Research Series: Measuring Variation to Maximize Value
This series of reports on geographic variation in performance provide comparative information that can be used as the basis of efficiency and quality improvement efforts.
To be effective the identification of geographic variation must meet two essential criteria. First, the measures of performance being compared must be risk adjusted using a clinically credible and understandable method of risk adjustment. Second, performance comparisons must be limited to those patients for whom there is a reasonable likelihood that the measures of performance are amenable to quality improvement efforts. The performance outcome measures contained in the geographic variation reports available here meet these two criteria.
The healthcare delivery system is complex and highly interrelated. Performance in one aspect of care can often impact performance in other aspects of care. For example, good length of stay performance (short length of stays) can lead to poor readmission performance because patients are being discharged too quick and too sick. The performance measures in the reports include a wide cross section of efficiency and quality outcome measures across care settings including inpatient, emergency department, outpatient surgery and post-acute care as well as overall population management.
A comprehensive performance evaluation of interdependent efficiency and quality outcome measures can provide the basic build blocks for value-based payment systems that balance cost and quality. All the efficiency and quality outcome measures and methods of risk adjustment used to compare performance are clinically credible and have in a uniform and consistent structure creating a language of value that can be used to understand the functioning of the healthcare delivery system within a geographic region and produce real value.
In this 3M Clinical and Economic Research report, the Potentially Preventable Emergency Department Visits (PPVs) methodology was used to identify emergency department visits that may be potentially preventable. If there are an excess number of PPVs compared to a national norm within a managed care plan or geographic region, it is likely the excess PPVs represent emergency department visits that could be avoided if the delivery system functioned effectively. Based on a risk-adjusted national norm, the analysis found considerable PPV performance variation across census regions, states and Core Based Statistical Areas (CBSAs) from the Office of Management and Budget.
Health care expenditures continue to steadily increase with hospital stays making up about one-third of health care expenditures. A well-functioning delivery system within a managed care plan or a geographic region should be able to minimize the need for hospitalizations. In this 3M Clinical and Economic Research report, the Potentially Preventable Admissions (PPAs) methodology was used to identify hospital admissions that may be potentially preventable. If there are an excess number of PPAs compared to a national norm within a managed care plan or geographic region, it is likely the excess PPAs represent hospital admissions that could be avoided if the delivery system functioned effectively.
Surgical Mortality as a Measure of Hospital Quality by Richard Averill, MS, Richard Fuller, MS, Ron Mills, PhD
While there is increasing consensus that comparative mortality data should be included in hospital payment incentive systems, attempts to develop clinically credible and unbiased measure of mortality have proved challenging. The primary intent of mortality measurement is to provide hospitals the incentive and the information to improve mortality performance through quality improvement initiatives. To be effective for quality improvement, the measure of mortality should be limited to patients for whom a hospital is reasonably responsible for the patient outcome and thereby amenable to quality improvement efforts. A comprehensive method of measuring and comparing surgical mortality was developed for this report.
Inpatient Quality Outcome Performance and Population Resource Utilization by Richard Averill, MS, Ron Mills, PhD
This 3M Clinical and Economic Research report focuses on the four Quality Outcome Performance Measures (QOPMs) that relate to hospital inpatient care or care in the emergency department that directly impact the volume of inpatient admissions and bed days. The report examines the impact of inpatient quality outcome performance on the overall functioning of the inpatient delivery system for the Medicare population in each state.
Medicare Beneficiaries with a High Risk of a Poor Outcome from COVID-19 by L. Gordon Moore, MD, Richard Averill, MS, Ron Mills, PhD
Early COVID-19 studies indicate that when older people contract the virus, they have a poorer prognosis, especially those 80 years or more and those with diabetes, chronic respiratory or cardiac diseases, immunosuppression or with multiple major comorbid chronic conditions. These COVID-19 risk factors were analyzed in conjunction with a comprehensive identification of patients with multiple high-severity comorbid chronic conditions to develop an operational definition of individuals with a high risk of a COVID-19 poor prognosis.
Geographic Variation in Hospital Quality Performance in Medicare by Disease and Procedure Categories by Richard Averill, MS, Richard Fuller, MS, Ron Mills, PhD
This supplement to the report “The Financial Impact of Geographic Variation in Hospital Quality Performance in Medicare” examines the geographic variation in quality outcome performance measures (QOPMs) for specific disease and procedure categories. The description and details of the QOPMs, the methods of risk adjustment, determination of national and best practice norms, methods for computing expected values and methods of estimating the financial impact of QOPM performance differences are contained in the “Financial Impact of Geographic Variation in Hospital Quality Performance in Medicare.”
Financial Impact of Geographic Variation in Hospital Quality Performance in Medicare by Richard Averill, MS, Richard Fuller, MS, Ron Mills, PhD
In a major new research study from 3M Clinical and Economic Research, 3M healthcare policy experts evaluate variation in inpatient and outpatient quality performance across geographic regions and simulate hospital payment system reforms based on hospital quality performance. Using clinically credible quality measures, the study quantifies the financial impact of quality performance in terms of the relative impact on Medicare payments. The overall objective of the study is to provide regulators, payers, and hospital-based organizations with meaningful and actionable information that can promote quality improvement efforts.