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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.”

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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.

View the full article at MinnPost>>

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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.”

View full article at Aligning Forces for Quality>>

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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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Study finds patient costs vary significantly among Minnesota clinics

Study of Minnesota clinics shows some are twice as expensive as others.

Article by: JEREMY OLSON, Star Tribune
Updated: December 18, 2014 – 9:00 AM

Spending on medical care varies dramatically depending on the clinics that Minnesotans choose — from $269 to $826 per patient per month — according to a first-of-its-kind analysis designed to make patients wiser shoppers and doctors more accountable for the cost of care.

The average patient cost $425 per month, but fully one in five of Minnesota’s clinics was substantially cheaper or more expensive than average, according to the analysis by MN Community Measurement (MNCM), a nonprofit agency formed a decade ago to compare clinics by the cost and quality of care.

Even after weighting the data for clinics that treat sicker or more problematic patients, the analysis found huge variations in cost.

“What’s striking is the difference,” said Jim Chase, MNCM’s president.

At Fargo-based 7-Day Clinic, a walk-in provider of basic services such as strep tests and vaccinations, regular patients cost only $269 per month, and at Hudson Physicians patients cost $344. On the other end of the scale, patients receiving most of their primary care from University of Minnesota Physicians cost $567 and patients with Mayo Clinic cost $826 per month.

The “total cost of care” report, released Thursday, was billed as a major advance in the consumer health care movement — and one that would soon be mimicked by other states and federal agencies seeking to place more cost and quality data in consumers’ hands.

Clinics have been ranked in the past on their costs for individual procedures such as colonoscopies. But the expensive clinics argued they were ultimately more efficient because they had fewer medical errors or could deliver quality care with fewer procedures.

Examining overall patient costs addresses that argument.

“It opens up dialogue about why Provider A is more expensive than Provider B,” said Paul Berrisford, chief operating officer of Entira, an East Metro clinic group where the average monthly cost per patient was $398. “That drives consumerism and internal competition.”

MN Community Measurement already has a track record of spawning change by publishing clinic data. Since 2004, for example, it has graded clinics in Minnesota and just across its borders on meeting care benchmarks for patients with diabetes. Since 2008, the share of diabetics at optimal health has increased from 17 percent to 39 percent.

The new report includes services that patients received away from their main clinic — such as imaging scans at radiology centers or surgeries at hospitals. But in the current era of health care reform, a primary care clinic is often considered the “medical home” for patients and bears responsibility for all medical services they receive.

Chase said the new cost ranking should motivate clinics to re-examine tests they order and reconsider referrals to higher-cost specialists.

Shared rewards

Northwest Family Physicians, based in Crystal, ranked favorably, with a monthly cost per patient of $360. In a separate study this fall, it was ranked by a Stanford University think tank as one of the most efficient clinics in the nation — partly because its doctors were trained to provide procedures such as allergy tests rather than refer patients to specialists.

Rewards from insurers or other organizations for measurably efficient care are shared by the entire staff, giving everyone motivation, said Dr. James Welters, Northwest’s president and chief medical officer. “Everybody gets it or nobody gets it.”

MNCM worked with doctors and other specialists over three years to figure out how to fairly evaluate clinics, and also to decide which patients were assigned to which clinics. They used data for all patients privately insured by Minnesota’s four largest health plans and assigned patients to family medicine, pediatric, internal medicine or OB-GYN clinics based on which ones they used most in 2013.

“The reason nobody has done it before is because nobody could get agreement” on how to set it up, said Erin Ghere, a spokeswoman for MNCM. “For the majority of people, it probably stands up that the provider they see the most is their primary care doctor.”

Small clinic groups with fewer than 600 claims for service were excluded. Researchers then adjusted the dollar figures, using a nationally accepted method developed at Johns Hopkins, to adjust for differences in the health of patients at different clinics. All providers reviewed their data in advance of Thursday’s public release.

Overall, the project amassed data on $8 billion in medical services received by 1.5 million patients last year, and reviewed 115 medical groups.

