MNCM has made progress in preparing for providing significant value to the community under MACRA. For years, MNCM’s role has been as the central point for quality measurement and data collection and reporting from clinicians to the State and Health Plans for various programs and reporting requirements. Work is now underway to include reporting to CMS for MIPS.
CMS Registry Application
MNCM submitted an application to become a Qualified Clinical Data Registry (QCDR). Currently and in the past, submitting to MNCM has allowed clinicians to attest they are meeting some of their CMS meaningful use requirements. With some modifications to our system, making this transition as a MIPS registry is feasible and a natural next step.
Several MNCM developed measures have a CMS QPP (Quality Payment Program) number and can be used locally and nation-wide. Additionally, data elements from the Diabetes (A1C) and Vascular (Ischemic IVD) measures also have a QPP number. Specifically:
- Q113 Colorectal Cancer Screening
- Q370 Depression Remission at 12 Months*
- Q371 Depression Utilization of the PHQ-9Tool
- Q411 Depression Remission at 6 Months*
- Q398 Optimal Asthma Control*
- Q001 Diabetes: Hemoglobin A1C* (from ODC measure)
- Q204 Ischemic IVD (from OVC measure)
*Denotes CMS priority classification “Outcome/High Priority”
Additional QCDR Measures
QCDR’s also have the ability to add additional community measures that may not yet have a QPP number but may also be considered as CMS “credit”. MNCM has asked that the MNCM NQF endorsed measures be included. These are:
- NQF0729 Optimal Diabetes Care
- NQF0076 Optimal Vascular Care
- NQF2643 Lumbar Spine Fusion-Avg. Change in Functional Status Following Procedure
- NQF2653 Total Knee Replacement-Avg. Change in Functional Status Following Procedure
- NQF 1885 Depression Response at 12 Months
- NQF 1884 Depression Response at 6 Months
MNCM is pleased with the progress made so far, and will be providing further detail regarding the registry process and programmatic details. Stay tuned!
MN Community Measurement (MNCM) recently published new results for two hospital-based health care quality measures and a refresh of five existing readmission measures. This information can be used to compare hospitals within Minnesota with state and national averages.
The results are available at MNCM’s public reporting website MNHealthScores.org.
The two quality measures are relatively new composites that are required by Centers for Medicaid and Medicare Services (CMS).
Value Based Purchasing Composite
The Hospital Value-Based Purchasing (VBP) composite measures the performance of acute-care hospitals on the quality of care they provide to Medicare beneficiaries, how closely best clinical practices are followed and how well hospitals enhance patients’ experiences of care during hospital stays.
The VBP measure combines results from different measure components into a single score for a hospital. A hospital score can range between 0 and 100. The statewide score is 46.0. A hospital’s performance rating is a comparison to the statewide score and is noted as “above average” (better), “below average” (worse) or “average” (the same). This information is from patients seen between January 1, 2015 and December 31, 2015.
Hospital Acquired Conditions Composite
One way to measure hospital quality is to see how many patients developed infections or other specific health issues as a result of their hospital stay, such as bloodstream infections, pressure ulcers, surgical complications, kidney damage, blood clots and other serious conditions.
The Hospital Acquired Conditions Composite measure combines results from different measure components into a single rating for the hospital. A hospital score can range between 1 and 10. The statewide score is 4.94. A hospital’s performance rating is a comparison to the statewide score and is noted as “lower than average” (better), “higher than average” (worse) or “average” (the same). This information is from patients seen between January 1, 2015 and December 31, 2015.
Additionally, MNCM refreshed data for five readmission measures for the period of July 1, 2012-June 30, 2015. Measures with refreshed data include Chronic Obstructive Pulmonary Disease (COPD), Heart Failure, Acute Myocardial Infarction (AMI), Pneumonia and Knee or Hip Surgery.
Results for these and other health care quality measures are available at MNCM’s public reporting website MNHealthScores.org.
For many Minnesotans, good health can be elusive, especially for people of color and new immigrants. Health care outcomes vary widely based on where a person lives, their race, preferred language or country of origin, according to a new report from MN Community Measurement (MNCM).
The 2016 Health Equity of Care Report pinpoints distinct differences in health care between numerous patient populations and geographic regions across Minnesota. Results in the 2016 Health Equity of Care Report clearly show that some racial, ethnic, language and country of origin groups have consistently poorer health care outcomes than other groups. The report also shows how those rates vary by medical group across the state and gives examples of what groups are doing to improve outcomes for their patients.
