Measurement of clinic performance and the transparency of measurement lead to improvements in health outcomes for patients. The MMA encourages Minnesota physicians to embrace measurement and its potential to move health care delivery towards high-quality and high- value. National and state efforts are working toward the use and reporting on health care quality indicators.
MN Community Measurement
MN Community Measurement (MNCM) is a nonprofit organization that develops health care quality measures, provides public reporting on quality, and offers data analysis. The MMA, Minnesota Hospital Association, and health plans sponsor MNCM.
Minnesota's Statewide Quality Reporting and Measurement System (SQRMS)
In 2008, Minnesota health care reform legislation mandated that physician clinics and hospitals collect and submit data on defined measures of quality. The Minnesota Department of Health contracts with MN Community Measurement to support SQRMS measure development, data collection, and reporting.
Measurement by MN Health Plans
In addition to measurement efforts by the state of Minnesota and the federal government (i.e., Medicare), Minnesota health plans also utilize measurement programs. Sometimes called physician profiling, these efforts measure and compare the performance of physicians on specific measures of cost and quality. Over time, such programs have evolved with health plans providing physicians with confidential reports to using such results in conjunction with insurance products, labeling physicians with star ratings or placing them into tiered provider networks. The MMA supports efforts to measure the cost and quality of physician groups or clinics, when such analyses are valid, reliable, and useful. However, the MMA opposes individual physician profiling efforts until research shows they can be done accurately. The MMA also does not support the tiering of physicians if information is not made available on the methodology used to assign tiers, and if validated benchmarks are not used when making quality comparisons.
- Medica Premium Designation Program A Medica program that provides public displays of cost and quality performance, based on claims data alone, at the individual physician level.
- Tiering In response to pressure from employers to hold down costs, all three of Minnesota's largest health plans — Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica — and the state of Minnesota have created tiered networks at the medical group, health system or care system level.
Medicare Physician Quality Reporting System (PQRS)
The Physician Quality Reporting System (PQRS) is a Medicare pay-for-quality reporting program. Originally known as the Physician Quality Reporting Initiative (PQRI), it was established by the Tax Relief and Health Care Act of 2006. Physicians and non-physician providers who participate in the program transmit data to CMS regarding the quality measures reported on in caring for their Medicare patients.
Medicare Value-Based Payment Modifier
The Medicare Value-Based Payment Modifier is a fee-for-service payment adjustment made to a physician or group of physicians based upon measures of the quality of care compared to the cost of care (i.e., value) during a defined performance period.
Medicare Physician Compare
Physician Compare is a CMS website that is used to provide the public with information about Medicare physicians and other providers. Physicians are encouraged to review the information for accuracy.
Formerly known as the Physician’s Sunshine Act, Open Payments is a national disclosure program that promotes transparency by publishing information about financial relationships between the health care industry (e.g., pharmaceutical companies and device manufacturers, physicians, and teaching hospitals. This program was mandated by the Affordable Care Act.
For more information, contact Janet Silversmith at 612-362-3763