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Medical Professionalism and the Future of Public Trust in Physicians

Viewpoint by Noam N. Levey, The Journal of the American Medical Association
May 12, 2015

The medical profession in the United States, by some measures, has much to be pleased about. Public confidence in the honesty and ethical standards of physicians has remained high for decades, even as other professions, including bankers, the clergy, and members of Congress, have endured a steady erosion in public trust. Even though physicians may not enjoy the exalted, even unquestioned, position they did in the middle of the last century, they remain among the most trusted professionals in the United States.

As major changes reverberate through the US health care system, however, the trust that patients have historically placed in clinicians is being challenged. A revolution in transparency in medicine is making an unprecedented amount of information available to the public, potentially undermining confidence in the profession. At the same time, the public is growing increasingly anxious about the broader health care system as increasing costs erode workers’ stagnating wages. Patients also are seeking to be more engaged in their own medical care, including how they confront the end of life, a subject that poses special challenges for the medical profession.

Together, these changes may transform expectations of physicians’ qualifications and affect how the public views organized medicine in general. That raises the stakes in the current debate over the medical profession’s systems of self-governance.

Few developments may be more transformative than the advent in recent years of new data and new federal disclosure requirements. Patients—as well as journalists, politicians and health care purchasers—can now obtain and analyze information about physicians’ billing practices, their ties to other entities in the health care industry, and the outcomes they achieve for patients in their care. This is subjecting the medical profession to a level of scrutiny that was once unimaginable.

For example, the 2014 release of Medicare physician payment data spawned multiple media reports identifying the nation’s top billers and prompted new questions about the kind of care physicians are providing. This has contributed to increased public concern about how much medical professionals and health care organizations of all kinds charge for the delivery of health care services. These data are also fueling demands that the famously opaque US health care system provide consumers with more meaningful information about how to select medical services and practitioners.

The work of investigative news organizations such as ProPublica with data on payments from the pharmaceutical and medical device industries to physicians has also focused attention on potential conflicts of interest in medicine. In the past several years, newspapers around the country have reported often unflattering stories about individual physicians in their communities.

Meanwhile, an increasing number of regional quality organizations, such as Minnesota Community Measurement and Maine Quality Counts, are collecting and posting outcome measures for local medical practices. Augmenting these data, new government and private sector payment systems such as the Medicare Shared Savings Program, although still imperfect, are publicly identifying and rewarding physicians and health care organizations that meet quality targets. These systems will increasingly allow patients to see which clinicians are lagging on key indicators.

How the public uses the new data and what precise effect the information will have remain unclear. To be sure, research suggests that even patients with chronic illnesses have limited awareness about publicly available physician quality information.

However, patients are learning more about their physicians at a time when their faith in the broader health care system and those who lead it is not high. In a recent nationwide poll of 1027 adults, just one-third of respondents expressed confidence in the US medical system, far behind other institutions, including the military, small business, and the police. Moreover, unlike residents of other industrialized nations, those in the United States are highly skeptical of the leaders of the US medical profession, a phenomenon that some researchers attribute to the perception that organized medicine has been more focused on protecting its own interests rather than working to advance broader public health goals.

Layered on top of this is a burgeoning public conversation about a disconnect between patients’ expectations for their medical care and what the health care system is configured to provide. Growing out of a decades-old consumer movement, this discussion in some sense is not new. However, the focus on some of the more complex health-related topics, such as death and dying, has raised new questions about how well the medical profession is prepared to meet patients’ desires and needs.

These may be difficult topics for individual physicians and for organized medicine to address, but the recent proliferation of articles and books on end-of-life care and dying well suggests that the public is eager to delve further into these subjects. Gawande’s moving new book about mortality, which, among other topics, explores medicine’s struggles to confront issues surrounding aging and death, has been on best-seller lists for weeks.

The medical profession has weathered other major shifts in the US health care system. Indeed, the revolution in managed care of the 1990s, which threatened to further undermine public trust in physicians, arguably had the opposite effect. Confidence in physicians, which had been slipping, stabilized as patients focused their dissatisfaction on insurers.

Today, patients may once again look to physicians as a trusted source and harbor amid the turmoil in the broader health care system, including narrowing insurance networks and rising cost-sharing requirements for consumers, as well as the ongoing political and legal battles over the Affordable Care Act. The medical profession could also emerge stronger as a result of many of the current challenges and ongoing changes in health care. Greater transparency, although threatening to some, improves performance, potentially boosting public confidence. More patient engagement should deepen the relationships between physicians and the people they care for, ultimately fortifying public trust in the medical profession.

Physicians ignore the forces shaping public expectations at their peril, however. While Americans may retain confidence in their own physicians, affording the profession some protection from threats to physicians’ credibility and authority, the shield may not be impenetrable. A national survey of 1508 adults about their views on medical care revealed some potentially troubling findings for physicians. Most survey respondents reported that physicians do not spend enough time with patients. Most respondents do not consider physician fees reasonable. Even fewer believe that physicians are trying to hold down the cost of medical care. Perhaps most relevant for the current debate over self-governance is that nearly 1 in 4 survey respondents disagreed with the statement “Doctors are usually up to date on the latest advances in medicine.”

