Minnesota Statewide Quality Reporting and Measurement System (SQRMS):

Minnesota Department of Health: Protecting, maintaining and improving the health of all Minnesotans Minnesota Statewide Quality Reporting and Measurement System (SQRMS): Clinic and Provider Registration, and Clinical Quality Data Submission Requirements January 21 & 22, 2014 Vidya Venkataraman

Overview State health reform Objectives and goals Annual measures update Registration and reporting requirements Quality measure results Resources 2

Context for State Health Reform High quality in Minnesota relative to other states Wide variation in costs and quality across different health care providers, with no evidence that higher cost or higher use of services is associated with better quality or better health outcomes for patients Health care costs are rising, placing greater share of health care costs on consumers What tools do consumers have to choose how to spend their health care dollars? 3

Health Care Growth Exceeds Growth in Income and Wages Source: MDH analysis of annual health plan reports. 4

Quality Measures: Statutory Requirements Minnesota Statutes, 62U.02, Subd. 1 and 3 The commissioner of health shall develop a standardized set of measures by which to assess the quality of health care services offered by health care providers The commissioner shall establish standards for measuring health outcomes, establish a system for risk adjusting quality measures, and issue annual public reports on provider quality 5

Objectives and Goals Enhance market transparency by creating a uniform approach to quality measurement Improve health / reduce acute care spending Quality measures must be based on medical evidence and be developed through a participatory process Public reporting quality goals: Make more quality information broadly available Use measures related to either high volume or high impact procedures and health issues Report outcome measures or process measures that are linked to improved health outcomes Not increase administrative burden on health care providers where possible 6

Historical Timeline December 2009 First set of administrative rules established SQRMS January 2010 Data collection for publicly reported quality measures began Health plans no longer permitted to require data submission on measures outside the standardized set November 2010 MDH issued its first public report with data on the standardized measures to be publicly reported First update to administrative rules November 2011, 2012, 2013 Annual updates to administrative rules 7

Annual Update of Quality Reporting Rules Jan Feb Mar Apr ❶ ❷ May Jun ❸ ❹ Jul Aug ❺ Sep Oct Nov Dec ❻ 1. MDH invites interested stakeholders to submit recommendations on the addition, removal, or modification of standardized quality measures to MDH by June 1 2. MDH receives preliminary recommendations from contractors and subcontractors mid-april; MDH opens public comment periods 3. MDH receives final recommendations by June 1; MDH opens public comment period 4. Measure recommendations are presented at a public forum toward the end of June 5. MDH publishes a new proposed rule by mid-august with a 30-day public comment period 6. Final rule adopted by the end of the year 8

Requirements 9

Registration Requirements Physician clinics must register annually with MDH S designee The primary purpose of annual clinic and provider registration is to facilitate the collection of clinical quality measures for SQRMS and other State quality improvement initiatives Provider Peer Grouping (PPG), Health Care Homes, Quality Incentive Payment System (QIPS), Health Care Delivery Systems (HCDS) Demonstration Clinic and provider registration determines quality measure submission requirements 10

Provider Peer Grouping Clinic and provider registration, and quality data are used by Provider Peer Grouping (PPG) (Minnesota Statutes, 62U.04) PPG creates reports on both provider cost and quality measures Accurate provider/clinic information (including full-time equivalents, or FTEs) helps properly credit each clinic with the patients they treat and the services they provide in the PPG reports FTE values should best reflect the time the provider practiced in a typical work week at each clinic site over the course of the 2013 calendar year To ensure your clinic receives credit for the patient care your staff provides: Provide full and accurate information during registration including the information about providers that practice at each clinic Follow the FTE instructions carefully and ask questions as needed Ensure providers at multiple practice locations are registered accurately Individual provider information is NOT tied to the data submitted for clinical quality public reporting 11

Reporting Requirements Submit data required to calculate the applicable quality measures, including the data necessary to perform risk adjustment for each applicable quality measures for all health care services provided by the physician clinic Submit the data using the standardized electronic format and procedures Report on a full population basis if it had an electronic medical record system in place for the entire prior measurement period 12

