Tracking Reform
Minnesota Medicine is updating readers monthly about key components of the 2008 Health Care Reform Act payment reform, health care homes, quality improvement, public health, and coverage expansion. Additional information is available online at www.mmaonline.net.
Payment Reform
Seven Baskets of Care Chosen
The Baskets of Care Steering Committee, a group that is exploring alternatives to current fee-for-service payment methods, has selected seven conditions or services for which it will create defined sets of services associated with their treatment or delivery. The seven conditions and services, called “baskets of care,” include:
- diabetes without comorbidities except for hypertension and hyperlipidemia,
- well-child care,
- preventive services for adults,
- asthma care for children,
- obstetrical care,
- total knee replacement, and
- low-back pain.
The committee will form subgroups to further define the baskets before the May 6 deadline for submission to the commissioner of health.
The intent of the baskets-of-care provision is to test whether alternative payment methods will yield flexibility and innovation among providers, as well as more transparent and simplified pricing for patients. Providers who choose to test the model will set a standard price for a particular basket that must be paid by all payers (excluding government programs).
David Estrin, M.D., a pediatrician with South Lake Pediatrics in Minnetonka and Plymouth, and Michael Tedford, M.D., an ENT physician at the Ear, Nose, and Throat Clinic and Hearing Center in Edina, represent the MMA on this committee.
Health Care Homes
Draft Health Care Home Criteria Announced
The Health Care Home Certification Work Group has recommended 16 standards that clinics will have to meet in order to be designated a health care home in Minnesota and receive a care coordination payment from the state. According to the proposed standards, health care homes would need to demonstrate that they can meet requirements in the areas of patient access, care management, performance improvement and reporting, and patient tracking.
To qualify, clinics will need an internal health care team that includes a care coordinator, a patient reminder system, a patient registry or some other method of tracking patient compliance, the availability of same-day appointments, and a host of other services.
The proposed standards will now move into the state’s rule-making process, where the public will have a chance to comment on them and lobby for changes. Keith Stelter, M.D., a family physician at Immanuel St. Joseph’s Clinic in Mankato, is the group’s MMA representative.
Advanced Practice Nurse Prescribing Rules
In January, Minnesota Commissioner of Health, Sanne Magnan, M.D., submitted a report to the Legislature that made 10 recommendations for averting a potential primary care workforce shortage. They include ensuring that advanced practice registered nurses (APRNs), physician assistants, and pharmacists can practice to the full extent allowed by their license.
The report recommended changing the nurse practice act by eliminating the requirement that APRNs have a written prescribing agreement with a physician. Instead, the report suggests changing the current requirement for collaborative management so that it includes a written plan outlining how an APRN will consult and collaborate with physicians and other health care providers and refer patients to them.
The goal is to include independent prescribing in the advanced practice nurses’ scope of practice, address nurses’ concerns about physicians managing their practice, and alleviate physician concerns about the potential legal liabilities of written prescribing agreements.
At press time, the MMA had not yet taken a position on these proposed changes.
The report also proposed replacing the current registration system for physician assistants with a licensing requirement and eliminating the limit on the number of physician assistants a physician may supervise. Right now, a physician can only supervise two physician assistants.
Another recommendation is to allow pharmacists to modify prescriptions under an agreed-upon protocol developed with the prescriber. This would allow pharmacists to make changes such as adjusting an anticoagulant dose. Currently, nurses, medical students, and physician assistants have this authority.
The report was based on the work of the Health Workforce Shortage Study Group.
Quality Improvement
Quality Measures Proposed
MN Community Measurement, which is under contract with the state to develop a standard set of measures for assessing the quality of patient care, recommended 17 ambulatory and 12 inpatient quality improvement measures to the Minnesota Department of Health for possible inclusion in a statewide quality reporting and payment system.
The health department’s deadline for creating such a system is July 1, 2009.
The ambulatory measures include those that MN Community Measurement already tracks such as blood sugar control for diabetics, along with new ones for depression care, health information technology use, patient satisfaction, proper use of antibiotics for adults with bronchitis, and lead screening for Medical Assistance
enrollees.
The inpatient measures include
- volume of abdominal aortic aneurysm repairs and mortality rate for the procedure,
- volume of coronary artery bypass grafts and mortality rate for the procedure,
- volume of angioplasties and mortality rate for the procedure,
- mortality rate for hip fracture patients,
- mortality rate for surgical patients with treatable complications,
- rate of pressure ulcers,
- rate of post-operative pulmonary embolism or deep vein thrombosis, and
- rates of obstetric trauma for vaginal deliveries that do and do not use instruments.
Peer Grouping Data
The Minnesota Department of Health announced that it has contracted with the Maine Health Information Center to manage and collect patient encounter data from health insurance claims.
The 2008 health care reform law requires health plans and third-party administrators to submit this data to the state. The encounter data will be used to compare health care providers on a composite measure of cost and quality.
The Maine group will start collecting the data from health plans and third-party administrators by July 1.