Perhaps a new system for recertifying physicians will restore some patients’ trust, although the effect may be small. Arcane procedures by professional societies that few have heard of seem unlikely to fundamentally move public opinion. Most patients would rightfully assume that organized medicine at a bare minimum had adequate protocols for self-regulation.

More consequential may be the behavior of physicians and their willingness to adapt to the changes under way in the US health care system. Patients across the country are experiencing new models of care that are more coordinated, more transparent, more responsive, and more personal. The best of these systems not only deliver better results, they make patients happier, as anyone who has seen them can attest. If physicians are viewed as standing in the way of these models, they risk the trust the profession has worked so hard to earn.

Read the original viewpoint at The Journal of the American Medical Association.

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Providers: Data helps patients be good consumers

By Nate Gotlieb, Mankato Free Press
Saturday, April 18, 2015

Local medical leaders appear to support the publication of health data, noting how it creates a level of transparency for patients.

“It really creates an element of accessibility which historically health care hasn’t had to do,” said Dr. Steve Campbell, chief quality officer of Mayo Clinic Health System Southwest Minnesota Region.

The site MNHealthScores.org ranks medical providers statewide on a variety of measures, with all the data publicly available. The site includes data on clinics, medical groups and hospitals, not individual doctors.

Dr. Julie Gerndt, chief medical officer for the Mankato Clinic, cautioned consumers from using the site to compare individual clinics, noting they won’t be able to draw accurate conclusions because of the small sample size. Medical group data provide a more accurate picture of the Mankato Clinic, she said.

Campbell said Minnesota should be proud of developing a culture of health care improvement. He said the scores are a reasonable tool for consumers if they want to look at health care providers based on metrics.

The electronic world is relatively new for health care, he said, noting that health care has historically been more reactive than proactive. He also said health care is shifting from a volume-based system to a value-based system and that future insurance reimbursements are going to be based on quality measures.

“It’s a different paradigm and one that is not without challenges,” he said. “(But) it’s still about providing the best care you can every day.”

Dr. Dan Holmberg of New Ulm Medical Center said this information motivates providers to work harder and try to improve. Allina uses data to compare clinics internally, he said, while the HealthScores help the center compare to its regional peers.

He said patients will get a better sense of being a consumer in the health care market over time.

“We don’t want our quality to be a mystery,” he said. “We want people to see the things we’re doing.”

Read the original article in the Mankato Free Press.

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Minnesota is leading the movement to reduce overtreatment and make health care more affordable

Minnesota is leading the movement to reduce overtreatment and make health care more affordable

By Sanne Magnan and Jim Chase | 06:00 am

A recent MinnPost article by Susan Perry shared excerpts from an article by Shannon Brownlee from the Lown Institute. In “Over-treated: Why Too Much Medicine Is Making Us Sicker and Poorer,” Brownlee delivered three main points: 1) only a few “lone ranger” doctors are working against a powerful medical complex that keeps delivering treatments patients don’t need; 2) these doctors can’t “buck” this aspect of modern medicine because of factors such as pharmaceutical marketing, fear of lawsuits, misguided patients, and lack of knowledge about medical evidence; and 3) reducing medical overtreatment will require large-scale political mobilization.

We applaud Brownlee for shining a light on the fact that many of our nation’s health-care systems have for too long overdiagnosed and overtreated patients, contributing to inappropriate care and waste we cannot afford. We as a nation — both the health-care system and citizens — have the flawed belief that more care is always better care, and that more expensive care provides even better care.

However, we disagree with the conclusions that only lone rangers are working on this issue and are unable to change the system. Minnesota is leading the movement to reduce overtreatment and make care more affordable.

No lone-ranger effort

The Institute for Clinical Systems Improvement (ICSI), a nonprofit health-care-improvement organization, and MN Community Measurement (MNCM), a nonprofit health-care measurement organization that publicly reports cost, quality and patient experience results, have been working with medical groups, hospitals and nonprofit health plans in Minnesota to deliver high-quality, appropriate care for years. This is not a lone-ranger effort; ICSI is composed of more than 50 medical groups representing 8,000 doctors, and MNCM reports on more than 300 medical groups, 1,600 clinics and 140 hospitals.