Data Submission Clinics can authorize MDH to use patient-level quality measure data to better fulfill its public health mission and administer SQRMS Clinics may submit patient-level quality measure data (Direct Data Submission or DDS) or summary-level quality measure data (Summary Data Submission or SDS) Certified Health Care Homes must submit patient-level quality measure data through the DDS method to meet program requirements De-identified patient level data will be used to: Refine risk adjustment methodologies Benchmark and evaluate Health Care Homes Research and analyze health disparities Design and evaluate public health interventions Validate quality measure results Publicly report clinic results 13

Quality Measures Optimal Diabetes Care (ODC) Optimal Vascular Care (OVC) Depression Remission at 6 Months 14

15 Optimal Diabetes Care, 2009 to 2012 Patients ^MHCP is Minnesota Health Care Programs, which include Medicaid and MinnesotaCare. The service year for Optimal Diabetes Care is January 1 through December 31. Source: MDH Health Economics Program analysis of SQRMS data. 15 15

Optimal Vascular Care, 2009 to 2012 Patients ^MHCP is Minnesota Health Care Programs, which include Medicaid and MinnesotaCare. The service year for Optimal Vascular Care is January 1 through December 31. Source: MDH Health Economics Program analysis of SQRMS data. 16 16

Depression Remission at 6 Months, 2010 to 2012 30% Patients 20% 2010 2011 2012 10% 5% 6% 7% 6% 7% 8% 5% 6% 6% 4% 4% 4% 0% All patient severity groupings Moderate Moderately Severe Severe The service year for Depression Remission at 6 months is February 1 through January 31. Source: MDH Health Economics Program analysis of SQRMS data. 17

SQRMS Chartbook 18

SQRMS Website 19

Resources Subscribe to MDH s Health Reform ListServ to receive weekly email updates www.health.state.mn.us/healthreform/announce/index.ht ml SQRMS website www.health.state.mn.us/healthreform/measurement/inde x.html SQRMS chartbook (coming soon!) www.health.state.mn.us/divs/hpsc/hep/chartbook/index.h tml 20

Contact Information For questions about SQRMS, contact: Denise McCabe, Denise.McCabe@state.mn.us, 651.201.3569 Vidya Venkataraman, Vidya.Venkataraman@state.mn.us, 651. 201.5933 21

Clinic & Provider Registration and Clinical Quality Reporting 2014 Preparations 22

MN Community Measurement Publicly reports health care quality measures with the goal of improving the health of patients. 2004: HEDIS measures by medical group. Health plan data. 2006: DDS measures by clinic site. Data submitted by clinics. 2010: Statewide Quality Reporting and Measurement System. 23

2014 Timelines Task Portal Opens Portal Closes Register MN Clinics & Providers December 2013 February 7, 2014 Cycle A Data Submission: -Optimal Diabetes Care -Optimal Vascular Care -Depression Care Measures January 13, 2014 January 13, 2014 February 3, 2014 February 14, 2014 February 14, 2014 February 28, 2014 Complete H.I.T. Survey February 15, 2014 March 15, 2014 Patient Experience Pre-Survey Validation Steps April 1, 2014 July 15, 2014 Cycle B Data Submission: -Total Knee Replacement (2013 Dates of Procedure) Cycle C Data Submission: -Optimal Asthma Care -Colorectal Cancer Screening -Maternity Care: Primary C-section Rate Data Submission: -Spine Surgery Measures (2014 Dates of Procedure) -Pediatric Preventive Care Measures April 15, 2014 May 16, 2014 July 14 2014 July 14, 2014 July 14, 2014 August 15, 2014 August 15, 2014 August 15, 2014 April 2015 May 2015 24

Getting Started on MNCM Website: www.mncm.org Getting Started on MNCM Data Portal: https://data.mncm.org/login 25

Registration Download instructions from mncm.org or MNCM Data Portal from the Resource tab. Access the MNCM Data Portal: https://data.mncm.org/login First time users must request login/password. Necessary registration information: Medical group information. Clinic and specialty information. Provider file. Clinic specialties determine which measures a clinic is required to report. Must complete registration before February 7, 2014. Registration must be completed before data can be submitted to MNCM. 26

