July 2012 Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration Medical Home Feedback Report Based on Medicare FFS Beneficiaries Assigned July 1, 2011 December 31, 2011 Practice Number Practice Name DEMO DEMO Prepared by RTI International 701 13th Street, NW, Suite 750 Washington, DC 20005-3967 CMS Contract No. HHSM-500-2005-00029I Task 13: Order #HHSM-500-T0013 RTI Project Number 0209853.029 i
CONTENTS Contents Report Overview...1 Utilization and Expenditure Measures...2 Quality of Care Measures...3 Utilization and Expenditure Trends...4 Quality of Care Trends...21 ii
REPORT OVERVIEW The Centers for Medicare & Medicaid Services (CMS) is one of several payers participating in your state s multipayer patient-centered medical home (PCMH) initiative. As a payer participant, CMS is providing participating practices with a feedback report that provides data related to quality of care, utilization, and Medicare expenditures for Medicare fee-for-service (FFS) beneficiaries assigned to your practice. We hope that you will use the data in this report for benchmarking and quality improvement purposes. A Technical Reference Guide has been created to provide more information on the methodology that was used to produce the report. The Technical Reference Guide also includes examples of the tables and graphs that are used in the report, accompanied by how to read me boxes explaining the content of the tables and graphs. This document can be found at http://mapcp.rti.org. All results are derived from Medicare claims submitted by your practice and other providers and facilities from which your assigned Medicare FFS beneficiaries received services. At the top of the tables and graphs are page numbers that will guide you to specific pages in the Technical Reference Guide that contain more detail about the methodology and other technical specifications used in the analyses. This report includes your practice s results for three data categories: Utilization measures Summary information for hospital and emergency room (ER) utilization measures Medicare expenditures Summary information on the share of care that you provide your Medicare FFS patients, average total Medicare expenditures per beneficiary, and average Medicare expenditures by type of service Quality of care measures Summary information about selected quality of care measures, such as LDL- Cholesterol (LDL-C), HbA1c screening, retinal eye examinations, neuropathy screening, and total lipid panel screening. For these measures, total lipid panel screening is among beneficiaries with heart disease, and HbA1c testing, retinal eye exam, LDL-C screening, and neuropathy screening rates are among beneficiaries with diabetes. Results contained in this report are based on Medicare FFS beneficiaries assigned to your practice for July 1, 2011 to December 31, 2011. Your practice has been assigned into one of two practice categories (high or low) based on the average Hierarchical Condition Category (HCC) risk score of your assigned Medicare FFS beneficiaries. Similarly, the other participating practices in the state have been grouped in the same way. This report compares your outcomes to the outcomes of practices that are in the same HCC risk score category. Please see the page 2 in the Technical Reference Guide for more information on the HCCs and the calculation of the HCC risk score. Based on the average HCC risk score of your assigned Medicare FFS beneficiaries, your practice is a "Low HIGH HCC" HCC practice. practice. Therefore, Therefore, the comparison the comparison group data group shown data shown in this report in this is report based is on based data on of data other of participating other participating practices in your state that also were defined as a HIGH "Low HCC" HCC practice, practice, based based on on the the average average HCC HCC risk risk score score of of their their assigned assigned Medicare Medicare FFS FFS beneficiaries. beneficiaries. 1
UTILIZATION AND EXPENDITURE MEASURES This section shows the utilization and expenditure results for your practice and the other practices participating in your state s PCMH initiative that also are in the same risk group category (hereafter, called the comparison practices). For more information on how the comparison group measures were calculated, see page 2 of the Technical Reference Guide. Table 1 presents utilization and expenditure measures for Medicare beneficiaries assigned to your practice and comparison practices between July 1, 2011 and December 31, 2011. During this time, 253 212 Medicare FFS beneficiaries were assigned to your practice location based on the beneficiary assignment methodology. Results in Table 1 cover July 1, 2011 through September 30, 2011. Measures reported per 1000 beneficiaries re reported per 1000 beneficiaries assigned to your practice between July 1, 2011 and December 31, 2011. For more information, see the Technical Reference Guide: Information on beneficiary assignment--page 1 