Through collaborative efforts, medical groups, health plans, patients and other stakeholders are focused on achieving the triple aim of better care, better health and lower costs. Some recent examples include:

  • Medical groups and health plans collaborated to embed evidence-based criteria into electronic health record systems to ensure appropriate diagnostic imaging scans were ordered. This saved an estimated $234 million, prevented an estimated 100 cancers from unnecessary X-rays and improved patient experience.
  • The RARE (Reducing Avoidable Readmissions Effectively) Campaign, led by ICSI, the Minnesota Hospital Association and Stratis Health, engaged 86 hospitals and 104 community partners to prevent 7,975 avoidable hospital readmissions. This saved an estimated $110 million and allowed Minnesotans to spend an estimated 31,900 more nights sleeping in their beds rather than in hospitals.
  • MNCM recently released the nation’s first publicly reported, statewide Total Cost of Care results for medical groups. By gathering all costs for treating patients — professional, inpatient, outpatient, pharmacy, lab, radiology and more — into an average monthly patient cost, consumers can now for the first time compare costs of care across 115 Minnesota medical groups, representing 1,052 clinics. Medical groups are using the information to evaluate how to provide more high-quality, cost-effective care.
  • ICSI, the Minnesota Medical Association, and the Minnesota Health Action Group are raising awareness statewide of the national Choosing Wisely campaign, which seeks to foster meaningful conversations between doctors and patients on care that is appropriate.

We agree wholeheartedly with Brownlee’s call to reduce medical overtreatment. Current health-care costs are unsustainable, especially since the health-care system alone only contributes to 20 percent of the population’s health. If we are overspending on health care, we take money away from education, employment and the environment — other factors that contribute more to our population’s health than doctors and clinics.

We also agree a large-scale mobilization is needed to reduce medical overtreatment. But it doesn’t have to be solely political — the work locally proves it.

New products, systems and efforts

Sanne Magnan, Jim Chase

Sanne Magnan, Jim Chase

We all have to mobilize — the health-care industry, our communities, and we as individuals. Politically this is being recognized through federally funded initiatives to develop and test health-care payment and care delivery models that will improve performance, increase the quality of care and decrease costs. Minnesota nonprofit health plans are designing new insurance products and payment systems that reward value, not just volume. Mobilization is also being encouraged through grant-funded efforts. ICSI is leading the Robert Wood Johnson Foundation (RWJF) funded initiative “Going Beyond Clinical Walls” to help bring clinicians together with community leaders and resources to provide better care and lower costs; a MNCM-led, RWJF-funded effort is helping consumers better understand and access information on the quality of healthcare provided by local physicians.

A better health-care system can emerge from existing strategies. We’re doing it here through strong community and health-care partnerships, and the willingness of diverse stakeholders to tackle complex issues that no entity can solve alone. There is still considerable work to be done, but Minnesota is a leader.

Sanne Magnan, M.D., Ph.D., is the president and CEO of the Institute for Clinical Systems Improvement. Jim Chase, M.H.A., is the president of MN Community Measurement. Learn more at ICSI.org and MNCM.org.

Visit MinnPost to read the original Community Voices commentary>>

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Picking the best?

How physicians get named to those top-doctor lists

BY SUZY FRISCHMNMonthly, Minnesota Medicine MARCH 2015

Who doesn’t like a thumbs-up for their work every now and then? For Clare Kearns McCarthy, MD, getting named to a local list of top doctors provides welcome validation that other physicians value her skills as an orthopedic surgeon. McCarthy says the lists can be helpful to patients and other physicians. Patients see making the list like getting a Good Housekeeping Seal of Approval.

“Patients like to see that you’re on the list. It’s a conversation starting point, and they are satisfied knowing their doctor is recognized. They are seeing someone who others trust as well,” says
McCarthy, a hand and upperextremity surgeon for Twin Cities Orthopedics in Edina who has appeared on MPLS.St.Paul Magazine’s list seven times and Minnesota Monthly’s three times. She also believes being on the lists may be helpful for physicians who need to refer patients. “It gives them a level of confidence when someone is on the list.”

There are numerous benefits to being named to a best-doctors list, say those who get cited. Physicians whose names appear on them often get props from their patients and other medical professionals. It also shines a light on their abilities, says Pamela Gigi Chawla, MD, a pediatrician and pediatric hospitalist at Children’s Hospitals and Clinics of Minnesota and senior medical
director of primary care.

Chawla, who has been honored by MPLS.St.Paul Magazine and Minnesota Monthly more than a dozen times, says Children’s receives a surge of calls from potential patients who want to see their doctors after the annual lists come out. “I don’t think people really look at this and say that this is about me,” she says. “It’s more about highlighting my institution and all the people who make what I do even possible.”

Peter Sershon, MD, chief of surgery at United Hospital and a urologic surgeon with Metro Urology in St. Paul, graced the cover of MPLS.St.Paul Magazine’s Top Doctors issue in 2013. He sees another benefit to the lists: They raise awareness about health and medical services. MPLS. St.Paul Magazine included an article about the robotic surgery program Sershon runs at United in conjunction with its Top Doctors list. He believes such attention might make screening for prostate cancer top of mind. “If this leads to more men with aggressive prostate cancer being diagnosed
early because they read something about it and got checked—even if it’s one guy—then it’s worth it,” he says.