“Minnesota is one of the healthiest states in the nation, at the same time we have some clear and persistent inequities in health status,” said Jim Chase, MNCM President. “Patients from specific geographic regions and populations, including those in Greater Minnesota, people of color, people who identify as Hispanic, immigrants and people who do not speak proficient English are less likely to receive preventive screenings and more likely to suffer from negative health outcomes.”
The third annual Health Equity of Care Report released by MNCM provides a new benchmark in understanding health inequity in Minnesota. The report is at http://mncm.org/health-equity-of-care-report/
The report’s major findings include:
- White patients generally had better health care outcomes across most measures and most geographic areas.
- Patients in Greater Minnesota overall had poorer health outcomes than patients in the 13-county Metro area.
- Patients born in Asian countries tend to have better outcomes across multiple quality measures and geographic regions than patients in other country of origin groups.
- Generally, patients from large medical groups in the Metro area had higher rates of optimal care.
- Across measures and geographic areas, American Indian or Alaska Native and Black or African American patients generally had the lowest health outcomes both statewide and regionally.
- Hispanic patients generally had poorer health care outcomes than non-Hispanic patients across all quality measures and most geographic regions.
- Patients born in Laos, Somalia and Mexico generally had poorer outcomes than other groups.
- Patients who preferred speaking Hmong, Somali and Spanish generally had lower screening and care rates compared to other preferred language groups.
Despite the somewhat stark results, examples of success exist and several such examples are featured in the 2016 Health Equity of Care Report. South Lake Pediatrics is highlighted in the report as one such example for their positive results for numerous populations for the Optimal Asthma Control for Children measure.
“We are very proud of our asthma work,” said Laura Saliterman MD, with South Lake Pediatrics. “A great deal of effort has gone into our asthma program and it has produced great results for our patients.”
The 2016 Health Equity of Care Report contains information collected from patients seen for appointments at medical groups throughout Minnesota, and evaluates health care quality in seven areas. Results for the seven health care quality measures were segmented by race, Hispanic ethnicity, preferred language and country of origin. These measures are further reported at statewide, regional and medical group levels. The seven measures are: Adolescent Mental Health and/or Depression Screening, Adolescent Overweight Counseling, Colorectal Cancer Screening, Optimal Asthma Control for Adults, Optimal Asthma Control for Children, Optimal Diabetes Care and Optimal Vascular Care. The Adolescent Mental Health and/or Depression Screening and Adolescent Overweight Counseling measures are new in the 2016 Health Equity of Care Report.
“To reduce and eliminate the barriers to health equity, we must understand where they exist and their scope,” said Chase.
This report is unique because medical groups across the state report the data in a standardized format, which allows MNCM to compare results across medical groups and regions.
MNCM released The Handbook on the Collection of Race/Ethnicity/Language Data in Medical Groups in 2008. This handbook defined and standardized the information that is to be collected from patients by clinics and medical groups, as well as set best practices for collection and reporting. Since then, Minnesota providers have steadily improved their collection and reporting of race, ethnicity, language and country of origin (REL) data. In 2016, nearly all Minnesota providers submitted REL data to MNCM and most did so using best practices. Only data from medical groups who have successfully demonstrated to MNCM that they follow these best practices is included in the Health Equity of Care Report.
Understanding why the gaps exist from one group to another and what can be done to reduce the barriers to optimal health are the reasons behind the MNCM effort to collect and report this information. Specific questions of why, and what is being done, according to Chase, are questions best answered by the state’s medical groups and others health equity advocates.
“We share this report with the community so that advocates, policymakers, public health professionals, communities of color and medical groups can take the necessary steps toward addressing the unique health concerns of their patients, stakeholders and constituents,” said Chase.
MN Community Measurement is a non-profit organization dedicated to improving health by publicly reporting health care information. A trusted source of health care data and public reporting on quality, cost and patient experience since 2003, MNCM works with medical groups, health plans, employers, consumers and state agencies to spur quality improvement, reduce health care costs and maximize value. Learn more at MNCM.org.