How to interpret this table page 5 Information on the utilization and expenditure measures pages 2-3 Table 1. Utilization and Expenditure Measures: July 1, 2011 September 30, 2011 Measure 2 Your Practice (N beneficiaries = 245) (N beneficiaries=212) Comparison State Comparison High HCC State Low HCC Practices Practices (N practices=46) = 6 (N (N beneficiaries=631) = 534) Utilization Hospitalization Rate (for any cause) (rate per 1,000 beneficiaries per quarter) 57.8 67.2 57.5 92.6 Hospitalization Rate (for ACSCs) (rate per 1,000 beneficiaries per quarter) 149.4 154.2 183.3 299.3 ER Visits / Observation Stays Rate(for any cause) (rate per 1,000 beneficiaries per quarter) 4.8 7.9 11.8 6.1 Percent of ER Visits / Observation Stays not leading to an admission (Percent of beneficiaries with a ER visit/ 4.8% 11.9 11.2% 20.9 observation stay during the quarter) Annual Expenditures (Average $ per beneficiary) Total Medicare ($) $751 689 $669 909 Acute Care Hospital (all-cause) ($) $315 160 $226 285 Acute Care Hospital (for ACSCs) ($) $106 87 $155 242 All other Inpatient Facilities 1 ($) $148 113 $77 136 ER/Observation Stay ($) $15 19 $27 45 Outpatient Department ($) $85 102 $146 129 Federally Qualified Health Centers (FQHC) and $0 0 $14 Rural Health Center ($) Primary Care Provider Services ($) $36 38 $26 43 Specialty Care Provider Services ($) $68 103 $52 98 Laboratory ($) $4 13 $4 16 Imaging ($) $6 27 $8 21 Home Health ($) $33 42 $34 41 Other 2 ($) $40 71 $55 79 1. Other inpatient facilities include psychiatric and rehabilitation hospitals and hospital units, as well as skilled nursing units long-term care hospitals. 2.Other expenditures = Part B (non-laboratory or imaging tests, ambulance, psychiatric visits, chiropractic visits, immunizations and vaccinations, physical therapy visits, other minor procedures, and pain management), Durable Medical Equipment, Hospice
QUALITY OF CARE MEASURES This section shows the quality of care results for your practice and the other practices participating in your state s PCMH initiative that also are in the same risk group category (hereafter, called the comparison practices). For more information on how the comparison group measures were calculated, see page 2 of the Technical Reference Guide. Table 2 presents the percentage of Medicare beneficiaries assigned to your practice between July 1, 2011 and December 31, 2011 who received total lipid panel testing, LDL-C screening, HbA1c testing, retinal eye examinations, and neuropathy screening. These quality of care measures are annual measures; therefore, the numbers in the table indicate the % of beneficiaries within each disease category who received the quality measure between October 1, 2010 and September 30, 2011. Total lipid panel testing is among beneficiaries with heart disease. HbA1c testing, LDL-C screening, retinal eye examinations, and neuropathy screening tests are among beneficiaries with diabetes. For Medicare beneficiaries with diabetes, we also present two composite measures that include all four of the quality measures that apply to those with diabetes: % of beneficiaries with diabetes who had all 4 of the diabetes quality measures % of beneficiaries with diabetes who had none of the diabetes quality measures See the Technical Reference Guide page 3 and pages 9-14 for more information on the quality of care measures. Table 2. Quality of Care Measures: October 1, 2010 September 30, 2011. Quality of Care Measure (% beneficiaries with the disease) N assigned beneficiaries with claims-based diagnosis of diabetes % had HbA1c testing % had retinal eye examinations % had microalbumin screening tests % had LDL-C screening % had all 4 diabetes process measures % had none of the diabetes process measures N assigned beneficiaries with claims-based diagnosis of ischemic vascular disease (IVD) % had total lipid panel test Your Practice (N beneficiaries) (N beneficiaries=212) Comparison State Low Practices HCC Practices (N practices=46) practices; (N beneficiaries) (N beneficiaries=631) 14 75 100.0% 92.3% 71.4% 56.4% 100.0% 60.7% 92.9% 80.3% 64.3% 32.3% 0.0% 2.7% 31 128 58.1% 69.7% 3
UTILIZATION AND EXPENDITURE TRENDS This section presents trends in utilization rates both before and after the start of the demonstration for beneficiaries assigned to your practice between July 1, 2011 and December 31, 2011, regardless of the number of months of enrollment in Parts A and B. We present trends for 8 quarters prior to the start of the demonstration (i.e., from 7/1/2009 to 6/30/2011) and for 1 quarter of the demonstration (7/1/11 9/30/11). Rates expressed per 1000 beneficiaries are per 1000 beneficiaries assigned to your practice between July 1, 2011 and December 31, 2011. Please see page 7 in the Technical Reference Guide for more information on how to interpret these trend graphs. Figure 1. Trends in Hospitalizations for Any Cause (Rate per 1000 beneficiaries): July 1, 2009 September 30, 2011. 4
