Profile of Medicare in Minnesota Report April 2012 · 2014-07-17 · Profile of Medicare in Minnesota 1 Stratis Health Purpose Stratis Health is pleased to provide this report on

0

Profile of Medicare in Minnesota

April 2012

Stratis Health, based in Bloomington, Minnesota, is a nonprofit organization that leads collaboration and innovation in health care quality and safety, and serves as

a trusted expert in facilitating improvement for people and communities. This material was prepared by Stratis Health, the Quality Improvement Organization for Minnesota, under a contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 10SOW-MN-C10-12-03 040212

http://www.stratishealth.org/�


1 Stratis Health www.stratishealth.org

Purpose Stratis Health is pleased to provide this report on Minnesota’s Medicare services, beneficiaries, and providers. The Profile of Medicare in Minnesota is intended as a resource for health care provider organizations, health care professionals, Medicare consumers, advocates, researchers, and the Minnesota community.

This report provides information and resources about the Medicare program to offer a picture of who receives medical services through Medicare, what type and quality of care they receive, and who provides that care.

Stratis Health, the Medicare Quality Improvement Organization (QIO) for Minnesota, has access to Medicare enrollment and claims data for fee-for-service Medicare beneficiaries in Minnesota, as well as statewide rates and information available through the Centers for Medicare & Medicaid Services (CMS). These data, presented in aggregate, have been supplemented with information from a variety of sources to provide a more complete picture of Medicare in Minnesota. Additional data sources include materials from the 2010 CMS Data Compendium, U.S. Census Bureau, Minnesota Department of Human Services, Minnesota Department of Health, Kaiser State Health Facts, Kaiser Family Foundation, Joint Commission, and Minnesota Hospital Association.

Throughout the report, resources for additional information are identified and cited. Because a variety of sources were used to compile this report, some figures, such as total Minnesota Medicare enrollment, may vary slightly based on the data source.

Stratis Health’s Role as the QIO Stratis Health is an independent nonprofit organization that leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities. The organization, founded in 1971, has worked at improving the state’s health care quality for more than 40 years. Stratis Health has served as Minnesota’s QIO under contract with the Centers for Medicare & Medicaid Services (CMS) since the QIO Program’s inception in the 1970s.

What are QIOs? CMS contracts with one organization in each state, as well as the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, to serve as that state/jurisdiction’s QIO contractor. QIOs are private, mostly nonprofit organizations, which are staffed by professionals, mostly doctors and other health care professionals, who are trained to review medical care and help beneficiaries with complaints about the quality of care they receive and to implement improvements in the quality of care available throughout the spectrum of care. QIO contracts are generally three years in length, with the current three-year contract covering the period 2011 to 2014. As Minnesota’s QIO, Stratis Health serves as an independent, locally integrated field team for CMS to help implement the Department of Health and Human Services’ National Quality Strategy and federal health reform efforts. The QIO Program is dedicated to improving health quality at the community level.

Stratis Health focuses on innovation spread in Minnesota. We support and convene providers, practioners, and patients in statewide learning and action networks to build and share knowledge, spread best practices, achieve rapid, wide-scale improvement. Our work supports CMS’ new




value based purchasing programs with expert technical assistance to providers that includes sharing best practices, assisting with data analysis, and conducting improvement activities. What do QIOs do? By law, the mission of the QIO Program is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. As the QIO for Minnesota, Stratis Health does two basic jobs:

1. Protects the rights of people with Medicare by following up on concerns and complaints. 2. Supports doctors and other health care providers in delivering health care that is

medically necessary, appropriate to patient needs, and follows professionally recognized standards of care. We work with doctors, hospitals, nursing homes, home health agencies, and managed care plans to ensure that the care given meets clinical standards and guidelines.

QIOs work in partnership with patients, providers, and practioners across organizational, cultural, and geographic boundaries. They engage providers at all levels of performance in rapid-cycle projects for collaborative learning and action that accelerate health care quality improvement. Why does CMS contract with QIOs? CMS relies on QIOs to improve the quality of health care for all Medicare beneficiaries. Throughout its history, the QIO Program has been instrumental in advancing national efforts to motivate providers in improving quality, and in measuring and improving outcomes of quality. It brings evidence-based best practices to the bedside, with the flexibility to respond to local needs. Stratis Health is uniquely positioned to effectively and efficiently meet the goals of the QIO Program in Minnesota. We are well integrated with the Minnesota health care community, have a great depth of knowledge and expertise in improving quality and patient safety, have a strong record of performance for all of our contracts and grants, and have continuously held the QIO contract in Minnesota since the inception of the program. For more information about the QIO Program, visit https://www.cms.gov/QualityImprovementOrgs.