Registration Clinic Registration: Register any and all clinic location in the state of Minnesota where primary or specialty care ambulatory services are provided for a fee by one or more physicians. Roll-up option for Clinical Quality Reporting: You may submit data as a single entity ( roll-up ) if all of the following apply, clinics must: Have common ownership AND Have a majority (more than half) of common clinic staff working across multiple locations must rotate between all clinics, AND The total clinical staff across all locations is no greater than 20 full-time equivalent (FTE). A clinic site must still be registered even if the data from that site will be submitted using the roll-up method. During clinic registration, you will indicate the main site that will report the data. Resource: Appendix A in the Registration Instructions. 27

Registration Provider Registration: Based on 2013 Calendar Year. Register all providers who bill through a medical group s clinic. Upload file of providers and required information. Providers include: Physicians (MD, DO, physicians with medical degrees from other countries and those who are locum tenens, residents and fellows). Advance practice registered nurses (e.g., Certified Nurse Practitioners, Certified Nurse Specialist, Certified Nurse Midwife). Physicians assistants. Required information: National Provider Identify or Provider ID number. Provider Type and Board Certified Specialty. Medical license number. Full-time equivalent (FTE) status for each clinic where the provider practices. 28

Measures for Required Reporting 2014 Cycle A: Optimal Diabetes Care Optimal Vascular Care Depression Remission at 6 months 2014 Cycle B: Total Knee Replacement 2014 Cycle C: Colorectal Cancer Screening Optimal Asthma Care Maternity Care: Primary C-Section Rate Other measures: Health Information Technology (HIT) Survey Patient Experience (Data submitted by Survey Vendors) Continue implementing processes: Spine Surgery Measure (2014 Dates of Procedure, Reporting anticipated 2015) Pediatric Preventive Care Measures (2014 Dates of Service, Reporting anticipated in 2015) 29

Optimal Diabetes Care Specialties: Family Medicine, General Practice, Internal Medicine, Geriatrics, Endocrinology. Exempt clinics : Less than 10% adults in clinic population. Dates of service: January 1, 2013 December 31, 2013. Denominator: ICD-9-CM codes that define diabetes mellitus. Patients ages 18 to 75. Visit criteria (2 face-to-face visits with provider in last 2 years for diabetes AND 1 visit to the clinic in the last 12 months for any reason). Composite or all-or-none measure. Numerator: Number of patients who meet all of the following targets: Blood sugar control (Target: HbA1c less than 8.0). Blood pressure control (Target: Less than 140/90). LDL or bad cholesterol control (Target: Less than 100). Aspirin documentation. Patients with co-morbidity of ischemic vascular disease: daily aspirin use or documented contraindication. Patients without co-morbidity of ischemic vascular disease: passes component automatically. Tobacco-free status. 30

Optimal Vascular Care Specialties: Family Medicine, General Practice, Internal Medicine, Geriatrics, Cardiology. Exempt clinics: Less than 10% adults in clinic population. Dates of service: January 1, 2013 December 31, 2013. Denominator: ICD-9-CM codes that define ischemic vascular disease (IVD). Patients ages 18 to 75. Visit criteria (2 face-to-face visits with provider in last 2 years for IVD AND 1 visit to the clinic in the last 12 months for any reason). Composite or all-or-none measure. Numerator: Number of patients who meet all of the following targets: Blood pressure control (Target: Less than 140/90). LDL or bad cholesterol control (Target: Less than 100). Aspirin documentation (Target: Daily aspirin use or valid contraindication). Tobacco-free status. 31

Depression Remission at 6 Months Specialties: Family Medicine, General Practice, Internal Medicine, Geriatrics, and Psychiatry/Behavioral Health professionals (if there is a physician on staff at the clinic site). Exempt clinics: Less than 10% adults in clinic population. Dates of service: January 1, 2013 January 31, 2014. 13 months reported to include grace period +30 days. Total population submission, no samples. Patient Health Questionnaire (PHQ-9). Numerator /Denominator: # adult pts with depression & PHQ-9 score <5 at 6 months(+/- 30 days) # adult pts (18+) with depression or dysthymia AND index contact PHQ-9 >9 32

