Tracking Reform
Quality Improvement
Defining Measures Proves Challenging
Minnesota’s 2008 health care reform act requires the Commissioner of Health to develop a standardized set of measures for assessing health care quality that can be used as the basis for both public reporting and incentive payments to physicians. Health plans must begin using the standardized quality measures—and only those measures—by January 1, 2010. But defining the standard set has been challenging.
In response to pressure from health plans to expand the standardized set to meet their needs, the Department of Health invited health plans to submit measures for possible inclusion in the standardized set. Plans were required to define each measure and explain the reason for including the proposed measure and how it aligns with MN Community Measurement criteria for public reporting (degree of impact, degree of improvability, degree of inclusiveness, national consensus, and degree of performance variation).
The MMA is working to ensure that there be physician review of any health plan-submitted measures prior to those measures being made part of the standardized set. The MMA is committed to ensuring that physicians are not burdened by varying specifications, multiple measure sets, and onerous data collection and that the measures are evidence-based, valid, and reliable. A final rule outlining the standardized set as well as the requirements for data collection, reporting, and incentive payments is expected to be published in mid-July.
State Makes Strides toward Peer Grouping
The MMA appointed four physicians to serve on the Peer Grouping Advisory Committee: family physician Terry Cahill, M.D., Blue Earth; pediatrician Peter Dehnel, M.D., Eden Prairie; orthopedic surgeon Darryl Dykes, M.D., Ph.D., Minneapolis; and cardiologist Doug Wood, M.D., Rochester. The 16-member committee is charged with developing recommendations for a methodology for comparing providers on cost and quality. The Commissioner of Health must finalize the methodology by January 1, 2010, and begin publicly reporting the results by September 2010.
Beginning July 1, 2009, all Minnesota health plans and third-party administrators will begin submitting encounter or claims data to the Maine Health Information Center, which was awarded the contract to collect the data that will serve as the foundation for the peer-grouping system. Minnesota health plans have expressed concern about the administrative and financial burdens associated with the submission of data and also about potential limitations associated with the required data elements.
Payment Reform
Baskets-of-Care Components Identified
Subcommittees submitted their recommendations in June for the components of eight “baskets of care.” With baskets of care, physicians are paid a fee for providing a set of services. A steering committee had previously identified seven conditions that should be compensated this way: uncomplicated diabetes, childhood asthma, preventive care for children, preventive care for adults, low back pain, obstetric care, and knee replacement. The diabetes subcommittee added a basket for prediabetes.
The recommendations include a fair amount of variation. For example, medications are included in the childhood asthma basket but not in the diabetes basket; preventive services for children covers children from birth to their second birthday but does not include immunizations; preventive services for adults includes only a health risk assessment. Doug Wood, M.D., an MMA member and co-chair of the Baskets of Care Steering Committee said the recommendations were well-received by the committee but that there were some concerns. For example, the recommendations for the obstetric care basket included prenatal care but omitted labor and delivery.
A work group is being formed to focus on coding, billing, legal, and other implementation issues. And a measurement work group has been formed to recommend quality measures for each basket.
Health Care Homes
MMA Appoints Member to Payment Committee
The MMA appointed pediatrician Amy Burt, D.O., Plymouth, to serve on the Health Care Home Payment Methodology Steering Committee. The committee is developing a system for paying certified health care homes for care coordination. The payment system is to be in place by January 1, 2010.