https://www.cms.gov/QualityImprovementOrgs�



Table of Contents Minnesota Benefits.………………………………………………………………………....….…. 4

Minnesota Medicare Population.………………………………………………………..…...……. 6

Minnesota Medicare Beneficiaries and the Care They Receive.…………………………...……. 12

Quality Data Reporting and Prevention.…………………………………………… 13 Drug Safety……………….…………………………………………………...…… 21 Patient Safety Nursing Home Pressure Ulcers and Restraints.…………………… 22

Beneficiary Complaints.…………………….………………………...…………… 22

Minnesota Provider Community…………………………………………………………...……. 23

Resources…………………………………………………………………………………...……. 25




Medicare Benefits What is Medicare? Medicare is health insurance for people age 65 or older; people younger than age 65 with certain disabilities; or people of any age with end-stage renal disease (ESRD), permanent kidney failure requiring dialysis or a kidney transplant. Medicare is administered by the U.S. government through the Centers for Medicare & Medicaid Services (CMS), an agency of the federal Department of Health and Human Services. Original Medicare Original Medicare, often called fee-for-service (FFS) Medicare, includes three components: Part A, Part B, and Part D. • Medicare Part A helps cover inpatient care provided by hospitals, skilled nursing facilities,

hospice, and home health agencies. • Medicare Part B helps cover services provided by doctors and other health care providers,

including home health agencies, as well as outpatient care, some preventive services, and durable medical equipment.

• Medicare Part D is a prescription drug option provided by Medicare-approved private insurance companies, which helps cover the cost of prescription drugs.

Medicare Advantage In addition to original Medicare, people eligible for Medicare can choose to enroll in Medicare Advantage plans, which are provided by Medicare-approved private insurance companies (health plans). Medicare Advantage plans (sometimes called Part C) cover benefits and services provided under Part A and Part B. Most Medicare Advantage plans cover Medicare prescription drug coverage (Part D). Some Medicare Advantage plans include extra benefits at an additional cost, such as vision, hearing, dental, and/or health and wellness programs.

Medicare Advantage plans are often structured like health maintenance organizations (HMO) or preferred provider organizations (PPO):

• A Health Maintenance Organization provides all basic health care services and requires an enrollee to select a primary care physician who is responsible for managing and coordinating all of the enrollee’s health care. Referrals are required for specialty or diagnostic services to cover the cost of that care.

• A Preferred Provider Organization has a network of primary care doctors, specialists, hospitals, and other providers. An enrollee is not required to select a primary care physician, nor receive referrals to see other providers in the network. Some Medicare PPO plans offer prescription drug coverage and additional benefits, such as vision and hearing screenings, disease management, and other services not covered under traditional Medicare. Monthly premiums and the cost of services vary depending on the plan.

Medicare Supplemental Insurance Some people elect to purchase supplemental coverage to help cover gaps in original Medicare (Part A and B). These Medigap insurance policies are standardized by CMS, but are sold and administered by private companies. Some Medigap policies sold before 2006 include coverage for prescription drugs. Medigap policies sold after the introduction of Medicare Part D on January 1, 2006, are prohibited from covering drugs. Medicare regulations prohibit a beneficiary


http://healthinsurance.about.com/od/understandingmanagedcare/a/choosing_PCP.htm�

http://www.medicare.gov/Publications/Pubs/pdf/11152.pdf�

http://healthinsurance.about.com/od/understandingmanagedcare/a/choosing_PCP.htm�



from having both a Medicare Advantage policy and a Medigap policy. Medigap policies may only be purchased by beneficiaries that receive benefits from original Medicare (Part A and B).

To learn more about Medicare, visit www.medicare.gov.

Source: A Quick Look at Medicare, CMS, July 2011, https://www.medicare.gov/Publications/Pubs/pdf/11514.pdf, viewed 3/30/12


http://www.medicare.gov/�

https://www.medicare.gov/Publications/Pubs/pdf/11514.pdf�



Minnesota Medicare Population

Approximately 47,672,971 people in the U.S. are enrolled in Medicare, representing 15 percent of the total population.1 In Minnesota, 789,263 Medicare beneficiaries had coverage in calendar year 2010,2 representing 15 percent of the state’s 5,303,925 residents.3

Approximately 16 percent of Medicare beneficiaries in Minnesota are also enrolled in Medicaid (dual enrollment), compared with 19 percent in the nation.

