Two new members have joined MNCM’s Measurement and Reporting Committee (MARC): Christopher Restad, MD and Lori Bethke, MD.
Dr. Christopher Restad
Dr. Restad is a doctor of osteopathy at Fairview Health Services. He has been the senior medical director of quality and patient safety at HealthEast primary care clinics and is currently serving in leadership roles in the Fairview ambulatory quality and safety departments. While serving in the Air Force, he participated in all levels of quality care metrics from local tracking to advisory councils with the Air Force surgeon general for ambulatory, surgical, and hospital settings. Chris will be serving on MARC as a large metro medical group representative.
Dr. Lori Bethke
Dr. Lori Bethke graduated from the University of Minnesota, Duluth School of Medicine and completed her residency at United Family Medicine Residency Program in 2003. Since then, she has worked at Entira Family Clinics practicing full spectrum family medicine, including obstetrics. She has served on Entira’s Board of Directors for the past eight years, as well as several other Entira committees. In addition, she sits on the HealthEast OB/GYN Peer Review and Clinical Council Committee. Dr. Bethke precepts residents at Phalen Village Family Medicine Program and enjoys hosting medical students in her medical practice from time to time. She was recently named Chief Medical Officer at Entira Family Clinics and is excited to serve in this new role. Outside of work, she enjoys spending time with her husband and two teenage sons – especially doing outdoor activities.
In November 2018, ICSI, StratisHealth, and MNCM facilitated an Affordability Summit attended by key community stakeholders interested in coming together to discuss affordability – currently a critical component impacting health care.
That day’s learnings and the three key priorities were summarized in an issue brief. This is the beginning of important collaborative work that Minnesota leads to address the high cost of health care.
Read The Issue Brief »
In February, MNCM released the “2018 Minnesota Health Care Quality Report.” This report summarizes all clinical quality measures collected by MNCM in 2018, including an online appendix with comparisons by medical group and clinic. Several medical groups are recognized for achieving high performance on at least 50 percent of the measures for which they were eligible. View the report.
The “2018 Minnesota Health Care Disparities Report by Insurance Type” and “2018 Disparities Report by Race, Ethnicity, Language, and Country of Origin” are expected to be released in early April. Watch for the press release soon!
The Minnesota Department of Health (MDH) recently submitted a report to the legislature on their work defining a quality measurement framework for the future of Minnesota. The report synthesizes the first phase of the project where information was collected from the community and workgroup regarding what the framework should contain and do.
You may access the report, a summary fact sheet, and other information by visiting the Quality Framework webpage. MDH will continue to provide updates on framework development – including opportunities for input – through the webpage and announcements.
See the Quality Measurement Framework »
In March, MNCM’s Measurement and Reporting Committee (MARC) approved several recommendations for the redesign of the spine surgery measures. Consideration of redesign was sparked by a request from the Centers for Medicare & Medicaid Services (CMS) who have adopted six MNCM spine measures into the Quality Payment Program. The evolution of these measures offered an opportunity for benchmarking capability and stability.
The spine measure redesign workgroup, led by Paul Huddleston from Mayo Clinic, reached consensus on several redesign recommendations that will enhance measure use and reporting.
The scope of work included three tasks:
- Consider a target-based measure construct for measures of functional status and pain
- Expand the denominator for the discectomy/laminotomy population
- Discuss the usability/value of the quality of life measures with PROMIS Global-10
After several meetings with thorough discussion, review of extensive data analysis and numerous constructs, the workgroup reached consensus on the following recommendations:
Modify the current measure constructs for functional status, back pain, and leg pain
Recalculation of existing data (no change in elements submitted).
- Functional status is less than or equal to 22 OR a change of 30 points or greater on the Oswestry Disability Index (ODI).
- Back pain is less than or equal to 3.0 OR a change of 5.0 points or greater on the VAS Pain scale.
- Leg pain is less than or equal to 3.0 OR a change of 5.0 points or greater on the VAS Pain scale.
- Patients who are not assessed remain in the denominator and are counted as not meeting the target.
- MARC requests additional monitoring of average pre-op scores as a proxy for appropriateness.
Expand the discectomy/laminotomy denominator population
It is very likely that medical groups are not using CPT codes to determine which patients to administer pre-operative assessments to; proceed forward with expanded denominator definition and delay public reporting.