Behind the scenes

Minnesota Monthly started publishing its Best Doctors list about a decade ago, and MPLS.St.Paul Magazine has done Top Doctors lists for nearly 20 years. The issues in which those features appear happen to be some of the magazines’ best-sellers.

So how do doctors get named to these lists? MPLS.St.Paul Magazine outsourced its research a few years back to Key Professional Media, which publishes “Super Doctors” and “Super Dentists” lists in national magazines. To generate nominations each year, it sends paper ballots to 5,000 licensed metro-area physicians and registered nurses asking them for names of one or more doctors they or a loved one have seen or would go to for care. The firm also emails all area physicians asking for nominations. This year, MPLS.St.Paul Magazine received 1,386 nominations.

In addition, the company does its own research. Staff members tap health-related government websites, volunteer and humanitarian organizations, universities, hospitals, medical societies and other professional organizations to add names to the list of nominees, including those of doctors who might work in smaller clinics or highly specialized areas. “There are numerous resources we use,” says research director Becky Kittelson.

The research team then evaluates candidates based on years of experience, fellowships, leadership positions, hospital appointments, academic achievements and positions, professional activities, board certifications, publications and lectures, and other honors, awards and achievements. The top-scoring doctors are named to a blue ribbon panel. Those physicians are asked to provide feedback on the nominees as well as other potential candidates from their specialty. Then the number crunching begins, taking into account all the points each candidate receives during the process, Kittelson says. From this, they generate the final list, which typically includes between 5 and 8 percent of local doctors.

“The rigor of our process is pretty astonishing,” says Deb Hopp, publisher of MPLS.St.Paul Magazine. She notes that rankings of other professionals are often done by those who use their services. “Our Top Doctors list has always been rankings by expert peers.”

For the magazine, the work is worth it, as newsstand sales for the Top Doctors issue are 30 to 40 percent over that of other issues, says Hopp. “It’s huge,” she adds. “People rely on it, and I think
doctors are extremely proud to be on it. They’ve come to understand how carefully the research is done, and it’s repeated every year.” The magazine also gives clinics and health systems a plaque honoring the physicians named to the list and the opportunity to buy congratulatory ads in that issue.

Minnesota Monthly has a similar process. It obtains the names of all physicians with active licenses in the 11-county metro area, plus Olmsted County to capture Mayo Clinic. Previously, the magazine sent those physicians postcards requesting nominations, but this year it hired Michigan-based Professional Research Services to administer the process. Now that company emails a group of approximately 10,000 doctors asking them to nominate physicians in about 30 specialty and subspecialty categories, says Editor Rachel Hutton.

It’s only a popularity contest if that’s the way doctors are voting.
– Rachel Hutton

During a three-week period, those doctors can log onto a website and vote for up to three physicians per specialty. Hutton says the response rate varies from year to year, but they get a representative sampling. The research firm then determines the number of votes doctors need before they are named to the list. That threshold can vary slightly each year, depending on the number of responses.

Minnesota Monthly’s final 2013 list included 509 names. In 2014, the magazine added several specialties including addiction medicine and Alzheimer’s disease, which expanded the list to
about 700 doctors. “The threshold is set so the number of doctors named is large enough that it gives people a good selection,” Hutton says. “We want to give people a few options in each category, if possible, but we also don’t want to overwhelm them with five pages of cardiologists.”

She explains that they only include specialties that have enough practitioners so that there is a choice about who is named to the list. They also restrict both nominations and Best Doctor
designations to local physicians who are in good standing with the Minnesota Board of Medical Practice.

Second opinions

Although most doctors feel honored to be chosen, many wonder why some truly excellent physicians don’t make the lists. “Some argue that it’s a popularity contest,” Hutton says. “But it’s only a popularity contest if that’s the way doctors are voting,” she adds. “It’s all in the hands of the doctors. We ask them to vote for peers they think are most qualified and whose performance is excellent, and we rely on them to vote with integrity.”

Jim Chase, president of the nonprofit quality improvement organization MN Community Measurement, says that when it comes to choosing a physician or clinic, he hopes patients also consider data on clinical outcomes and patient satisfaction. “The public thinks the lists are a good thing to have, and they are valid for what they are,” he says. “But it’s only providers who respond, and it’s not every provider, and being named might have to do with who you know and not really the data.”

He notes that MN Community Measurement provides information on the quality of care at clinics and patient experience ratings on its Minnesota Health Scores website.

Tim Anderson, MD, a pediatrician with Southdale Pediatric Associates in Burnsville, agrees that magazine lists shouldn’t be the deciding factor when choosing a physician. Anderson, who takes care of babies and children with complex mental and physical conditions, says he thinks the reason he’s made MPLS.St.Paul Magazine’s Top Doctors list is because he works with so many hospital specialists and nurses, so he is known and his name comes to mind when they’re voting for pediatricians.