The National Quality Forum (NQF) Board of Directors has selected Shantanu Agrawal, MD, as the organization’s new president and chief executive officer (CEO). NQF is a non-profit, non-partisan, public service organization that reviews, endorses and recommends use of standardized health care performance measures. NQF also advises Medicare on measures to include in their value-based purchasing programs with physicians.
Jim Chase, President of MNCM, serves as Vice Chairman of the NQF Board of Directors. Chase joined the NQF Board in January 2014.
“Shantanu understands the importance of advancing quality and patient safety both from the frontlines of medicine and from a national policy perspective,” said Bruce Siegel, MD, MPH, NQF Board chair and president and CEO of America’s Essential Hospitals. “He is the innovative, passionate, focused visionary that NQF needs now to ensure that we respond strategically and effectively to the nation’s changing healthcare landscape.”
A board-certified emergency medicine physician who has worked in both academic and community settings, Dr. Agrawal is the former deputy administrator and director for the Centers for Medicare & Medicaid Services’ (CMS) Center for Program Integrity (CPI). Dr. Agrawal succeeded Helen Darling, NQF interim president and CEO, as of January 30, 2017.
“NQF was created 16 years ago by private- and public-sector leaders out of their shared sense of urgency about the impact of healthcare quality on patient outcomes, workforce productivity, and healthcare costs. These issues, and NQF’s role to address them, are just as urgent today, if not more so,” said Dr. Agrawal.
Dr. Agrawal completed his undergraduate education at Brown University, medical education at Weill Medical College of Cornell University, and clinical training at the Hospital of the University of Pennsylvania. He has a master’s degree in social and political sciences from Cambridge University.
Get your datebook, update your smartphone and sync your calendar to “Save The Date” of Wednesday, September 13, 2017, for the MN Community Measurement (MNCM) Annual Seminar.
Plans are underway to build upon the successful 2016 MNCM Annual Seminar (remember Ann Bancroft) and deliver a series of speakers, interactive discussions, networking and professional development opportunities for a wide swath of quality measurement advocates and implementers.
This one-day annual educational event will once again occur at the Earle Brown Heritage Center, just a few miles north of downtown Minneapolis in Brooklyn Center, MN. Stay tuned for additional details about the 2017 topics and featured speakers.
Save the date, September 13, 2017. See you there!
MN Community Measurement (MNCM) is in the process of becoming a CMS qualified registry so that clinics currently submitting data to MNCM on existing MNCM measures can meet their Federal needs to submit results for at least six quality measures* for 2017 performance period for the Merit-based Incentive Payment System (MIPS). MNCM has several measures that are NQF endorsed and currently used in Federal programs such as the Physician Quality Reporting System (PQRS).
Three of the MNCM depression measures and the asthma measure are in MIPS. The components of the diabetes (AIC component) and vascular (aspirin component) measures as well as the colorectal cancer screening measure are also included in MIPS and can be calculated from data currently submitted to the MNCM Data Portal. Other MNCM NFQ endorsed measures are also in the process of being evaluated for MIPS eligibility for Minnesota providers. Much of the work done by the Minnesota community on patient reported outcome measures, such as in depression or post procedural change in function, will become increasingly more important in MIPS. MNCM will be providing more information throughout the first quarter of 2017. Stay tuned!
* The minimum number of measures required in 2017 is six and includes two outcome measures.
MN Community Measurement (MNCM) welcomes Bentley Graves as its newest board member. He is Director of Health Care and Transportation Policy at the Minnesota Chamber of Commerce. Graves worked for nearly eight years on Capitol Hill in Washington, DC. His policy experience includes work on small business concerns, health care, transportation, taxes, education, foreign affairs, defense, and federal appropriations. Graves graduated cum laude from Hillsdale College in Michigan with a degree in Political Economy, is a member of the Consumer and Small Employer Advisory Committee of MNsure, the state’s health insurance exchange, and a member of the Advisory Panel for Own Your Future, an initiative designed to help Minnesotans prepare for their Long Term Care needs.
MN Community Measurement (MNCM) has published the Slate of Measures for Public Reporting in 2017. The complete list can be found on the MNCM website (www.mncm.org) and this link.
The annually updated listing of ambulatory and hospital measures was approved by the MNCM Measurement and Reporting Committee (MARC) and the MNCM Board of Directors in December 2016.
One measure was retired, Appropriate Testing for Children with Pharyngitis.