- Expansion of denominator from single CPT code 63030 to include all the following discectomy/laminectomy CPT procedure codes: 63005, 63012, 63017, 63030, 63042, and 63047. No narrowing by diagnosis. Name changed to discectomy/ laminectomy to reflect expanded population.
- Add the same exclusions currently used for the lumbar fusion population; spine related cancer, fracture or infection and scoliosis (neuromuscular, idiopathic, or congenital).
- No submission for discectomy/laminectomy 2018 dates of procedure. Submit 2019 dates of procedure in 2020 for private reporting.
- Change in submission timeframe more appropriate for this measure with a shorter assessment period.
MARC, a subcommittee of the MNCM Board of Directors, approved these amended recommendations March 13, 2019. Measure changes pending final Board approval in May 2019.
For more information, please refer to the summary report and measurement specification example.
Feedback about these changes will be accepted at firstname.lastname@example.org until Friday, April 12, 2019. Questions can be directed to email@example.com.
MNCM is pleased to welcome Anne Pearson, MD, CPE as the newest members of its Board of Directors.
Anne Pearson is the Vice President, Medical Director of Provider Integration at Fairview Health Services. In her role, Dr. Pearson is responsible for the integration of two legacy medical groups comprised of 1,400 employed providers. In addition to her leadership role, Dr. Pearson is a family medicine physician. She sees patients at the HealthEast clinic in Vadnais Heights.
Dr. Pearson attended the Loyola Stritch School of Medicine in Chicago and completed her residency in family medicine at the University of Minnesota. She is an experienced medical leader who has served in a variety of roles including site medical director, regional medical director, and vice president of the HealthEast Medical Group/executive medical director for primary care. In 2014, Dr. Pearson become a Certified Physician Executive (CPE) through the American Association of Physician Leaders. In 2017, she received her Lean Bronze Certification.
Dr. Pearson served on the HealthEast System Board of Directors for six years and is currently on the Board for the Community Health Network, an Accountable Care Organization (ACO).
Dr. Pearson has a passion for improving quality and patient experience. She has chaired the ambulatory quality committee at HealthEast and served on the quality committee of the Board. She been a part of care redesign work at HealthEast and Fairview and is also part of the customer experience team at Fairview. Much of her focus has been guiding providers to put the patient at the center of improvement work including a focus on achieving quality outcomes, advancing access work, and partnering to think differently about how our care teams work together to serve patients.
MN Community Measurement (MNCM), an independent nonprofit organization that empowers health care decision makers with meaningful data to drive improvement, has released a report highlighting quality measures for health care provided by medical groups across Minnesota. The “2018 Minnesota Health Care Quality Report,” presents data collected by MNCM, including an online appendix with comparisons by medical group and clinic. Several medical groups are recognized for achieving high performance on at least 50 percent of the measures for which they were eligible.
Addition of New Statewide Analysis
MNCM added a new statewide analysis showing that substantial gains could be achieved if performance on quality measures was raised to a benchmark level defined by current high performers. An example of this is illustrated with the average rate for colorectal cancer screening. The current statewide average rate for colorectal cancer screening is 71 percent; however, the benchmark is at 75 percent. Another example is outlined in optimal asthma control for children. The statewide average is 58 percent, with the benchmark at 71 percent. For these examples, if all medical groups achieved the benchmark levels, over 54,000 more patients would be screened for colorectal cancer and over 9,000 more children would have their asthma under control. (See report, page 8.)
“The benchmark analysis illustrates the potential impact of raising statewide performance to the current level of groups with highest performance,” says MN Community Measurement President Julie Sonier. “However, for some measures – such as the measures for depression care – the current benchmarks are low, which calls attention to the need for improvement across the board to get better health outcomes for Minnesotans.”
