCM today to discuss MNCM’s 2016-2017 Medicare Certified PQRS program.

Those who report satisfactorily for the 2016 program year will avoid the 2018 PQRS negative payment adjustment.

The submission period is fast approaching, with December kickoff meetings and January through February submission. Contact MNCM this month to get registered.

The Physician Quality Reporting System (PQRS) is a quality reporting program that encourages individual eligible professionals (EPs) and group practices to report information on the quality of care to Medicare.

Individual EPs and group practices who do not satisfactorily report data on quality measures for covered professional services are subject to a negative payment adjustment under PQRS. Note that program participation during a calendar year will affect payments after two years (i.e. 2016 program participation will affect 2018 payments). So act today.

The PQRS negative payment adjustment applies to all of the individual EP’s or PQRS group practice’s Part B covered professional services under the Medicare Physician Fee Schedule (MPFS).

Accordingly, individual EPs and group practices receiving a negative payment adjustment in 2016 (based on participation in 2014) will be paid 2.0 percent less than the MPFS amount for that service.

For 2017 and 2018 (based on participation in 2015 and 2016 program years), the negative payment adjustment is also 2.0 percent.

To learn more, and for those interested in participating in MNCM’s PQRS reporting program, please contact Tony Weldon at


MARC Approves Recommendation to Publicly Report HEDIS Measure – Comprehensive Diabetes Care: Eye Exam

In November 2016, MNCM’s Measurement and Reporting Committee (MARC) approved a recommendation to publicly report the Comprehensive Diabetes Care: Eye Exam HEDIS measure in the 2018 report year (2017 dates of service) to align with federal programs (e.g., MACRA, Star Ratings) and NCQA accreditation.

This is an example of MNCM’s work to actively align measures to meet the current and future requirements for both clinicians and health plans.

This HEDIS measure reports the percentage of patients 18-75 years of age who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal or dilated eye exam (no evidence of retinopathy) in the 12 month prior the measurement period. This measure is not well suited to provider data collection as eye exams are often performed outside of a medical group’s system. The data for this measure will come from health plan claims which provide a much more comprehensive picture than the medical record alone. Minnesota-based health plans will collect the data and submit it to MNCM for aggregation and reporting. To confirm, data for this measure will not be submitted by medical groups through the direct data submission process as part of the Optimal Diabetes Care measure.

Additionally, results will be privately reported to medical groups in the 2016 report year (2015 dates of service).

For more information, contact


MNCM Responds to Medical Group Survey Feedback

Each year, MN Community Measurement (MNCM) conducts a survey of our medical group stakeholders to gather feedback on the products and services we offer. In 2016, the survey was fielded in May. MNCM received responses from 132 medical groups, representing 48 percent of all registered groups.

Some of the medical group survey highlights include:

  • Two-thirds of respondents felt that MNCM measures were “well-aligned/aligned” locally and nationally
  • Nearly all respondents (94 percent) used MNCM measures in quality improvement initiatives
  • Medical group staff that interact most with MNCM (Data Analysts and Quality Improvement) rated MNCM customer service at 8.32 and 8.73 out of 10 points respectively. These customer service rates increased from 2015
  • On average, over 80 percent of respondents rated all MNCM data collection guides as “very helpful/helpful”

Medical groups were also able to provide open-ended comments. One theme emerged with medical groups indicating a strong interest in receiving registration and data collection guides sooner to help them better plan for upcoming data reporting. In addition, MNCM received multiple requests to open annual registration sooner as registration comes on the heels of Cycle A data reporting.

As a result, MNCM diligently updated all 11 data collection guides for 2017 by mid-November – this is on average 3-4 months earlier than last year. In addition, annual registration opened two weeks early (December 1).

MNCM sincerely appreciates the feedback received through the medical group survey and hopes that improvements made based on survey feedback enhance 2017 data reporting activities. Thank you to all who took the time to help improve this important effort.