Students low, Mayo high

Mayo had appealed the cost results for its Rochester clinic group, which were 98 percent above average. Clinics aligned with the Mayo Clinic Health System in southeast Minnesota also posted high costs — $524 per patient, or 20 percent above the state average. But Mayo officials particularly disagreed with the Rochester data.

While MNCM removed some of the highest-cost patients who distorted clinic results, Mayo officials said 5 percent of their patients made up 50 percent of their clinic costs. Remove these patients, which included a heart transplant recipient, and Mayo is average for costs, said Dr. John Wald, Mayo’s medical director for public affairs.

While all clinic groups in the state could have high-cost patients, such as those suffering unexpected cancers, Wald said no clinic group in Minnesota has a patient population as challenging as Mayo’s. “Not everyone can make that claim,” he said. “Certainly not everyone can claim the number of complex patients that we see.”

Some results were predictable — such as low average costs for the student health services at the University of St. Thomas, at one end, and higher costs at Mayo and the University of Minnesota, which are renowned for treating complex patients at another.

Chase said that doesn’t change the reality that some clinics spend more than others, even if they have responsibilities such as medical education and research that others don’t.

The analysis also found stark regional patterns. In addition to Mayo, the Gundersen and Olmsted clinic groups serving southeast Minnesota were among the most expensive.

West Side Community Health Services of St. Paul had a high cost — $535 per patient per month — despite being a community clinic focused on low-income, adolescent and minority populations. A clinic executive said the numbers were inflated by West Side’s substantial population of costly HIV patients.

Chase said the data can influence health care in several ways:

For patients, he said, the goal isn’t necessarily to pick doctors on the cheap. But knowing the costs could help in an era of limited insurance networks and increased deductibles.

For clinics, the goal is to become cheaper, not the cheapest, he said; nobody expects equivalency between Mayo and 7-Day Clinic. But if all clinics cut spending by $12 per patient per month, Minnesota patients and insurers would save $750 million in health care costs each year, he said.

Jeremy Olson • 612-673-7744

Read the article on the StarTribune>>

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40 States Get An ‘F’ On Access To Doctor Information

By Bruce Japsen
12/16/14 @ 8:00 am

Most states fail when it comes to providing publicly available information on the quality of their physicians, according to a new report.

The Health Care Incentives Improvement Institute gave 40 states and the District of Columbia a failing grade of “F” while four other states received a “D,” which is also considered failing. Thus, a majority of Americans – more than four in five – are making uninformed choices when it comes to choosing a physician, authors of the report say.

There was little improvement from last year’s first annual “State Report Card on Transparency of Physician Quality Information,” with the same two states as last year earning the only “A” grades.

States were graded on the availability of quality information on physicians as well as how accessible it was to the public. The findings are disappointing given the push by employers, insurance companies and health policymakers for more transparency in health care at a time millions more Americans have medical care coverage under the Affordable Care Act.

“Consumers are flying blind when it comes to selecting hospitals and physicians, and the overall quality and affordability of American health care won’t be improved until we find a way to solve this problem,” Francois de Brantes, executive director of the Institute, known as “HCI3” in the industry, said in a statement accompanying the report.

Just six states passed with a “C” or higher. Minnesota and Washington each earned an “A” while California and Maine received “B” grades. Wisconsin and Massachusetts were each awarded a “C.”

In a state like Minnesota, which earned a rare “A” for its quality reporting, doctor practices are compared on several performance measures as well as the patient’s experience in the doctor’s office. Measures and comparisons of practices are available on conditions like asthma care and colon cancer screenings on the Minnesota HealthScores web site.

Though insurance companies like UnitedHealth Group UNH -0.21% (UNH), Cigna CI +0.12% (CI), Aetna AET -0.1% (AET) and Humana (HUM) have their own ratings for doctors, health plan information isn’t part of the Institute’s report. Consumers often don’t trust insurer ratings, industry analysts say, so advocates for transparency are pushing states to disclose more doctor quality information to the public. The information from those states earning high grades generally comes directly from the doctor practice or hospital system.

“The goal of this report is to not only highlight efforts that are doing well, but also to grab the attention of lawmakers in states lacking this vital information for their residents,” de Brantes said. “If your state isn’t receiving an A or B, it can and should.”