Anderson says finding a doctor you feel comfortable with and can communicate with is what really matters. “Feeling listened to and understood at the end of a visit is the most important thing.”

Download a PDF of the original article>>

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Health beat: Do report cards improve health care?

Article by: JEREMY OLSON, Star TribuneUpdated: February 5, 2015 – 6:38 PM

For 10 years, MN Community Measurement has been putting heat on medical clinics by publicly ranking them on patient care — starting with performance measures on diabetes and vascular disease and now expanding into C-section rates and knee replacements.

Progress in that decade is beyond question. The share of diabetics at these clinics whom achieved optimal health has increased from 17 percent in 2008 to 38 percent last year, according to the 2014 health care quality report the organization released last week.

But after all this time, nobody really knows whether public measurement itself is responsible for the good news.

Doctors might be extra motivated because they don’t want their clinics to look bad to patients and peers. But it’s also possible that MN Community Measurement is simply a mirror reflecting progress at a pivotal time in our nation’s health care.

A study published this month in the Journal of the American Medical Association questioned whether publicized outcome data has any impact. Comparing surgical outcomes among U.S. hospitals that publicly reported their mortality and morbidity data, versus those that didn’t, researchers found comparable levels of progress in both groups.

Community Measurement’s executive director, Jim Chase, is confident that public measurement plays a key role — maybe like the gas that is needed in a car before someone can drive it.

“It’s hard to prove how much of it is due to just the measurement,” he said.

What has become clear in 10 years is that clinics have worked hard to make change happen, he said. Little tweaks to practices don’t cut it.

“You’ve got to do things differently,” he said. “It’s not by accident or just coming to work 10 minutes earlier.”

That’s why overall progress might be incremental — colorectal cancer screening rates at Minnesota clinics nudged up from 69 percent in 2013 to 70 percent last year — but is actually because some clinics made very large jumps.

Waconia-based Lakeview Clinic, for example, jumped 26 percentage points in its share of adolescent patients who receive their recommended vaccinations. Park Nicollet’s clinic in Rogers increased its share of diabetic patients at optimal health by 29 percentage points.

“Sometimes [the effort] pays off,” Chase said, “and you get a big change.”

View the full article at the StarTribune>>

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Total cost of care and health equity in Minnesota: Conversation with MNCM’s Jim Chase

Minnesota Community Measurement (MNCM) is a national leader in bringing together healthcare stakeholders to address important, but difficult quality and cost issues. In this podcast interview, MNCM’s president Jim Chase and I discuss two new reports, one on the total cost of care and the other on health inequities.

Listen to the interview.

Here are the topics we covered, along with timestamps:

  1. What is MNCM? (0:10)
  2. You have released a total cost of care report for MN physician groups. What is total cost of care? (0:38)
  3. Why does total cost of care matter? (1:16)
  4. What adjustments do you make for the health status of patients in different practices? Do you exclude patients who are outliers? (1:46)
  5. How applicable is the TCC metric to an individual patient deciding where to seek care? (2:56)
  6. To what extent is TCC a proxy for negotiated rates as opposed to total resource use? (4:08)
  7. What stakeholders were involved in bringing this report to fruition? (5:23)
  8. Why do you think MN is the first state to issue a report like this? (7:23)
  9. How do you pair total cost of care with quality? (8:38)
  10. You’ve also recently released a Health Equity report. What kinds of inequities are included? How are they measured? (9:42)
  11. What are some key differences you observe? Do they match up with the hypotheses you went in with? (11:08)
  12. This is a touchy subject, so how did you get everyone to cooperate? What was MNCN’s role? (12:54)
  13. Beyond identifying that there are inequities, how do you address them? (14:14)
  14. Are there any explicit linkages between the TCC and Health Equities reports? (15:10)
  15. It’s been a busy couple months for MNCM. What’s next? (15:52)

By healthcare business consultant David E. Williams, president of Health Business Group.

View the full article at Health Business Blog>>

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A new statewide study by the nonprofit MN Community Measurement shows that the cost of health care in Northeast Minnesota is higher than it is in other areas of the state

A new statewide study by the nonprofit MN Community Measurement shows that the cost of health care in Northeast Minnesota is higher than it is in other areas of the state, writes John Lundy of the Duluth News Tribune. The average cost for a month of care at Essentia Health clinics in Northeastern Minnesota is more than $80 above the average cost at St. Luke’s hospital clinics, but all 11 Northeastern Minnesota clinics listed in the report charge more than the statewide average. Why? No one really knows, but officials at both organizations swear they are working to bring costs down.

View the full article at Minnpost>>

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Northland clinics are expensive, study finds

Northland clinics are expensive, study finds

The average cost for a month of care at Essentia Health clinics in Northeastern Minnesota is more than $80 above the average cost at St. Luke’s hospital clinics, a first-of-its-kind report shows.