MNCM Health Equity Advisory Council Begins Work

Massey & Trajano to lead new MNCM workgroup

A new advisory council comprised of community-based organizations and health care representatives convened their initial meeting on October 10.  The Health Equity Advisory Council (HEAC) is co-chaired by Gaye Massey, Chief Executive Officer at YWCA St. Paul and Dan Trajano, MD, of Blue Cross and Blue Shield of Minnesota. The council is charged with providing advice to the MNCM Board of Directors on health equity measurement and reporting.

“Health equity, like patient safety, is both necessary and urgent,” said advisory council member Julia Joseph-DiCaprio, MD.

At the October meeting, the group reviewed the Health Care Disparities Report, the MNCM Health Equity of Care Report, sociodemographic data currently collected by MNCM such as Race, Ethnicity, Language and Country of Origin as well as opportunities to align with other community-based health disparities efforts.

HEAC members include co-chairs Massey and Trajano, Tesha Alston, Jennifer DuPuis, Renee Frauendienst, Bentley Graves, Jamie Gulley, Lynn Hassan Jones, Andrea Hillerud, Julia Joseph-DiCaprio, Mariam Mohamed, Ekta Prakash, Jonathan M. Rose, Patricia Ruiz de Somocurcio, Michelle Waste, Pahoua Yang and Marie Zimmerman.

Future meetings will include discussions on ideas for new variables associated with disparities.


Jim Chase, President of MN Community Measurement to step down in 2017

Will continue to serve until successor is named

MN Community Measurement (MNCM) announced that Jim Chase, who has led the organization since it was launched in 2004, plans to step down in 2017. Chase has developed MNCM from a pioneering startup to a nationally recognized model for public reporting on health care quality and cost. He will continue to lead the organization until the Board of Directors appoints a new president.

“After more than a decade of service, Jim has advised the board that it is the right time for him to pass the reins to a new leader,” said Tim Hernandez, MNCM board chair. “We are grateful for his vision in improving the quality of care in our state and we are confident that his successor will have a strong foundation on which to build.”

MNCM started as a pilot project in 2003. That year, it became the first in the nation to use electronic medical records to begin collecting and publicly reporting on health care quality from clinics across the state. In 2004, it released its first quality report. It provided information about care in areas such as asthma, diabetes, breast and cervical cancer and well child visits.

“MNCM has a solid foundation to continue to lead towards better value in health care especially as Medicare and other organizations move towards greater transparency around quality and cost,” said Chase.

MNCM has developed more than 70 measures, collects information about quality and patient experience and reports results from more than 1,500 clinics, 500 medical groups and 135 hospitals on MNCM’s public reporting website

Under Chase’s leadership, other accomplishments for MNCM include:

  • National endorsement. The National Quality Forum (NQF), considered the gold standard for health care measurement in the United States, endorsed nine MNCM measures for conditions including knee replacement, spine surgery and care for diabetes, depression, asthma and heart and arteries.
  • Adopted by Medicare. The Centers for Medicaid and Medicare Services has adopted MNCM measures for diabetes and depression to be used nationwide.
  • Cost of Care. MNCM launched the nation’s first statewide public reporting of a total cost of care measure by medical group. The measure is endorsed by the NQF and is now being used by organizations in 35 states.
  • Health disparities. The MNCM Health Care Disparities Report measures care for patients with commercial insurance compared to patients enrolled in government programs.
  • Health equity. The MNCM Health Equity of Care Report has information about the care for patients based on race, ethnicity, preferred language and country of origin.
  • Physician ratings. Consumer Reports magazine published MNCM physician group ratings in 2013 and 2016.
  • Transparency. The Health Care Incentives Improvement Institute gave MNCM an A rating for transparency.
  • Screening for teens. MNCM was among the first in the nation to report clinic data on screening for obesity and depression in teens.
  • Patient experience. MNCM launched and publicly reported the largest survey of patient experience by clinic.

The board is conducting a national search for Chase’s successor and has convened a search committee. Applications will be accepted until the position is filled. Interested candidates should send a letter of introduction and a resume to the selection committee via email to or by mail to Jamie Stevenson, Human Resources Department, P.O. Box 52, Minneapolis, MN. 55440-0052.