Total Knee Replacement Specialties: Orthopedic clinics that have surgeons who perform total knee replacements. Starting with dates of procedure: January 1, 2012 December 31, 2012. LONG lag time for post-op collection (15 months post-op); First data submission will be in May 2014. Full population measure, no sample. Denominator: Primary and Revision Knee Replacement by CPT Codes (ICD-9 codes are also available if a system cannot search by CPT codes). Measures (Rates stratified by Primary or Revision): Average change in patients post-op functional status at one year (9 to 15 months post-op). Resource Tab in portal has more detailed information and tools. 33

Optimal Asthma Care Specialties: Family Medicine, General Practice, Internal Medicine, Pediatrics, Allergy/Immunology, Pulmonology. Dates of service: July 1, 2013 June 30, 2014. Denominator: ICD-9-CM codes that define asthma. Patient age groups: 5 to 17 & 18 to 50. Visit criteria (2 face-to-face visits with provider in last 2 years for asthma AND 1 visit to the clinic in the last 12 months for any reason). Composite or all-or-none measure. Numerator: Number of patients who meet all of the following targets: Patient s asthma well controlled (Target: Differs by type of asthma control tool administered to patient). Patient not at elevated risk of exacerbation (Target: Less than two visits to emergency department and hospitalizations). Patient is educated about asthma (Target: Written asthma management plan contains all necessary information per specifications). 34

Colorectal Cancer Screening Specialties: Family Medicine, General Practice, Internal Medicine, Geriatrics, Obstetrics/Gynecology. Exempt clinics: Less than 10% adults in clinic population. Dates of service: July 1, 2013 June 30, 2014. Denominator: Patient ages 50 to 75. Visit criteria (2 face-to-face office visits in last 2 years AND 1 visit to the clinic in the last 12 months). Numerator: Number of patients who are up-to-date with appropriate screening exam. Colonoscopy (Target: Had screening in last 10 years), OR Sigmoidoscopy (Target: Had screening in last 5 years), OR Stool Blood Tests (Target: Had screening during measurement year). 35

Maternity Care: Primary C-Section Rate Specialties: Family Medicine, General Practice, Obstetrics/Gynecology, Perinatology. All clinics that are part of a medical group in which the medical group has providers who perform cesarean section procedures. Dates of service: July 1, 2013 June 30, 2014. Total population submission, no samples. Denominator: ICD-9 and CPT codes that identify deliveries. Singleton deliveries with one live born baby. Nulliparous flag (woman s first pregnancy and delivery). Vertex position delivery of a term (greater or equal to 37 weeks gestation) baby via a vaginal or cesarean birth. Numerator: Number of newborns delivered via C-section. Prenatal Care Flag: Every patient must have prenatal care flag (Flag of 1 or 2) populated. 36

Spine Surgery Measures Specialties: Orthopedic Surgeons and Neurosurgeons who perform lumbar spinal discectomy/laminotomy and lumbar spinal fusion procedures. Dates of Procedure: January 1, 2013 December 31, 2013. Need to implement assessment tools as soon as possible. LONG lag time for post-op collection (15 months post-op); First data submission anticipated in Spring 2015. Full population measure, no sample. Denominator: CPT and ICD-9 codes that identify each population. Two populations: Lumbar Discectomy/Laminotomy. Lumbar Spinal Fusion. Measures (Rates stratified by clinical condition for the procedure: Three months post-op for discectomy population (6 to 18 weeks post-op). One year post-op for spinal fusion population (9 to 15 months post-op). Various outcome and process measures for each population. 37

Pediatric Preventive Care: Adolescent Mental Health and/or Depression Screening Specialties: Family Medicine, General Practice, Internal Medicine, Pediatrics/Adolescent Medicine. Clinics that provide well-child visit services are eligible. Dates of Service: January 1, 2014 December 31, 2014. Currently in pilot phase and pilot results will be reviewed Spring 2014; First data submission anticipated in Spring 2015. Denominator: Patients ages 12 to 17. Seen by eligible provider in an eligible specialty face-to-face for a well-child visit at least once during the measurement period. Numerator: Number of patients who had a mental health and/or depression screening documented in medical record. 38