Five measures will be evaluated in 2017 for potential retirement. The five measures to be considered for retirement are Appropriate Treatment for Children with URI (HEDIS measure), Follow-up Care for Children Prescribed ADHD Medication (HEDIS measure), Use of Spirometry Testing in Assessment and Diagnosis of COPD (HEDIS measure), Maternity Care C-Section Rate (DDS measure) and Pediatric Preventative Care Overweight Counseling (DDS measure).
On January 3, 2017, MinnPost published an article titled, “Minnesota health and medical experts cite greatest concerns — and hopes — for 2017.” In the article, several health and medical experts including Jim Chase, MN Community Measurement President, were asked to answer the following question: With a new administration taking over the White House, what is your greatest concern for your particular corner of the health/medical field in the coming year? What is your greatest hope?
“2017 will be a time of great opportunity to improve our health system. We can adopt a more efficient enrollment and purchasing system for people with high risks and those who need subsidies. We can expand payment methods that focus on patient outcomes and encourage less waste on treatments with marginal benefits. We can agree on better performance metrics across payers so we reduce the administrative burden on doctors while expanding transparency about their results. We can do more to reduce health disparities by race and income by providing more information that helps address both the social and care difference that cause these disparities. The greatest risk is people waiting to see what happens in Washington and not taking the actions we know have worked to give Minnesotans better care: focusing on patient and community needs, testing new processes and partnerships to improve outcomes, and sharing information on results.” — Jim Chase, president of Minnesota Community Measurement
The full MinnPost article can be read at this link.
A new report from MN Community Measurement (MNCM) highlights the significant variation of costs across medical groups in Minnesota and examines the drivers that impact and influence health care costs.
“The continued rise of health care costs and the burden this places on families, businesses and the community makes it critical for medical groups and the community to work together,” said Jim Chase, MNCM President. “This is our endeavor in this new report.”
The 2016 Cost & Utilization Report features analysis and comparative data on medical group performance in Total Cost of Care (TCOC), which includes all costs associated with treating commercially-insured patients, including professional, facility inpatient and outpatient, pharmacy, lab, radiology, behavioral health and ancillary costs. MNCM posted total cost results in the fall on MNHealthScores.org. New in this report is information that breaks out the total cost into price and utilization.
This report shows the variation or difference in total cost by medical group. Further, the report shows how much of the variation was due to the amount medical groups were paid relative to others and how much was due to the utilization or use of services. The report also contains more detailed utilization measures such as the rate of admissions, emergency room visits, office visits and pharmacy use, using the same patients and time period as TCOC.
For example, the 2016 Cost & Utilization Report shows that depending on where you go for care:
- A strep test can range from $8 to $101
- Total Cost of Care can range from $365 to $914 per month on a risk adjusted basis
- Amount of resource use for a patient ranges from 22 percent below average to 33percent above average, after accounting for patient risk
- Emergency room use (utilization of ER as a health care service) ranges from 37 percent less than expected to 104 percent more than expected, after accounting for patient illness
A goal of the 2016 Cost & Utilization Report is to help medical groups better identify opportunities to reduce costs for their patients. The report helps evaluate the categories of care that are driving the majority of providers’ costs and the medical groups can then take actions to reduce their costs and provide more efficient care. The report helps consumers make informed decisions on where to receive care. Further, the report can be used by health plans, employers, and policy makers, all of whom have a stake in addressing the challenges of rising health care costs.
The 2016 Cost & Utilization Report includes a suite of measures which encompasses 119 separate measures of cost and utilization to give a comprehensive view of the drivers of health care costs.
The 2016 Cost & Utilization Report provides insight into individual procedure costs (Average Cost per Procedure chapter), statewide and regional views into total cost of care (TCOC chapter), along with newly published perspective on the resources used (Resource Use and Price Index chapter) and the utilization of health care (Utilization Ratios chapter). When possible, this report displays information on these measures statewide, regionally, and by medical group for ease of analysis.
Reviewed and considered as a whole or individually by chapter, these measures provide unique insight into tracking, comparing and taking actions to manage and reduce health care costs.
The results of these measures are based on 2015 health insurance claims of more than 1.5 million commercially-insured patients enrolled with four Minnesota health plans: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica and PreferredOne.
View the current, and previous MNCM cost of care reports here.