Depression Measure Changes Proposed at MARC Meeting

In October, MNCM’s Measurement and Reporting Committee (MARC) approved recommendations for redesign of the depression measures. The consideration for redesign is in response to use of the measures in federal programs, a desire to include adolescents and a recent adaptation of the measures for use in the National Committee for Quality Assurance’s (NCQA) Healthcare Efectivness Data and Information Set (HEDIS) program.

The depression measure development workgroup, led by Michael Trangle from HealthPartners, included provider representation from primary care, pediatrics, adult and adolescent psychiatry. The scope of redesign consideration focused on the inclusion of adolescents, expansion of the window for follow-up, consideration of additional patient reported outcome (PRO) tools, and a review of appropriate exclusions.

Incorporate adolescents into the depression measures and expand the follow-up assessment window

After a through discussion on the relevance of measuring depression outcomes for adolescents, the workgroup reached consensus that it was important to include adolescents in the measurement of depression outcomes. Further, the recommendation would modify the age range to include adolescents age 12 and older and report measures as two separate stratifications by age (not combined) into ages 12 to 17 and ages 18 and older.

The workgroup also reviewed the concept of expanding the window for follow-up among adolescents, in part, due to the challenges in following up with adolescent patients. In the end, the workgroup acknowledged that follow-up is challenging for adults as well and determined it is reasonable to expand the follow-up assessment window for all patients. The follow-up assessment window will be expanded to +/- 60 days for all patients and all outcome measures.

Additional Patient Reported Outcome tools reviewed

MNCM is frequently asked “Why just the PHQ-9 tool?” In response, the workgroup considered 21 Patient Reported Outcome (PRO) tools. Information on each was collected using standardized criteria and compiled for review. Many tools did not have the required cut-points for remission or scoring levels that address severity of depression symptoms. Many of the tools listed were acceptable for screening for potential depression but did not support the diagnosis of depression or measuring progress of symptoms (outcomes) over time. Ultimately, the workgroup reached consensus on adding only the PHQ-9M tool.

The workgroup decided to allow the use of both tools (PHQ-9 and PHQ-9M) and not restrict tool use by age. They believed it was best to leave the decision up to the medical groups in terms of which tool best fits their practice (e.g., a pediatric practice could use the PHQ-9M for all their patients including “older” patients and a family practice clinic could use the PHQ-9 for all their patients ages 12 and older).

MARC also approved modifications to exclusions.

In order to minimize disruption, allow time for medical groups to make changes and to permit future comparability of performance over time, MARC approved the workgroup’s recommendations in their entirety for 2018 dates of index reported in 2020 (i.e., for 2020 Report Year dates of index event January 1, 2018 to December 31, 2018).

Feedback about these changes will be accepted at until Friday, December 9, 2016.

For more information, see the summary document link, or contact


New Data Shows MN Hospitals On Par With, Or Better Than, National Averages

MN Community Measurement (MNCM) today announced the availability of new results for five hospital-based health care quality measures. This information can be used to compare hospitals within Minnesota with state and national averages. The results are available at MNCM’s public reporting website

“These measures are relevant for patients seeking health care and also have value for hospitals as they strive to improve their quality of care,” said Jim Chase, MNCM President. “Hospitals have been submitting outcome data for years, and it’s important to draw attention to what they are reporting and to put it into context for patients.”

Three of the measures are based on mortality or death rates that occur within 30 days following hospitalizations for heart attack (acute myocardial infarction), heart failure and pneumonia. For these measures, lower rates of death are better. On all three measures, the statewide average was the same or lower than the national average. These results show that Minnesota hospitals had average or better than average performance compared to hospitals in other parts of the nation.