Read the full article at Forbes>>

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Health beat: Small west-metro clinic has big effect on care, cost

Article by: JEREMY OLSON , Star Tribune

Updated: December 12, 2014 – 5:55 PM

Providing high quality care at the lowest cost is a tough double play for doctors to turn.

Yet a small Twin Cities practice is getting national notice for the feat, even while going up against competitors with, well, bigger payrolls.

A Stanford Medicine think tank recently examined 15,000 primary care groups across the country, stripping away clinics that didn’t finish in the top 25 percent for quality, and also in the top 25 percent for low cost.

About 750 were left. Researchers with the Peterson Center on Healthcare then looked for the best of the best and came up with 11 “most valuable” groups.

One was Northwest Family Physicians, a primary care group in Crystal, Plymouth and Rogers.

Defying stereotypes that only large groups can provide affordable care in modern medicine, the 16-doctor practice made the cut for a variety of innovations, including “up-skilling” their doctors so they can provide procedures such as colonoscopies and allergy tests in-house.

“The cost is significantly lower than doing these things in a hospital,” said Dr. James Welters, Northwest’s president and chief medical officer.

Good fortune allowed the practice to stay independent. Others have found new requirements such as electronic medical records so expensive that they have had little choice but to merge or get bought out.

Northwest invested in e-records a decade ago, when the cost was more manageable. Now, e-records are integral to the clinic strategy of keeping patients caught up with care.

“A cold is never just a cold in our office,” Welters said.

Not that Northwest is perfect. MN Community Measurement ranks Northwest highly for diabetes and depression care, but ho-hum for asthma management and cancer screenings. Welters said that is one limit of being small: the practice can’t improve in all areas at once. But the recognition is still worth celebrating while his group keeps working at improvement.

“It’s not just for us,” he said. “It’s for people like us — smaller, independent primary care clinics. Unfortunately, the health care system is stacked against us.”

Read the full article at the StarTribune>>

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The Next Mayo: Part 1 – Mayo faces new price of success

The stakes are high for the world-class hospital, which must transform itself amid a new era of reform.

Story by Jeremy Olson

Angie Carlson faced a tough choice when buying health insurance for her employees at DataIQ in Eden Prairie last year: Keep her existing coverage, which allowed employees to use the vaunted Mayo Clinic, or exclude Mayo and instantly save 5 percent on premiums.She knew her workers would appreciate the savings. But how would they feel about losing access to one of the best known health systems in the world? None of them had ever traveled to Rochester for medical care, but one had an eye condition that might suddenly require sophisticated treatment.“What if that worsens?” she wondered.Carlson stuck with Mayo this year, and will do so again next year. But her debate underscores the challenges facing Minnesota’s premier medical institution as economic, demographic and political forces combine to transform the way health care is delivered and paid for in the United States.Mayo has been lauded by President Obama and influential health economists as an example of superb care and medical efficiency. Yet Mayo also has a reputation in Minnesota — confirmed by publicly available health data — for high prices.

How Mayo resolves that paradox will determine the future of a clinic that has become a signature Minnesota brand. Mayo draws patients from all 50 states and more than 130 countries each year. With nearly 41,000 Minnesota employees, it is the state’s largest private employer and, as of this year, a partner with taxpayers in a $327 million venture to elevate the state as a global medical destination.

“If Mayo Clinic were perceived as being too expensive and not worth it, it would be a huge risk to the organization,” said Mayo CEO Dr. John Noseworthy.

As Mayo celebrates 150 years of history, it’s adapting aggressively to meet the coming wave of reforms. It is extending its brand nationally through exclusive affiliation agreements with smaller hospitals around the country. It’s investing more money in a lab that develops and exports cost-saving medical techniques. And it’s formed an unusual alliance with the nation’s biggest health insurer, UnitedHealth Group, to use “Big Data” to prove and improve the value of Mayo’s services.

Premium care, prices

The financial squeeze facing hospitals and clinics has been building for years; total U.S. health spending has slowed sharply since 2008 and last year grew at the slowest pace on record.