But both systems’ clinics — indeed, all 11 Northeastern Minnesota clinics listed in the report  by the nonprofit MN Community Measurement — charge more than the statewide average.

Based on 2013 claims data from the four largest health insurance plans in the state, the report shows the average total cost of care per patient, per month at St. Luke’s clinics was $462 — 6 percent higher than the statewide average of $435. At Essentia Health East Region clinics — those in Northeastern Minnesota plus Wisconsin — the cost was $543, or 25 percent above the statewide average.

It’s not a new phenomenon, said Dr. Mike Van Scoy, medical director of population care management at Essentia. The health plans have historically paid more for clinical services in Northeastern Minnesota than in the state as a whole, he said.

“That having been said, it’s high and we all are aware of the problems with the high cost of care,” Van Scoy said. “And we want to do something about that.”

The report, allowing Minnesota consumers to compare the cost of clinics as they might compare the cost of pickup trucks, is new for Minnesota and hasn’t been done anywhere else in the country, said Jim Chase, president of MN Community Measurement.

“Measures like this have been used with individual plans and only shared with providers, but this is the first time … it’s been made public across multiple payers for an entire state,” Chase said in an interview.

The report, published in December, evaluated costs from more than 1.5 million patients at 115 medical groups representing 1,052 clinics across Minnesota and neighboring communities, according to a news release from MN Community Measurement, a nonprofit dedicated to publicly reporting health care information.

Health care costs evaluated for the report totaled more than $8 billion.

The news release noted that if the average per-patient cost were reduced by just $12 a month, Minnesotans would save $750 million in health care costs annually.

‘We think it should be transparent’

The report used the full cost of care — both the amount paid by patients and by their insurers. It used a method developed at Johns Hopkins to take into account the higher costs associated with sicker patients and more complex cases. Medical groups were given the opportunity to review their results and appeal if they felt the results were invalid, according to Community Measurement.

John Strange, CEO of St. Luke’s, said he hadn’t seen the results ahead of time.

Von Scoy said he had.

“We didn’t challenge the result, and we didn’t challenge the concept,” he said. “We think it should be transparent.”

Essentia has been working since 2011 to reduce costs, he said. The hope is to “bend the cost curve.” He illustrated by holding his hand so it was pointing up at an angle, and then lowering the angle. The cost of health care inevitably will rise, he said, but the Essentia system is dedicated to slowing that increase.

“We know that our costs have increased, but they have increased less than the cost of health care provided by our peers,” Van Scoy said. “So directionally, we’re headed in the right path. We’re still higher, but we predict at a certain point we’re going to be much more competitive.”

Clinics in Duluth tend to be somewhat more expensive, Strange said, because they treat a higher percentage of Medicare and Medicaid patients — 60 percent for St. Luke’s clinics. Medicare payments don’t meet the clinics’ cost of providing care, and Medicaid in Minnesota pays only half as much as Medicare, he said. So rates paid by commercial insurers go up to make the difference.

“I call it the silent tax,” Strange said.

Van Scoy said Essentia’s costs may be higher because the system makes a point of offering significant services at clinics in smaller communities.

“I have a friend who’s a (gastroenterologist), and he wakes up at 4:35 in the morning to drive up to Ely to do a clinic up there,” Van Scoy said. “And he can’t necessarily see a lot of patients and do lots of colonoscopies, but for the people who need him to come up there, he’ll go. And so we have used the higher rate for the community benefit.”

Competition

Strange said little about the price difference between the two Duluth-based systems.

“In this case it shows us being relatively effective in relationship to Essentia,” he said, but added, “Essentia is a good system. They deliver a good product.”

Van Scoy, too, was cautious about comparing the two.

“I think there’s good people at St. Luke’s and they wake up every day trying to do a good job,” he said. “And I have friends that go there, and I want them to get good care, too. But I just think that what we do is — we just kind of have a different outlook of our mission, and we’re really not similar health care systems.”

But competition — or the lack of it — could be one reason rates are generally higher in one region of the state than another, Chase said.

“I think we’re seeing in some areas where there’s only a couple of systems or only one predominant system, that the pricing and total cost seems to be higher than others,” he said.

Consumers shouldn’t look at just cost but also quality and patient experience information that already is available from MN Community Measurement, he said.

Essentia Health encourages consumers to do that, Van Scoy said, linking to the information on its own home page.

“It shows you everything from patient safety to hospital-acquired conditions to chronic disease management,” Van Scoy said. “It’s scary, but it’s the right thing to do.”

View the full article at the Duluth News Tribune>>

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Study: Hudson Physicians lowest cost in metro area

Hudson Star-Observer

Hudson Physicians is the lowest cost clinic in the Twin Cities metro area, according to a study released by Minnesota Health Scores. They found that in 2014 the average regular patient cost was $344 per month at Hudson Physicians – substantially less than the $425 average across Minnesota.