National Average/Minnesota Average

Heart attack      14.1%/13.5%
Heart failure      12.1%/12.1%
Pneumonia         16.3%/15.9%

For the heart attack measure, Mayo Clinic Hospital in Rochester performed significantly better (lower), at 11.6 percent, than the national average of 14.1 percent. Mayo Clinic Hospital was the only Minnesota hospital different than the national average. All other Minnesota hospitals were similar to the national average for the heart attack measure.

For the heart failure measure, Mayo Clinic Hospital in Rochester performed significantly better (lower), at 9.4 percent, than the national average of 12.1 percent. Mayo Clinic Hospital was the only Minnesota hospital different than the national average. All other Minnesota hospitals were similar to the national average for the heart failure measure.

For the pneumonia measure, Park Nicollet Methodist Hospital (13 percent) and Mayo Clinic Hospital (12.3 percent) performed significantly better (lower) than the national average of 16.3 percent. Park Nicollet Methodist Hospital and Mayo Clinic Hospital were the only two Minnesota hospitals different than the national average. All other Minnesota hospitals were similar to the national average for the pneumonia measure.

The remaining two measures are composites, meaning they combine two or more components of care and wrap them into one comparable result. This is a common way health care is analyzed nationally and in Minnesota.

Readmission Reduction Program (RRP) results
The RRP measure is a hospital’s readmission ratio. The goal is to avoid readmissions for the same condition within 30 days of discharge from the hospital. Two examples include pneumonia and Chronic Obstructive Pulmonary Disease. A ratio of less than 1.0 means there were fewer readmissions across conditions than the national average. A ratio greater than 1.0 means there were more readmissions than the national average. For this measure, lower readmission ratios are better.

The statewide readmission average is .97 or 3 percent below the national average. Four hospitals performed significantly better than the statewide average in readmissions: Mayo Clinic Hospital in Rochester, Lakeview Memorial Hospital in Stillwater, Mayo Clinic Health System in Mankato and HealthEast Woodwinds Hospital in Woodbury.

Emergency Department Transfer Communication (EDTC) results
One element of hospital quality can be seen in how hospitals communicate when transferring patients. The EDTC measure was developed to track communications and facilitate care coordination. It measures the percentage of patients with complete medical record documentation communicated to another healthcare facility prior to the patient being transferred. For this measure, higher results are better.

One hospital, Essentia Health in Fosston, scored 100 percent on this measure. The statewide EDTC average was 62 percent. This means that 62 percent of patients transferred from hospital emergency departments to another health care facility had the required documentation forwarded within 60 minutes of leaving the hospital.

Thirteen Minnesota hospitals performed significantly better than the statewide EDTC average, including: Bigfork Valley Hospital in Bigfork, CentraCare Health in Sauk Centre, CHI St Gabriel’s Health in Little Falls, CHI St Joseph’s Health in Park Rapids, Cuyuna Regional Medical Center in Crosby, Essentia Health in Fosston, Mayo Clinic Health System in Cannon Falls, Pipestone County Medical Center in Pipestone, Redwood Area Hospital in Redwood Falls, Riverwood Healthcare Center in Aitkin, Sanford Jackson Medical Center, Sanford Tracy Medical Center and Windom Area Hospital in Windom.

Hospital-based health care quality measures are available at MNCM’s public reporting website


MARC Recommends Modifications to Colorectal Cancer Screening Measure, Changes Set to Begin Soon

The Measurement and Reporting Committee (MARC) of MN Community Measurement in October approved a recommendation to align with recently released guidelines and the HEDIS Colorectal Cancer Screening measure. The proposed changes are set to begin report year 2017, for 2016 dates of service.

Dating back to 2006, MNCM has publicly reported a colorectal cancer screening measure. In 2010, MNCM converted this measure to our Direct Data Submission (DDS) process which enabled clinic level reporting. The measure continued to be adapted from the National Committee for Quality Assurance’s (NCQA’s) HEDIS Colorectal Cancer Screening measure, however, with recent changes in guidelines for colorectal screening a few technical changes were required.