Minnesota and U.S. Medicare Beneficiaries Enrolled in Medicaid (Dual Enrollment) Minnesota U.S.

N Percent N Percent Full Dual Eligible 117,691 91.12 6,887,573 77.42 Partial Dual Eligible 11,469 88.80 2,008,447 22.58 Total Dual Eligible 129,160 8,896,020 Source: Statehealthfacts.org (2007 data)

Although the majority of Medicare beneficiaries are age 65 or older, younger people who are disabled or have end stage renal disease (ESRD) also are eligible to receive Medicare benefits. In Minnesota, approximately 13 percent of Medicare beneficiaries were younger than age 65 in 2006 and received Medicare benefits due to total or permanent disability or ESRD compared with 16 percent in the U.S.

Minnesota and U.S. Medicare Beneficiaries by Eligibility Category Minnesota U.S. N Percent N Percent Aged (65+) 612,456 86.63 36,255,198 83.92 Disabled/ESRD 94,531 13.37 6,945,065 16.08 Total 706,987* 43,200,263 Source: Statehealthfacts.org (2006 data) Medicare Advantage enrollment increased 5.7 percent nationally between 2009 and 2010, with 11.1 million beneficiaries in the U.S. in Medicare Advantage plans, or almost one in four.4

1 Statehealthfacts.org (2011 data)

In Minnesota, 44.4 percent of Medicare beneficiaries are enrolled in Medicare Advantage programs, compared with 25.6 percent nationally.2 Minnesota’s high level of Medicare managed care—nearly half of the state’s beneficiaries are covered through a Medicare managed care plan—has a number of implications for the state. CMS determines eligibility for some of its pilot and demonstration projects based on fee-for-service Medicare enrollment, so Minnesota is limited or ineligible for some projects that would otherwise benefit the state. Also, Medicare managed care data is held by the health plans and is not available to be aggregated with Medicare fee-for-service data when analyzing the state’s health care to understand successes, needs, and opportunities for improvement. Lastly, the state will need to understand the implication this has with the advent of state health insurance exchanges.

2 Medicare enrollment database (2010), excluded death prior to 12/31/2010 3 U.S. Census Bureau (2010 data) 4 Gold M, Phelps D, Jacobson G, Neuman T. Medicare Advantage 2010 Data Spotlight. Plan Enrollment Patterns and Trends. MPR/Kaiser Family Foundation analysis of CMS State/County Market Penetration Files, 2010. www.kff.org/medicare/upload/8080.pdf., viewed 2/8/2012


http://www.kff.org/medicare/upload/8080.pdf�



In Minnesota, three health plans or affiliates accounted for 71 percent of Medicare Advantage enrollees in 2010.4

Minnesota Medicare Advantage Market Share of the Top Three Health Plans Health Plans Percent Medica Health Plan 33.2% UCare Minnesota 25.3% HealthPartners, Inc. 12.6% Source: Medicare Advantage 2010 Data Spotlight

Low-income Medicare beneficiaries have options to help pay for the Medicare Part B deductable. Qualified Medicare beneficiaries (QMBs), specified low-income Medicare beneficiaries (SLMBs), and qualified individuals (QIs) are people with incomes at or below the national poverty level. For these individuals, the Medicaid program may cover the cost of Medicare premiums, deductibles, coinsurance, and certain non-Medicare-covered services that Medicare beneficiaries normally pay out of pocket.

Minnesota and U.S. Medicare State Buy-Ins for Part A and Part B5

Minnesota U.S. Part A Buy-Ins 8,124 571,960 Part B Buy-Ins 91,630 7,703,292 Part B Qualified Medicare Beneficiaries (QMBs) 12,657 3,746,230 Part B Specified Low-Income Medicare Beneficiaries (SLMBs) 1,995 945,296 Part B Qualified Individuals (QIs) 0 337,254 Part B Medicare Advantage Organizations (MAOs) 0 385,897 Source: 2010 CMS Data Compendium (2010 data)

Approximately 68 percent of Minnesota Medicare beneficiaries participate in Medicare Part D, compared with 58.7 percent nationwide.

Minnesota and U.S. Medicare Part D Enrollment5

Minnesota U.S.* Total Part D Enrollees Part D Benefit Plan (PDP) Enrolled Medicare Advantage Prescription Drug (MAPD) Enrolled

533,397 280,548 252,849

27,972,325 17,753,704 10,218,621

Retiree Drug Subsidy (RDS) 72,738 6,692,198 Total Medicare Enrollees 784,246 47,670,485 Source: 2010 CMS Data Compendium (2010 data) *Includes beneficiaries with residence unknown, those pending state designation, and those residing in the Northern Marianas and the Marshal Islands. Data based on August 2010 update.