High Performing Medical Groups
The report recognizes eight primary care or multi-specialty medical groups that have achieved high performance on at least 50 percent of the measures for which they were eligible. These medical groups are:
- Allina Health
- Entira Family Clinics
- Essentia Health
- HealthPartners Clinics
- Mankato Clinic
- Mayo Clinic
- Park Nicollet Health Services
- Stillwater Medical Group
High Performing Pediatric Groups
The report also recognizes four pediatric groups that achieved high performance on at least 50 percent of the pediatric measures for which they were eligible. These pediatric groups are:
- Central Pediatrics
- Fridley Children’s and Teenagers’ Medical Center
- South Lake Pediatrics
- Wayzata Children’s Clinic
South Lake Pediatrics Chief Medical Director Michael Garvis, M.D., says, “We have seen steady and consistent improvement and have continued to make small changes along the way, as new suggestions or best practices have surfaced. This has resulted in excellent vaccination rates, as well as low emergency room and hospitalization rates for asthma and mental health patients. We have also been able to intervene with our chronic patients with the consistency of our care coordinators who focus on our mental health, chronic asthma, developmentally challenged, and medically complex patients.”
Showing Consistent Improvement
Ten medical groups demonstrated consistent improvement on multiple measures over time. Consistent improvement is defined as having at least a two-percentage point increase each year since 2016. Medical groups showing consistent improvement include:
- Cuyuna Regional Medical Center
- Entira Family Clinics
- Fairview Mesaba Clinics
- HealthEast Clinics
- Hutchinson Health
- Lakewood Health System
- Mayo Clinic
- Park Nicollet Health Services
- Ridgeview Sibley Medical Center
- Sanford Health – Sioux Falls Region
Lakewood Health System, located in central Minnesota, and Park Nicollet Health Services, achieved consistent improvement on five measures since 2016.
“At Lakewood, we use all available resources including our internal data, state, county, and even our local schools to help improve the health of the communities we serve,” says Lakewood Chief Medical Officer John Halfen. “Having this information is crucial and allows us to put strategies in place through our care teams, education, and systems changes, which can directly impact those areas needing improvement. In doing this, we have seen an immediate benefit to our population health which the long-term viability of our system is dependent on.”
About MN Community Measurement
MN Community Measurement is a nonprofit organization dedicated to empowering health care decision makers with meaningful data to drive improvement. A trusted source of health care data since 2005, MNCM works with doctors, hospitals, clinics, insurance companies, and state agencies to collect, analyze, and report health care data related to quality, cost, and patient experience. Learn more at www.mncm.org.
The February 2019 Measurement Minute is ready to view here.
In January, MNCM released the third report in a series of topic reports, “2018 Preventive Health Measures.” This report presents data collected by MNCM in 2018 on quality measures for preventive health services in Minnesota, including an online appendix with comparisons by medical group and clinic. It includes information on cancer screening, infectious disease screening, and vaccinations for children and adolescents. Medical group results for the immunizations for adolescents measure – now including the new HPV vaccine component – are publicly reported for the first time. View the report.
The “2018 Minnesota Health Care Quality Report” will be released on February 28. Watch for the press release soon!
MNCM is in the process of developing a new suite of software to alleviate the burden of provider quality reporting. The new approach will allow MNCM to implement an automated data extraction method to retrieve encounter data necessary for quality measurement from participating providers. This process can either be completed by an extraction by the clinic group or by utilizing the MNCM extraction technology. Once encounter data is extracted and retrieved, MNCM will then be able to apply measurement specifications centrally to determine the appropriate measure denominator. The new MNCM software suite is called Process Intelligence Performance Engine (PIPE).
More About PIPE
PIPE is a platform for application integration, process automation, data extraction, and clinical measurement analysis. PIPE can integrate applications that weren’t built to be connected and automate processes across such heterogenous systems; cloud/SaaS applications with premise systems, legacy systems with modern web applications, and back office systems. This aspect of the software suite is known as the Process Intelligence (PI). Clinic groups can choose to work with MNCM to utilize the PI to extract the necessary information, or they can manually extract the information from their EHR and other systems.
Once the data has been extracted, the information is moved into the MNCM Performance Engine (PE). The PE will be able to quickly analyze the data and provide real-time denominator and numerator reporting back to the clinic group. Unlike the current process, PIPE can retrieve clinic data monthly and report back to each clinic group on a monthly and quarterly schedule.
The initial pilot will begin the second quarter of 2019. Organizations that transition to PIPE can continue to use the new platform going forward. Organizations that are currently utilizing the existing process will be able to continue to do so. Additional organizations will be onboarded throughout 2019.
Organizations that are interested in reducing their reporting burden can contact Will Muenchow, Director of Technology and Data Integrity, at firstname.lastname@example.org.