“We have been recognized for our quality with many awards over the years,” said Ernie Wallin, Clinic Administrator for Hudson Physicians. “To now be recognized as the lowest cost in the metro area on top of that is quite an honor. It shows our commitment to the people of the St. Croix Valley and to a better way to be treated.”

The statistics were compiled by MN Community Measurement, an independent health care research organization. Its mission is to “accelerate the improvement of health by publicly reporting health care information.” The study, performed at the end of 2014, reflects data through the last year.

The measurement is based on a new system developed by MN Community Measurement that is being copied in many other places nationwide for the purpose of bringing reliable data to consumers who need to make choices about their health care.

In a separate measure of quality, the same group noted that Hudson Physicians also ranks among the top clinics in many key areas, including the treatment of children, diabetes, vascular and maternity care. Hudson Physicians is located at 403 Stageline Road.

Minnesota Health Scores searchable report can be found on the web at www.mnhealthscores.org/.

View the full article at the Hudson Star-Observer>>

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Minnesota has major racial and ethnic health inequities, report finds

By Susan Perry | 08:54 am

Minnesota may consistently appear at or near the top of various national health performance scorecards, but not all people in the state are equally likely to see themselves reflected in those high rankings.

MinneapolisSomaliWomen640In fact, Minnesota has some of the largest racial, ethnic and geographic inequities in health status and incidence of chronic disease in the country, according to a report released Monday by MN Community Measurement, a nonprofit that works to improve health care in the state by collecting, assessing and publishing health data.

“Recent immigrants are the ones who seem to have the greatest disparity in their outcomes. But we also see some big gaps for African-American and Hispanic populations,” said Jim Chase, president of MN Community Measurement, in a interview with MinnPost.

Furthermore, disparities appear to vary by region within racial and ethnic groups, sometimes significantly. For example, the report found that the gap in health-care outcomes for Hispanics is different — much narrower — in the East Metro than in other parts of the state.

“We hope this report helps us work with groups to understand what’s driving that and what can be done to reduce those disparities,” said Chase.

Key findings

Using data collected from medical groups across the state, the new report focuses on health-care outcomes in five areas: diabetes care, vascular care, asthma care for adults, asthma care for children and colorectal cancer screening.

“We had to start with measures that we were already collecting from the medical groups,” said Chase. In future reports, his organization hopes to add measures for three other areas: maternity care, depression and preventive pediatric care (such as immunizing against childhood diseases).

The report found a number of disparities in health-care outcomes among Minnesota’s various racial and ethnic populations, including these key ones:

  • White and Asian patients generally had higher outcomes rates, while American Indian and black patients generally had lower rates, both statewide and across regions.
  • Hispanics generally had lower outcomes rates than non-Hispanics, both across the five quality measures and in most geographic regions. Hispanics living in the East Metro and St. Paul regions, however, had notably higher rates than non-Hispanics for two measures: optimal vascular care and asthma care for adults.
  • Immigrants from African countries — particularly those from Somalia — had the lowest health-care outcomes rates statewide. For example, only 22 percent of Somali immigrants had been screened for colorectal cancer compared to 70 percent of the study’s patients statewide.
  • Asian immigrants tended to have higher outcome rates across multiple measures and geographic areas. In fact, Vietnamese immigrants had the highest statewide rate for optimal diabetes care of any racial or ethnic group.
  • There was one exception to these higher rates among Asian immigrants: those born in Laos. They generally had lower health-care outcomes than other Asian-born patients and other patients in general.

The report wasn’t designed to identify the specific reasons for these disparities, but it does suggest that some of those racial and ethnic disparity gaps may be the result of a language barrier. “Variation in English proficiency can add to the challenges of health care access and the attainment of better health care outcomes,” the report notes.

But such health-care inequities also reflect, as a Minnesota Department of Health report noted last year, “social, economic and environmental disadvantages, such as structural racism and a widespread lack of economic and educational opportunities.”

Geographical barriers

The current report also found that health-care outcomes rates in Minnesota varied considerably by geographic area. For example, compared to other regions of the state, the East and West Metro regions generally reported better outcomes across multiple measures for most racial and ethnic groups. The southwest and northeast regions of the state, on the other hand, tended to have poorer outcomes.

The southwest region scored particularly low for colorectal cancer screening. That may be the result of people needing to travel further distances to get the screening, said Chase.

“In Greater Minnesota it can be more challenging to staff [medical clinics] with the same number of providers as you can in the Twin Cities,” he added.

‘A call to action’

In the report, Chase and his colleagues at MN Community Measurement write that they hope their findings will “serve as a call to action to our community to examine and use this data to build a foundation for understanding and reducing health inequity in our state and communities.”

As background information in the report points out, racial and ethnic minorities represent about a third of the U.S population today — a percentage that is projected to expand to more than half by 2043.