More than 59 percent of all Medicare beneficiaries live in urban areas in Minnesota. Counties surrounding cities have higher numbers of Medicare beneficiaries than rural counties. Although rural numbers are smaller, many rural counties have a much higher proportion of Medicare beneficiaries than urban counties. While 30 percent of the state’s total population lives in rural Minnesota,6

5 CMS Data Compendium (2010 data)

41 percent of Medicare beneficiaries age 65 and older live there.

6 Minnesota Planning Perspectives, July 2000, http://www.gda.state.mn.us/pdf/2000/rural_01.pdf, viewed 4/17/12


http://www.gda.state.mn.us/pdf/2000/rural_01.pdf�



Rural - Urban Distribution of Minnesota Medicare Beneficiaries <18 18-64 65-74 75-84 85+ Total

Rural 15 42,792 141,372 92,576 45,146 321,901 Urban 21 71,268 211,469 124,848 59,306 466,912 Total 36 114,060 352,841 217,424 104,452 788,813

Source: Medicare Enrollment Database (2010)

Number of Medicare Beneficiaries by Minnesota County





Proportion of Medicare Beneficiaries per Minnesota County





More than half of all Medicare beneficiaries in Minnesota are women (54.8 percent), and women account for a larger share of beneficiaries age 85 and older (67.4 percent).

Sex and Age of Minnesota Medicare Beneficiaries

<18 18-64 65-74 75-84 85+ Total

Female 15 54,575 184,876 123,248 70,467

433,181 (54.8%)

Male 21 59,594 168,122 94,296 34,049

356,082 (45.1%)

Total

36 (0.004%)

114,169 (14.4%)

352,998 (44.7%)

217,544 (27.5%)

104,516 (13.2%)

789,263


Minnesota Medicare Beneficiaries by Age Group


36

114,169

352,998

217,544

104,516

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

<18 18 - 64 65 - 74 75 - 84 85+




The majority of Medicare beneficiaries in Minnesota are White (94.3 percent). Although the number of beneficiaries representing racial and ethnic minorities in Minnesota is small, it is increasing. Younger Medicare beneficiaries are more likely to be non-White than older beneficiaries, with 39.7 percent of non-White beneficiaries under age 65. Approximately 13.0 percent of White Medicare beneficiaries are younger than age 65. These statistics indicate the Medicare population in Minnesota will continue to become more diverse in the future.

Race and Age of Minnesota Medicare Beneficiaries

<18 18-64 65-74 75-84 85+ Total

White 11 96,612 335,510 210,116 102,037

744,286 (94.3%)

Black * 9,592 5,637 2,565 764

18,558 (2.4%)

Asian * 2,048 3,711 1,981 825

8,565 (1.1%)

Other * 2,015 4,014 1,310 252

7,591 (1.0%)

Native American * 2,314 2,172 973 225

5,684 (0.7%)

Hispanic * 962 797 406 126

2,291 (0.3%)

Unknown 19 626 1,157 193 287

2,282 (0.3%)

Total

30 (0.004%)

114,169 (14.5%)

352,998 (44.7%)

217,544 (27.6%)

104,516 (13.2%)

789,263

Source: Medicare Enrollment Database (2010) *Too small to report




Minnesota Medicare Beneficiaries and the Care They Receive In 2010, Minnesota had 132,469 fee-for-service hospital admissions of Medicare beneficiaries, with a 17.16 percent 30-day readmission rate and 36.73 percent 180-day readmission rate.

Admissions: Top 10 Causes of Hospital Admission for Minnesotans with Medicare in 2010 Condition N Pneumonia 8,408 Heart Failure 6,414 Psychoses 6,041 Esophagitis, Gastroenterology, and Miscellaneous Digestive Disorders 5,007 Cardiac Arrhythmia and Conduction Disorders 4,573 Septicemia 4,359 Chronic Obstructive Pulmonary Disease (COPD) 4,086 Nutritional and Miscellaneous Metabolic Disorders 3,720 Kidney and Urinary Tract Infections 3,429 Gastrointestinal (G.I.) Hemorrhage 3,232 Source: CMS Clinical Data Warehouse (2010)