But the scale of Mayo’s challenge became clear last year with the debut of Minnesota’s MNsure insurance exchange, which allows consumers to compare health plans by price and coverage. The only plan in Rochester to include Mayo Clinic as an “in-network” provider cost two to three times more than comparable insurance plans in the Twin Cities. Eventually, state regulators persuaded a second insurer, Medica, to offer a plan on the exchange for Rochester-area residents. But even its network did not include Mayo’s primary care clinics in the city of Rochester itself.

Mayo’s leaders argue that the cost figures are misleading. They say data comparing Minnesota hospitals fail to reflect the fact that Mayo treats sicker patients and more complicated diseases — some of which have been mistreated or misdiagnosed elsewhere.

But a Star Tribune analysis of 2012 hospital and insurance data found that Mayo charges more than its Minnesota competitors for even the most common procedures. A colonoscopy at Mayo cost $1,311, compared to just $573 at Allina specialty clinics and $449 at Fairview clinics in the Twin Cities, according to Minnesota Community Measurement, a state-sponsored nonprofit that tracks cost and quality data. A knee X-ray cost private insurers $92 at Mayo, $69 at Allina and $51 at Fairview.

Those disparities make little sense to business executives such as Angie Carlson. “Even if they bought … top of the line equipment for colonoscopies,” she said, “there still is only one way to do a colonoscopy.”

Mayo’s higher fees partly reflect its market dominance in southeast Minnesota, where it has the clout to command higher payments from insurers. Twin Cities hospitals, for example, discount their rates by 40 to 50 percent in order to be included in the networks of large private insurers, according to data from the Minnesota Hospital Association. Mayo’s hospitals — St. Marys and Methodist — by contrast, discount their rates to private insurers by roughly 20 percent, the data show.

So even when Mayo’s prices are comparable — it charges $10,562 for a knee arthroscopy and Abbott Northwestern Hospital charges $10,424, according to hospital association data — it is possible that Mayo is discounting less and getting more of its sticker price back from insurers.

And that may be taking a toll. Insurance brokers say more customers are willing to sacrifice the cachet of having Mayo in their plan, especially this year, as employers cope with rising premiums taking hold under federal health reform. Individuals and small businesses can now find limited-network plans that exclude Mayo and other higher-cost providers.

“You see fewer people signing up for [plans with] Mayo when they realize what the additional cost is,’’ said Paul Howard, a broker with the DCI agency in Chanhassen, which helps individuals and small businesses select benefits.

Mayo officials say they aren’t seeing the consequences in terms of fewer patients. Mayo treated 1.2 million patients from 135 countries last year, an increase from 2012. They also point to a partnership with Wal-Mart, the world’s largest retailer, which said this fall that it will cover 100 percent of employees’ treatment and travel costs for breast, lung and colorectal cancers if they went to Mayo. And, for 2015, Medica added a plan on MNsure for Rochester-area residents that only covers services provided by Mayo doctors and facilities.

Still, patient choices could shift as consumers make greater use of websites, such as MNsure, that make hospital charges more visible, said Garrett Black, a vice president at Blue Cross and Blue Shield of Minnesota.

“With the level of transparency and consumer choice that is emerging … people are going to choose with their wallets,” he said.

Insurers such as Blue Cross have been trying to steer patients to less expensive hospitals and clinics through “tiered” benefits, which offer financial incentives such as lower coinsurance payments. In Blue Cross’ Distinction program, for example, Mayo shows up as a high-quality provider for cardiac care, knee and hip replacements, and spine surgeries. But it doesn’t receive the “Plus” designation that the insurer awards to hospitals with a combination of high quality and low cost in those specialties.

Similarly, the ranking system used for Minnesota state employees’ health insurance ranks Mayo’s primary care clinics in Rochester among the most expensive, and gives workers financial incentives to choose others.

Costs vs. outcomes

Mayo officials don’t argue with the cost figures. But they say sticker price is a crude measure by which to judge a hospital or clinic.

“Despite the reputation of high cost that some people would try to pin on us, we think we can do pretty well and we are constantly working to do better,” said Dr. Douglas Wood, medical director at Mayo’s center for innovation.