Minnesota’s foreign-born population is increasing even faster than in the rest of the country. It has tripled since 1990, while the national average has only doubled. The state’s immigration pattern also differs from the national one in that about one-third of Minnesota’s immigrants were born in Latin America, compared to more than half of immigrants nationally. About 20 percent of Minnesota’s immigrants were born in Africa, however, compared to only about 4 percent nationally.

In addition, Minnesota — particularly the Twin Cities — is home to a relatively large American Indian population.

‘Important work to be done’

When it comes to narrowing health disparities in Minnesota, “there is important work to be done,” said Chase. Minnesota is unique, he added, in that so many groups around the state “are actually collecting this type of information and trying to use it for improvement.”

“Patients shouldn’t be surprised now if they are asked much more frequently what their race or ethnicity is,” he added. “What we’re hoping is that patients actually welcome that question because they realize that, ‘Oh, they’re not asking it to find ways to not get me care, but to find ways of giving me better care.’”

You can download read the full report on the MN Community Measurement’s website.

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MN Releases Nation’s First Total Cost of Care Data for Medical Groups

Aligning Forces for Quality

07 Jan 2015

A new report has just been published by MN Community Measurement that allows consumers for the first time to compare the cost of care at medical groups across the state. Costs from more than 1.5 million patients were included in the report, which is the nation’s most comprehensive look at the total cost of care. Information is available for 115 medical groups, representing 1,052 clinics across Minnesota and in neighboring communities on MNHealthScores.org.The average monthly cost of medical care per patient is $435 and just a small reduction could save millions. A reduction in the average per patient cost of just $12 per month, or $144 per year, would save Minnesotans $750 million in health care costs annually.

Total Cost of Care is a National Quality Forum (NQF)-endorsed methodology, which includes all costs associated with treating commercially-insured patients, including professional, facility inpatient and outpatient, pharmacy, lab, radiology, behavioral health and ancillary costs. NQF is considered the gold standard of health care measurement.

The total cost of care is the full cost – paid by both patients and health insurance companies. The amounts have been risk-adjusted and outlier costs have been removed to create a level playing field for all medical groups so true differences in cost can be evaluated.

This report includes data based on 2013 claims from the four health plans in Minnesota with the largest commercially-insured populations: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica and PreferredOne. The health care costs evaluated for this report totaled more than $8 billion.

“Total cost of care is a major problem in our society, not just for health care,” said Dr. David Satin, family medicine physician with University of Minnesota Physicians and assistant professor at the University of Minnesota’s Medical School. “There’s a wide swath of things we can do today to improve the total cost of care – in particular beginning to discuss and eliminate unwarranted variation in care.”

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Study finds Minnesota’s priciest health providers

By Staff reporter- Minneapolis / St. Paul Business Journal
Dec 18, 2014, 2:30pm CST

Which health provider Minnesotans choose to visit can have a big impact on the total cost of their medical care, according to a study released Thursday by nonprofit MN Community Measurement.

The study analyzed 115 primary care providers using health insurance claims data covering 1.5 million patients. The organization found notable differences in cost between providers.

At the lowest end was Moorhead-based Seven Day Clinic, with a monthly cost of $269. At the high end was Rochester-based Mayo Clinic, at $826 per month. Those dollar figures combined payments from insurers and patients. (See the organization’s full list here.)

This is the first time MN Community Measurement analyzed the state’s care providers using the total cost of care metric, which takes into account a full range of procedures a patient undergoes, including surgeries and lab work. The organization adjusted for risk, so health providers who treated sicker patients weren’t penalized.

Seven clinics provided care at lower-than-average costs and most of them were independently owned medical groups.

There’s been a lot of debate nationwide about whether consolidation drives up the cost of care partly because larger systems can command higher prices from insurers. MN Community Measurement didn’t set out to answer the question of whether a provider’s size influenced cost, said organization President Jim Chase.

A quick look comparing market share and prices show there may be at least some correlation, however.

As of Dec. 31, Minneapolis-based Allina Health was the dominant care provider in the Twin Cities market, with about 33 percent of the market. Minneapolis-based Fairview Health Services ranked second, with about 20 percent, and HealthPartners Inc. third, with 17 percent. Those health systems ranked out the same way when it came to cost: Allina at $434, a number that also was about equal to the average cost of care in the state; Fairview, $408 (six percent below average) and Bloomington-based HealthPartners, $392 (10 percent below average).

That wasn’t true in all cases for the metro area, however. For instance, University of Minnesota Physicians, based in Minneapolis, was among the state’s most expensive providers, with a monthly cost of $567. Also, HealthPartners cost less than many other small providers.

Minnesota’s largest health system merger in recent years was HealthPartners’ acquisition of St. Louis Park-based Park Nicollet Health Services. The health providers are still listed separately in Minnesota Community Measurement’s report. However, HealthPartners was less expensive: $392 compared to Park Nicollet’s $424.

MN Community Measurement may look into whether size plays a role in pricing in the future, Chase said. Overall, he hopes the study will make pricing more transparent for consumers and businesses.

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