Readmissions: Top 10 Causes of Hospital Readmission for Minnesotans with Medicare in 2010 Condition N Heart Failure 1,405 Pneumonia 1,402 Psychoses 1,269 Esophagitis, Gastroenterology, and Miscellaneous Digestive Disorders 901 Septicemia 818 Chronic Obstructive Pulmonary Disease (COPD) 815 Cardiac Arrhythmia and Conduction Disorders 745 Nutritional and Miscellaneous Metabolic Disorders 710 Kidney and Urinary Tract Infections 561 Renal Failure 557 Source: CMS Clinical Data Warehouse (2010) Quality Data Reporting and Prevention Stratis Health has been working with health care providers in Minnesota to improve care in clinical areas of importance to seniors. Efforts have focused on acute myocardial infarction, heart failure, pneumonia, and surgical care improvement in hospitals and on breast cancer screening, colorectal cancer screening, and pneumococcal and influenza immunization in clinics. Where appropriate, ages are limited to align with preventive screening guidelines. Quality indicator measurement results are presented below in order to describe the current state of these clinical areas for Minnesota Medicare beneficiaries.




Minnesota Medicare Priority Topics Measurement Results

Acute Myocardial Infarction (AMI) Measures for Discharges 1/1/2010-12/31/2010 Acute Myocardial Infarction (AMI) Measures Percent AMI - 1: Aspirin at Arrival 99.0 AMI - 2: Aspirin Prescribed at Discharge 99.2 AMI - 3: ACEI or ARB for LVSD 96.8 AMI - 4: Adult Smoking Cessation Advice/Counseling 99.3 AMI - 5: Beta-Blocker Prescribed at Discharge 98.8 AMI - 7a: Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival * AMI - 8a: Primary PCI Received Within 90 Minutes of Hospital Arrival 94.5 AMI - 10: Statin Prescribed at Discharge 97.0 AMI - Appropriate Care Measure (All measures) 96.5 Source: CMS Clinical Data Warehouse (2010) *Sample size too small to report

Heart Failure (HF) Measures for Discharges 1/1/2010-12/31/2010 Heart Failure (HF) Measures Percent HF - 1: Discharge Instructions

Discharge Instructions Breakdown (must include all for HF – 1): Activity Diet Discharge medications Follow-up appointment Weight monitoring Symptoms worsen

86.4

96.9 97.3 93.5 98.7 92.9 94.0

HF - 2: Evaluation of LVS Function 96.1 HF - 3: ACEI or ARB for LVSD 95.2 HF - 4: Adult Smoking Cessation Advice/Counseling 96.7 HF - Appropriate Care Measure (All measures) 86.0 Source: CMS Clinical Data Warehouse (2010)




Pneumonia (PN) Measures for Discharges 1/1/2010-12/31/2010 Pneumonia (PN) Measures Percent PN - 2: Pneumococcal Vaccination 92.5 PN - 3a: Blood Cultures Performed Within 24 Hours Prior to or 24 Hours After Hospital Arrival for Patients Transferred or Admitted to the Intensive Care Unit Within 24 Hours of Hospital Arrival

94.1

PN - 3b: Blood Cultures Performed in Emergency Department Prior to Initial Antibiotic Received in Hospital 95.7

PN - 4: Adult Smoking Cessation Advice/Counseling 94.2 PN - 5c: Initial Antibiotic Within 6 Hours of Hospital Arrival 96.6 PN - 6: Initial Antibiotic Selection for CAP in Immunocompetent Patient 91.0 PN - 7: Influenza Vaccination 92.1 PN - Appropriate Care Measure (All measures)* 86.8 Source: CMS Clinical Data Warehouse (2010) * PN-7 (seasonal measure) is not included in this calculation

Surgical Care Improvement Project (SCIP) Measures for Discharges 1/1/2010-12/31/2010 Surgical Care Improvement Project (SCIP) Measures Percent SCIP-INF - 1: Prophylactic Antibiotic Received Within 1 Hour Prior to Surgical Incision 96.5

SCIP-INF - 2: Prophylactic Antibiotic Selection for Surgical Patients 97.9 SCIP-INF - 3: Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time 97.1

SCIP-INF - 4: Cardiac Surgery Patients With Controlled 6 A.M. Postoperative Serum Glucose 92.6

SCIP-INF - 6: Surgery Patients with Appropriate Hair Removal 99.5 SCIP-INF - 9: Urinary Catheter Removed on Postoperative Day 1 or Postoperative Day 2 With Day of Surgery Being Day Zero 90.6

SCIP-INF - 10: Surgery Patients with Perioperative Temperature Management 98.6 SCIP-Card - 2: Surgery Patients on Beta Blocker Therapy Prior to Arrival Who Received a Beta Blocker During the Perioperative Period 94.3