In addition to the current numerator screening options (colonoscopy every 10 years, flexible sigmoidoscopy every five years, or fecal occult blood test annually), MARC recommended two additions to achieve alignment with the HEDIS Colorectal Cancer Screening measure for the 2017 report year: A) CT Colonography during the measurement year or the four years prior to the measurement year; and B) FIT-DNA test (e.g. Cologuard®) during the measurement year or the two years prior to the measurement year. Additionally, MARC recommends removal of CT Colonography as an allowable exclusion.

NCQA released their final specifications on October 3, 2016, which added the two aforementioned screening methods to the HEDIS Colorectal Cancer Screening measure and clarified that there are two types of FOBT tests: guaiac (gFOBT) and immunochemical (FIT).

For more information, contact


Cost of health care in area on rise

[As seen in the Mankato Free Press] By Brian Arola,, Oct 12, 2016

MANKATO — Medical care costs for insured patients in Minnesota rose by more than 5 percent last year, according to new data analysis.

The 5.6 increase in medical costs statewide is the biggest since the MN Community Measurement nonprofit started releasing cost of care data for medical groups two years ago.

The nonprofit measures costs by tallying insurance claims made by the more than 1.5 million patients enrolled in the four health plans available in Minnesota last year.

On top of being a larger increase than the 3.2 percent one highlighted in last year’s report, the uptick also far outpaces income increases for Minnesotans over the same time period.

Jim Chase, president of MN Community Measurement, said that’s a concern for families trying to keep up with medical costs.

“That’s worrisome when you think of how much pressure there is on families,” he said.

Higher costs in Greater Minnesota, where there are fewer options available to patients, are also a problem, he said.

The cost of care for insured patients at the medical groups included in the report ranged from $365 to $914 per month. Area medical facilities fell in the middle of the two marks. Mayo Clinic Health System in Mankato came in at $534 per month, a 2.9 percent increase from the previous year. Mayo facilities in St. James, Waseca and New Prague all came in lower per month — New Prague, at $461 per patient, being the lowest.

In a statement, Mayo Clinic Health System spokesman Micah Dorfner said measuring costs for care at destination centers such as Mayo Clinic can be complicated. While the clinic supports efforts to transparently measure costs for care, distinctions should be made in the data to reflect the difference between complex care and community care. As a health system, Dorfner said steps are being taken to mitigate costs.

“Mayo Clinic Health System continues to take significant steps to manage cost of care, including improving access, reducing costs and increasing transparency,” he said.

Mankato Clinic saw a larger increase in cost of care than the Mankato Mayo over the past year — 11.7 percent — but still had a lower overall cost at $490.

The increase from year to year could be explained by a variety of factors, said Randy Farrow, CEO of Mankato Clinic. Pharmacy costs, an unusual number of major medical procedures in a given year, or more visits associated with preventive care could all lead to higher costs for care, he said.

Of the factors the clinic can control, Farrow said it’s typical to have about a 2 to 3 percent increase in costs per year, mostly to make up for inflation and wage increases.

Pharmacy costs were one of the factors Farrow said the clinics don’t control — apart from their willingness to prescribe generic drugs — but they could still be attributed to the clinic in insurance claims. At a 9.3 percent increase, take-home pharmacy costs were the services with the largest increase from last year.

In an unintentional way, preventive care could also be a driver of increased costs. Farrow said if clinics are encouraging patients to be proactive with their health, it could lead to more visits to the clinic in a given year. More visits equal higher costs for care, although the short-term expense should be eclipsed by cost savings related to maintaining a healthier lifestyle in the following years.

Whatever the cause of the increases, Farrow said the transparent cost for care measures are good from both a patient and medical group perspective.

“It’s good to start having people see this data and be more transparent,” he said. “I think it’s going to make us all better and more competitive because we know price is an issue.”

The issue isn’t expected to go away next year either, Chase said. Premium hikes for individual insurance plans announced recently could foretell a similar increase in cost of care next year.

“I’m guessing we’ll see continued acceleration of health care costs, and that’s worrisome,” he said.
Follow Brian Arola @BrianArolaMFP.