Pediatric Preventive Care: Obesity/BMI and Counseling Specialties: Family Medicine, General Practice, Internal Medicine, Pediatrics/Adolescent Medicine. Clinics that provide well-child visit services are eligible. Dates of Service: January 1, 2014 December 31, 2014. Currently in pilot phase and pilot results will be reviewed Spring 2014; First data submission anticipated in Spring 2015. Denominator: Patients ages 3 to 17. Seen by eligible provider in an eligible specialty face-to-face for a wellchild visit at least once during the measurement period. Numerators: Number of patients who had a BMI assessment documented in medical record. Number of patients with a BMI percentile greater than 85% AND had documentation of both physical activity and nutrition discussion, counseling or referral document in medical record. 39

Results Reporting by Minnesota Department of Health. MN Community Measurement (DDS): www.mnhealthscores.org Health Care Quality Report Health plans and Minnesota Bridges to Excellence will communicate with you regarding their individual P4P programs. 40

Data Submission Requirements Direct Data Submission (DDS): MNCM s DDS terms and conditions which is agreed to when choosing a data submission method. Complete a Business Associate Agreement with MNCM. Submit, in good faith, a.csv patient-level file to the secure MNCM Data Portal that includes data from all eligible clinic sites. Participate in the data validation process as required by MNCM. Have results publicly reported on www.mnhealthscores.org and other reports. Adhere to and follow all data submission timelines and formatting specifications. Summary Data Submission: MNCM s SDS terms and conditions which is agreed to when choosing a data submission method. Adhere to and follow all data submission timelines and formatting specifications. Participate in the data validation process as required by MNCM. 41

Data Submission Methods Can occur after all steps in the Data Portal are completed. Primary payer type identification. DDS: MNCM/Health plans determine payer type and other risk adjustment variables. SDS: Clinic determines payer type and other risk adjustment variables. Payer Types: Commercial/Private, Minnesota Health Care Programs, Medicare, Uninsured/Self-pay. Health plan P4P and MN Bridges to Excellence. DDS: must be used to qualify for P4P programs. SDS: Cannot be used for P4P programs. 42

Denominator Certification Assurance that patient population (denominator) is identified according to measure specifications. Each measure has its own denominator certificate and is available on the MNCM data portal. Documentation needed. Describe process used to identify patients. Denominator template form. Source code, query, screen shots. Upload certificate to MNCM Data Portal. MNCM reviews for completeness and will contact the group with questions or approve the denominator certificate. 43

Total Population versus Sample Total population: Most precise rates. Submit total population when: Measure requires total population submission (e.g., Depression, Primary C-section, Total Knee Replacement). EMR was in place for a full measurement period, including the 12 months prior to the measurement period (e.g., EMR was in place at any stage of implementation as of 01/01/2012, then total population would need to be submitted for OVC and ODC). Random sample: Can be submitted if total population submission is not required as noted above. Minimum number each clinic must submit: 60 patients per clinic, per measure. If there are less than 60 eligible patients at a clinic, submit all patients. Excel list: use the RAND function in Excel. Paper list: select every Nth patient. 44

Data Collection Can happen: After denominator certification is completed. After billing and patient records are complete for dates of service for the measure. Data collection methods EMR extraction. Manual data abstraction. Data collection tools (Found under Resources tab) Data Collection Guides. Data collection forms. Data spreadsheet templates. Exclusions templates. 45

Data Submission Methods Process of submitting data via the secure internet MNCM Data Portal. Two methods accepted for state requirement: Direct Data Submission (DDS): Clinic uploads file onto the MNCM Data Portal. Summary Data Submission (SDS): Clinic calculates and submits summary counts for each data element. 46

Data Validation Data Validation is a 4-step process: Denominator certification. Data quality checks. Validation audit. Two-week medical group review. All medical groups are subject to a validation audit. Audit conducted to validate that the submitted data matches the source data in the patient medical record. Collaborative process between MNCM and clinic. Occurs after data submission and prior to public reporting. MNCM utilizes the NCQA 8 and 30 process for validation audits. 47

Thank you! MNCM site: www.mncm.org Download registration instructions. Learn about upcoming Q&A sessions. MNCM Data Portal: https://data.mncm.org/login Register clinics and providers. Register contact info to receive communications. Resources tab. Download planning calendar. Download data collection guides and tools. FAQs by measure/topic. Questions about registration and technical support. support@mncm.org 612-746-4522 48