SCIP-VTE - 1: Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered 93.7

SCIP-VTE - 2: Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery

92.3

Source: CMS Clinical Data Warehouse (2010)




Mammography Rates by Race in Female Fee-for-Service Medicare Beneficiaries Ages 52-69 Within Two Year Period 1/1/2009-12/31/2010 Mammography rates by race in female FFS Medicare beneficiaries ages 52-69 within two year period 1/1/2009-12/31/2010 Percent

White 66.96 Overall 66.10 Black 61.91 Other 58.14 Hispanic 55.86 Unknown 54.17 Asian 50.80 Native American 45.89

Source: Medicare Claims Data (2010)

Colorectal Cancer Screening Rates by Race for Fee-for-Service Medicare Beneficiaries Ages 50-80 As of 12/31/2010 Colorectal cancer screening rates by race for Fee-for-Service Medicare beneficiaries ages 50-80 as of 12/31/2010 (colonoscopy within 10 years, sigmoidoscopy within five years, double-contrast barium enema within five years, or fecal occult blood test within one year)

Percent

Overall 53.42 White 54.22 Native American 44.83 Other 42.00 Black 40.23 Hispanic 33.54 Asian 30.50 Unknown 27.82





Pneumococcal Immunization Rates by Race for Fee-for-Service Medicare Beneficiaries Ages 65+ as of 12/31/2010 Pneumococcal immunization rates by race for Fee-for-Service Medicare beneficiaries ages 65+ as of 12/31/2010 Percent

Overall 58.37 White 58.93 Other 44.82 Asian 43.87 Hispanic 43.64 Black 41.64 Unknown 36.49 Native American 34.77


Influenza Immunization Rates by Race for Fee-for-Service Medicare Beneficiaries Ages 65+ for the 2009 Flu Season 8/1/2009-3/31/2010 Influenza immunization rates by race for Fee-for-Service Medicare beneficiaries ages 65+ for the 2009 flu season 8/1/2009-3/31/2010 Percent

Overall 62.56 White 62.98 Other 55.53 Asian 54.59 Native American 49.19 Hispanic 45.27 Black 44.88 Unknown 43.33





Mammography Rates by County for Minnesota Fee-For-Service Female Medicare Beneficiaries Ages 52-69 for the Two-Year Period 1/1/2009-12/31/2010





Colorectal Cancer Screening Rates by County for Minnesota Fee-For-Service Medicare Beneficiaries Ages 50-80 as of 12/31/2010 Colonoscopy within 10 years, sigmoidoscopy within five years, double-contrast barium enema within five years, or fecal occult blood test within one year.





Pneumococcal Immunization Rates by County for Minnesota Fee-For-Service Medicare Beneficiaries Ages 65+ as of 12/31/2010





Influenza Immunization Rates by County for Minnesota Fee-For-Service Medicare Beneficiaries Ages 65+ for the 2009 Flu Season 8/1/2009-3/31/201





Drug Safety Drug-related problems can have profound medical and safety consequences for Medicare beneficiaries. Stratis Health has been working with Minnesota providers, Medicare Advantage organizations offering Medicare Advantage plans under Part C, and prescription drug sponsors offering prescription drug plans under Part D to improve the rates of potentially inappropriate medications (PIM) and drug-on-drug interactions (DDI). In Minnesota, PIM rates are significantly lower than national rates and DDI rates are approximately equal. The list of drugs used for this measure encompasses drugs found on the updated Beers list, Zhan’s list, and in HEDIS® 2006 measures. The Beers list was developed by a group of 12 clinicians with expertise in geriatrics and led by Mark Beers, M.D. Released in 1991, the Beers list was initially created to help clinicians determine which medications should be avoided in nursing home patients as seniors in nursing homes are particularly at risk for suffering medication-related problems. Since then, the Beers list has been updated twice, with the most current revision released in 2003. Despite controversy, the Beers list has remained the most enduring list of drugs to be cautious of prescribing for the Medicare population. Certain medications on the list are either no longer the drugs of choice and should be replaced by better alternatives, or have no clinical justification. The Zhan criteria extends the Beers list to identify drugs that should always be avoided, are rarely appropriate, or have indications for use in elderly patients but are frequently misused. In 2006, the National Committee on Quality Assurance included drugs to avoid in the elderly as a HEDIS® measure for quality.