Mayo’s tradition of paying physicians a salary, rather than fees for each procedure, encourages doctors to collaborate, while eliminating the incentive faced by many American doctors to bill for more and more procedures. As a result, Mayo doctors say it’s more likely to make an accurate diagnosis the first time, sparing patients the expense of repeat tests and unnecessary procedures.

Mayo’s neurology department, for example, has developed particular expertise in the diagnosis of multiple sclerosis. In some cases, Mayo doctors found that patients did not have the condition after they had already undergone expensive tests and thousands of dollars in treatments at other hospitals, said Dr. Charles Rosen, a Mayo transplant surgeon.

Organ transplants are another example. Even if Mayo charges more for the initial surgery, its patients suffer fewer deaths and fewer follow-up transplants due to complications, Rosen said.

“If you avoid that [second] one, you save a bunch of money,” he said.

Even the higher price for a standard colonoscopy may be justifiable, according to Dr. Vijay Shah, chairman of Mayo’s gastroenterology department. Mayo doctors conduct more thorough searches and remove dangerous polyps in the first procedure, while other doctors wait until a second procedure, he said. The hospital achieves high success rates, and reduces complications such as perforations of the colon, by funding extensive training for its gastroenterologists before they can fly solo, he added.

“A blood draw, that’s a pretty standard procedure,” Shah said. “But to have a long tube stuck all the way up through your back side? That’s an invasive procedure that requires competence and excellence.”

And where Mayo does charge more per procedure, there is evidence that it simply uses fewer of them.

In a 2008 study, the Dartmouth Atlas of Health Care estimated the United States could save $50 billion annually in spending on end-of-life care if all hospitals operated as efficiently as Mayo, largely because it had found ways to excise waste and unnecessary care. Mayo is now working with other hospitals through Dartmouth to identify savings in nine areas of notoriously wasteful medicine.

“What’s really important about Mayo is that they have shown they can do integrated, high quality care that doesn’t involve a huge quantity of care,” said Jon Skinner, a health economist for the Dartmouth Atlas, which is based at the Dartmouth University medical school in Hanover, N.H. “It doesn’t involve … lots of surgery and lots of procedures and lots of hospital admissions that other hospitals are doing and claiming they need to do.”

Later this year, Minnesota Community Measurement will, for the first time, rank hospitals by the total cost of caring for each patient — rather than the amount charged per procedure. This would theoretically favor a hospital that performs one colonoscopy instead of two, or makes a correct diagnosis the first time.

But Mayo’s CEO, Noseworthy, is warning that this first round of data will end up looking bad for Mayo, because it won’t adequately adjust for the fact that Mayo treats sicker patients.

Innovating for efficiency

When compared to other “destination” medical centers around the country, Mayo does appear more cost efficient. Noseworthy said that, in part, reflects Mayo’s investments in research that makes medical care more efficient.

“Mayo is very strong right now, and we’re in a very strong position to lead going forward,” Noseworthy said, “but to lead one has to innovate.”

A streamlined patient-tracking system in its ICU, for example, has been credited with reducing hospital errors and reduced lengths of stay; it is being tested at five U.S. hospitals and will produce an estimated $80 million in savings over three years.

A tissue-freezing technique in Mayo’s pathology lab produces faster test results, giving surgeons the ability to treat patients in a single procedure rather than wait for lab results and schedule follow-up operations. Improved preparation of patients for orthopedic surgeries has allowed Mayo to reduce the use of intravenous narcotics in recovery, reducing drug costs as well as patients’ hospital stays. A Medicare demonstration project subsequently found Mayo with the lowest costs for hip and knee replacements out of 19 major U.S. medical centers.

“You do things up front that allow the patients really to heal in a natural manner,” said Dr. Robert Cima, a surgeon and chairman of Mayo’s Surgical Quality Subcommittee. “That allows them to feel and act as if they are able to leave” the hospital.

Even large insurers that monitor Mayo’s costs acknowledge these efficiencies. Blue Cross, for one, is exploring the creation of an insurance plan that would include Mayo in specialties where it is clearly superior, such as the diagnosis and care of multiple sclerosis. “The more complex the care is,” Black said, “the more cost effective Mayo becomes.”

Jeremy Olson • 612-673-7744

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