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Provider Peer Grouping

Provider Peer Grouping. House Health & Human Services Reform Committee. MDH has made efforts to address some of providers’ concerns. MHA expected an open, stakeholder-driven process with transparent formula for PPG

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Provider Peer Grouping

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  1. Provider Peer Grouping House Health & Human Services Reform Committee

  2. MDH has made efforts to address some of providers’ concerns • MHA expected an open, stakeholder-driven process with transparent formula for PPG • MHA appreciates department’s responsiveness to flaws with initial report sent to hospitals • Incomplete data • Old data (2008-09) • Hospitals with low volumes had skewed scores • Misleading methodology that forced the appearance of variation in quality E.g., Hospital A had 99% and received 10 points Hospital B had 96.3% and received 1 point

  3. MDH acknowledges that it is unable or unwilling to resolve some concerns • 2010 data will be reported in 2013 “Agedness of data is becoming an increasing liability to how well PPG can be actionable for consumers” MDH slide presentation, slide 24, Jan. 10, 2012 • Hospitals’ performance on many quality measures is almost identical, yet MDH must force variation as PPG is currently designed • Risk adjustments fail to account for some significant differences between hospital services Trauma Inpatient psychiatry Medical education Neonatal ICU

  4. State’s intended uses of PPG reportspresume usability, reliability • Public reporting (currently required by statute) • Health plans must use PPG results for at least one of their commercial products (currently required by statute) • Incorporate into Health Insurance Exchange website Even though MDH acknowledgesthat PPG data are not actionable by consumers

  5. MHA’s suggested solutions • Amend statute to … • Allow providers to verify the data used to measure their cost of care and quality of care • Require any displayed differences in quality to be based on statistically significant differences in scores on relevant measures • Delay or remove requirement that health plans use PPG results in insurance plan design • Establish a stakeholder board to oversee PPG process and ensure reliability of results before publication

  6. Alternative directions for Provider Peer Grouping • Make ongoing efforts reliable, usable & fair • Data must be accurate • Data must be more current • Providers need to be allowed to verify data MDH uses • Displayed differences in quality must be relevant and statistically significant Take a different direction If PPG can’t be improved, do we need a different approach?

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