Minnesota Medicare PIM and DDI Rates Minnesota PIM rates 8.77% DDI rates 8.59%

Source: Medicare Claims Data (1/1/2010-6/30/2010) U.S. data not yet released

Top 10 PIM for Minnesota

Brand Name Percent Nitrofurantoin Monohydrate/Macrocrystals 18.5 Cyclobenzaprine Hydrochloride 16.2 Acetaminophen-Propoxyphene Napsylate 12.8 Premarin 10.7 HydrOXYzine Pamoate 6.8 Atropine SO4-Diphenoxylate HCl 5.2 Nitrofurantoin Macrocrystals 4.8 Methocarbamol 3.5 Propacet 100 2.7 Dicyclomine Hydrochloride 2.1

Source: Medicare Claims Data (1/1/2010-6/30/2010)




Top 10 DDI for Minnesota

Precipitant Brand Name Object Brand Name Percent Levothyroxine Sodium Warfarin Sodium 20.4 Triamterene/Hydrochlorothiazide Lisinopril 11.2 Levothyroxine Sodium Jantoven 5.9 Spironolactone Lisinopril 5.9 Azithromycin Warfarin Sodium 4.6 Ciprofloxacin HCL Warfarin Sodium 3.9 Amiodarone HCL Warfarin Sodium 3.1 Atenolol Clonidine HCL 3.1 Sulfamethoxazole/Trimethoprim DS Warfarin Sodium 2.6 Metoprolol Tartrate Clonidine HCL 2.5

Source: Medicare Claims Data (1/1/2010-6/30/2010) The object drug is the drug in which effects or pharmacokinetics is impacted by subsequent administration of another drug. The precipitant drug triggers the change in effects or pharmacokinetics of another drug being administered. Drug interactions resulting in increased morbidity, mortality, and higher economic costs is a widely recognized public health issue.

Patient Safety Nursing Home Pressure Ulcers and Restraints Stratis Health provides technical assistance to nursing homes in Minnesota to improve rates of pressure ulcers and restraints.

Minnesota Nursing Home Rates for Pressure Ulcers and Use of Restraints Minnesota Nursing Home Measures 2008 2009 2010 Pressure Ulcers 9.63% 8.47% 7.93% Restraints 3.16% 2.24% 1.40% Source: MDS 2.0 (7/2008, 7/2009, 7/2010) Beneficiary Complaints Under Medicare, QIOs review complaints about the quality of care Medicare patients receive. Complaints come from Medicare patients and/or their representatives. In reviewing a complaint, the QIO looks at the services a patient received and decides whether those services met professional standards of health care that are commonly accepted by physicians and others in the medical community.

Quality-of-care complaints may involve more than one concern due to the following: (1) more than one quality-of-care concern in a single setting; (2) the same quality-of-care complaint for a single patient episode of illness involving multiple settings and/or providers; or (3) more than one quality-of-care concern involving more than one health care setting and/or provider. For example, a Medicare beneficiary complaint related to a hospital stay might include several quality-of-care concerns, or a beneficiary who has been hospitalized, then moved into a skilled nursing facility or other outpatient hospital setting might have the same quality-of-care concern occur in each setting. Consequently, for a specific setting or provider, the number of quality-of-care concerns confirmed by the QIO may exceed the number of beneficiary cases reviewed.




Minnesota Medicare Beneficiary Complaint Cases: Number and Review Results Total beneficiary complaint cases reviewed by the QIO 42 Cases with a confirmed quality concern 13 (30.95%) Cases without a confirmed quality concern 29 (69.05%) Cases per 10,000 Part A Medicare beneficiaries 0.51 Source: Case Review Information System (CRIS) (7/1/2010-6/30/2011)

Minnesota Complaints by Setting or Provider Care Setting or Care Provider

Total Number of Concerns

Number of Confirmed Concerns

Percent of Confirmed Concerns

Hospital 217 24 11.06 Skilled Nursing Facility 31 2 6.45 Physician 40 0 0.00 Other Provider 20 5 25.00 Source: Case Review Information System (CRIS) (7/1/2010-6/30/2011) Note: Skilled nursing facility includes swing and swing critical access, individual cases may involve more than one setting and/or provider