Figure 2. Trends in Hospitalizations for Ambulatory Care Sensitive Conditions (Rate per 1000 beneficiaries): July 1, 2009 September 30, 2011. Please see pages 3-4 in the Technical Reference Guide for more information on how the ambulatory care sensitive conditions (ACSCs) were defined. 5
Figure 3. Trends in Emergency Room (ER) Visits / Observation Stays for Any Cause (Rate per 1000 beneficiaries): July 1, 2009 September 30, 2011. 6
Figure 4. Trends in Emergency Room (ER) Visits / Observation Stays That Did Not Lead to a Hospital Admission (Rate per 1000 beneficiaries): July 1, 2009 September 30, 2011. This measure is calculated as (1 the percent of ER visits or observational stays that lead to a hospital admission). These are considered potentially avoidable ER visits. 7
EXPENDITURE TRENDS This section presents trends in expenditure measures both before and after the start of the demonstration, for beneficiaries assigned to your practice between July 1, 2011 and December 31, 2011, regardless of the number of months of enrollment in Parts A and B. We present trends for 8 quarters prior to the start of the demonstration (i.e, from 7/1/2009 6/30/2011) and for 1 quarter of the demonstration (7/1/11 9/30/11). Rates expressed per 1000 beneficiaries are per 1000 beneficiaries assigned to your practice between July 1, 2011 and December 31, 2011. Please see page 7 in the Technical Reference Guide for more information on how to interpret these trend graphs. Figure 5. Trends in Average Annual Total Expenditures per Medicare FFS Beneficiary: July 1, 2009 September 30, 2011. 8
Figure 6. Trends in Average Acute Care Hospital All-Cause Expenditures per Medicare FFS Beneficiary: July 1, 2009 September 30, 2011. 9
Figure 7. Trends in Average Other Inpatient Facilities 1 Expenditures per Medicare FFS Beneficiary: July 1, 2009 September 30, 2011. 1. Other inpatient facilities include psychiatric and rehabilitation hospitals and hospital units, as well as skilled nursing units long-term care hospitals. 10
Figure 8. Trends in Average ER/Observation Stay Expenditures (all-cause) per Medicare FFS Beneficiary: July 1, 2009 September 30, 2011. 11
Figure 9. Trends in Average Outpatient Department Expenditures per Medicare FFS Beneficiary: July 1, 2009 September 30, 2011. 12
Figure 10. Trends in Average Federally Qualified Health Center and Rural Health Center Expenditures per Medicare FFS Beneficiary: July 1, 2009 September 30, 2011. 13
Figure 11. Trends in Average Primary Care Provider Services Expenditures per Medicare FFS Beneficiary: July 1, 2009 September 30, 2011. 14
Figure 12. Trends in Average Specialty Care Provider Services Expenditures per Medicare FFS Beneficiary: July 1, 2009 September 30, 2011. 15
Figure 13. Trends in Average Laboratory Expenditures per Medicare FFS Beneficiary: July 1, 2009 September 30, 2011. 16
Figure 14. Trends in Average Imaging Expenditures per Medicare FFS Beneficiary: July 1, 2009 September 30, 2011. 17
Figure 15. Trends in Average Home Health Expenditures per Medicare FFS Beneficiary: July 1, 2009 September 30, 2011. 18
Figure 16. Trends in Average Other 1 Expenditures per Medicare FFS Beneficiary: July 1, 2009 September 30, 2011. 1.Other expenditures = Part B (non-laboratory or imaging tests, ambulance, psychiatric visits, chiropractic visits, immunizations and vaccinations, physical therapy visits, other minor procedures, and pain management), Durable Medical Equipment, Hospice 19
Figure 17. Trends in Average Acute Care Hospital Expenditures for Ambulatory Care Sensitive Conditions (ACSCs) per Medicare FFS Beneficiary: July 1, 2009 September 30, 2011. 20
QUALITY OF CARE TRENDS This section presents trends in quality of care measures both before and during the start of the demonstration, for beneficiaries assigned to your practice between July 1, 2011 and December 31, 2011. Because quality of care measures are, by definition, annual measures, we present trends for 2 annual time periods: a year that is completely pre-demonstration (7/1/2009 6/30/2010) and a year that contains one quarter of the demonstration (10/1/2010 9/30/2011). In future feedback reports, when a full year of the demonstration has been completed and we have a full year of demonstration data available, we will report a year of predemonstration quality measure results and a year of demonstration quality measure results, for comparison purposes. Please see page 8 in the Technical Reference Guide for more information on how to interpret these trend graphs. Figure 18. Trend in Quality Measures for Medicare FFS Beneficiaries with Diabetes: July 1, 2009 June 30, 2010 and October 1, 2010 September 30, 2011: Your Practice 21
Figure 19. Trend in Composite Measures for Medicare FFS Beneficiaries with Diabetes: July 1, 2009 June 30, 2010 and October 1, 2010 September 30, 2011: Your Practice 22
Figure 20. Trend in Complete Lipid Panel Testing for Medicare FFS Beneficiaries with Heart Disease: July 1, 2009 June 30, 2010 and October 1, 2010 September 30, 2011: Your Practice 23