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Health care rated on cost, quality

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

Mankato-area medical groups are above-average in treating diabetes, vascular care and colorectal cancer screening, according to a report by a nonprofit group that measures health care providers.

The area’s two largest groups, Mayo Clinic Health System and the Mankato Clinic, vary in measures such as treating asthma and depression, however. Mayo ranks average and below average in those areas, while Mankato Clinic is above average in asthma care and among the top 15 groups in the state in many depression-care aspects.

Those results are among the thousands posted on MNHealthScores.org, which publishes data on Minnesota clinics, medical groups and hospitals. The nonprofit MN Community Measurement publishes the scores, updating them throughout the year.

MNHealthScores compares clinics, medical groups and hospitals to the state average in categories ranging from diabetes care to depression. There are five ratings: Top, which signifies the top 15 clinics or medical groups in a category, above average, average, below average and not reportable. For hospitals there is no top category.

MN Community Measurement also tracks total cost of care, which compares cost of care at medical groups across the state. The cost data are based on 2013 from the four Minnesota health plans with the largest commercially insured populations. The average monthly cost of medical care per patient is $435, according to the site, with adult patients averaging $514 and kids averaging $216.

Here is the data on local medical groups and hospitals:

Mankato Clinic

The HealthScores includes data on 12 clinics within the Mankato Clinic medical group. The clinic ranks in the top 15 in 10 of 24 medical-group categories, including colorectal cancer screening, diabetes care for adults and six of seven depression measures. It ranks above average in four categories, average in seven categories and below average in three (cold treatment for children, chlamydia screening and bronchitis).

Dr. Julie Gerndt, chief medical officer for the Mankato Clinic, said the clinic has had more time to work on diabetes and colon care and has honed in on those two measures. Its diabetes project for adults was the first quality-improvement project in the clinic, she said, and the clinic is using the model to address all chronic diseases.

“Each time we’ve stepped into a new chronic disease, we’ve seen very good results for patients,” she said.

In total cost of care, the Mankato Clinic ranks average with an overall monthly average cost of $517 for adults, $220 for pediatric patients and $439 overall.

Five reported procedures at the clinic cost significantly more than the statewide average, however. At $1,218, a colonoscopy at the Mankato Clinic was more than double the statewide average cost, according to the site.

Gerndt said historical charges for service don’t necessarily match insurance reimbursements. The more significant measure, she said, is overall cost of care, which is average.

Gerndt said the clinic has a metrics scorecard with more than 80 quality measurements that it looks at monthly. All of the MN Community Measurement metrics are included, and many of the measures are designated by Medicare.

The clinic shares patient-satisfaction data all the way down to the provider level, she said, and clinic leaders meet with providers every year.

“These things matter,” Gerndt said, “and if we see an area where we’re below average or even average, we want to improve that situation.”

Mayo Clinic Health System

As a hospital, Mayo Clinic Health System in Mankato is below the statewide average in two patient deaths categories as well as surgery complications. The hospital scores average in 13 categories, including all patient-experience categories. According to the site, it had the highest rate of adverse events in adults in 2013.

The data don’t explain why the rate of mistakes is so high, but the hospital did record more procedures than most hospitals at 5,077. River’s Edge Hospital in St. Peter, which ranked average, reported just 259 procedures, by comparison.

The HealthScores’ patient-safety data comes from the federal Agency for Healthcare Research and Quality. The Minnesota Hospital Association collects it.

The Minnesota Department of Health also collects patient-safety data and publishes an adverse-health events report annually. According to that report, Mayo Clinic Health System reported four adverse health events out of 66,310 patient days.

The HealthScores track data on 43 of the 65 clinics in the entire Mayo Clinic Health System, which includes clinics in Iowa, Wisconsin and Georgia. As a whole, Mayo Clinic Health System ranks in the top 15 in one of 16 measures (assessing symptoms after total knee replacement surgery) and above average in three measures. It ranks average in eight measures and below average in four.

In cost the system as a whole ranks 20 percent higher than the statewide average. It is 22 percent higher than average for adults and 9 percent higher than average for pediatric patients. The site does not report the cost of individual procedures for the group.

Dr. Steve Campbell, chief quality officer of Mayo Clinic Health System Southwest Minnesota Region, said one could make the assumption that patients with more complicated conditions go to more established clinics, which could lead to higher costs.

Open Door Health Center

The Mankato-based federally qualified health center serves people regardless of their ability to pay and offers a sliding-scale fee to those eligible. While it reports quality measures and sets goals like other health care providers, clinic leaders say the rankings do not tell the whole story, noting its unique challenges.

The center ranks below average in nine of 10 categories for which it reports but receives high patient ratings and positive comments, CEO Sarah Kruse said. “In fact, nearly all patients would recommend our services to a family member or friend.”

The center faces challenges such as a transient population and patients who may not see health as a primary goal. Therefore its scores may not necessarily reflect the center’s improvements over time, Kruse said.

Open Door sees a lot of new patients, some of whom are more worried about just living than their health, she said. The center has a higher percentage of uninsured patients than any other clinic, she said, and its patients don’t access primary care as much as traditional patients.

Kruse said Open Door is working hard to build a quality-improvement program and is hoping to start digging deeper to help patients identify their health goals. Some patients have great improvements, she said, while others have not reached the benchmarks.

“We celebrate that success with them and keep them moving forward to reach their individual health goals,” she said.

River’s Edge 

The St. Peter hospital ranks average in 11 of 12 categories and above average in another (patient experiences: quiet rooms at night).

As a medical group, River’s Edge has scores in just four categories. It ranks below average in adult asthma care and adult diabetes care, average in colorectal cancer screening and in the top 15 in assessing depression symptoms.

Roxanne Portner, director of quality and infection control at River’s Edge, said the clinic has implemented some best practices with diabetes and expects to move into the average category there.

River’s Edge implemented electronic medical records in October, and this year will be a cross between paper and electronic records, Portner said. Having electronic records should make data easier to track.

New Ulm Medical Center

The center’s clinic is part of the Allina Health Specialties medical group, for which the website reports data on 36 clinics.

The medical group ranks in the top 15 in 13 of 27 categories, including most depression categories and high blood pressure treatment. It ranks below average in just one category — vascular care.

In cost nearly all procedures at Allina Health Specialties rank at or below the statewide average.

As a hospital New Ulm Medical Center ranks average in each of 15 categories.

Read the original story in the Mankato Free Press.