Minnesota Provider Community CMS continues to evolve the focus of the Medicare QIO Program. The new three-year QIO contract, which began August 2011, further expands Stratis Health’s quality improvement work across the continuum of care to include communities and transitions of care across provider settings. The following data provide an overview of these health care settings in Minnesota. Each setting was designated as urban, rural, or super rural based on the 2011 CMS zip code to carrier locality file because it allowed for evaluation of location by zip code, rather than county, which was too large. Hospitals Minnesota has 148 hospitals that serve residents through 9.8 million outpatient visits and 593,000 inpatient visits per year.7 Of these hospitals, 48 are publicly owned by a city, county, district, state, or federal jurisdiction and 85 hospitals are part of larger health systems.7 The majority of hospitals are private and nonprofit (96, 64.9 percent).7 Eighty five (57.4 percent) hospitals in Minnesota are accredited by the Joint Commission.8 Of all the hospitals in Minnesota, 132 are acute care hospitals; 53 of which are prospective payment system (PPS) hospitals and 79 of which are rural hospitals with the federal Critical Access Hospital designation, which means they receive cost-based federal payments to preserve access to care in rural areas. In short-stay and critical access hospitals, there are 18.7 beds per 1,000 enrollees. In long-stay hospitals, there are 1.5 beds per 1,000 enrollees.9

This compares to 17.8 and 2.4 respectively in the nation.8 The Minnesota Hospital Association is the trade association for hospitals in Minnesota.

7 Key Facts about Minnesota Hospitals. Minnesota Hospital Association. www.mnhospitals.org/index/tools-app/tool.160, viewed 2/8/2012

8 The Joint Commission. www.qualitycheck.org, viewed 2/8/2012 9 2010 CMS Data Compendium (2009 data)


http://www.mnhospitals.org/index/tools-app/tool.160�

http://www.mnhospitals.org/index/tools-app/tool.160�

http://www.qualitycheck.org/�



Primary Care Clinics More than 750 clinics in Minnesota focus on providing primary care services to adults (does not include pediatric-focused clinics). Many clinic sites are part of a health system or large multi-site medical group. Of all primary care clinics in Minnesota, 24.8 percent are super rural, 19.8 percent are rural, and 55.5 percent are urban. Minnesota has 12,370 employed physicians, of who 4,400 practice family, internal, and general medicine.10

The main professional associations for primary care physicians in Minnesota are the Minnesota Medical Association and the Minnesota Academy of Family Physicians. The clinic association is the Minnesota Medical Group Management Association.

Nursing Homes Minnesota has 386 licensed, registered, or certified nursing homes, which have an average of 83 certified beds (range 15-397), and serve an average of 76 residents (range 15-35).11

Minnesota and U.S. Medicare Skilled Nursing Facility Utilization

Of all Minnesota nursing homes, 50 (12.9 percent) are located within a hospital; 235 (60.9 percent) are non-profit; 109 (28.2 percent) are for-profit; and 42 (10.9 percent) are designated city, county, or hospital district government.10 Four (1.0 percent) nursing homes in Minnesota are accredited by the Joint Commission.8 Of all nursing homes in Minnesota, 31.6 percent are super rural, 28.8 percent are rural, and 39.6 percent are urban.10 Minnesota’s nursing home trade associations are Care Providers of Minnesota and Aging Services of Minnesota.

Minnesota U.S. Total Residents 37,365 1,887,965 Total Discharges 37,645 2,030,965 Total Covered Days 1,096,031 70,586,895 Average Days Per Discharge 29 35 Total Reimbursement $407,044,131 $25,583,022,245 Average Reimbursement Per Day $371 $362 Average Reimbursement Per Discharge $10,813 $12,596 Source: 2010 CMS Data Compendium (2009 data) Home Health Agencies Minnesota has 1776 licensed, registered, or certified home care providers in Minnesota and 203 Class A licensed, Medicare certified home health agencies.12

Eighty two (40.4 percent) are for-profit; 79 (38.9 percent) are non-profit; 41 (20.2 percent) are city, county, or hospital district government; and 1 (0.4 percent) is tribal.11 Of all Class A licensed, Medicare certified home health agencies in Minnesota, 28.1 percent are super rural, 24.1 percent are rural, and 47.8 percent are urban.11 Minnesota’s home health care trade association is the Minnesota Home Care Association.

10 Statehealthfacts.org (2010 data) 11 Medicare claims data (2010 data) 12 Minnesota Department of Health, Health Care Facility and Provider Database, www.health.state.mn.us/divs/fpc/directory/fpcdir.html, viewed 2/8/2012


http://www.health.state.mn.us/divs/fpc/directory/fpcdir.html�



Minnesota and U.S. Medicare Home Health Agency Utilization Minnesota U.S. Total Patients 29,076 3,283,229 Total Visits 669,258 129,241,449 Average Visits Per Patient 23 39 Total Payments $113,645,576 $18,895,276,901 Average Payment Per Patient $3,909 $5,755 Source: 2010 CMS Data Compendium (2009 data) Hospice Programs Minnesota has 113 licensed, registered, or certified hospice programs, with 63 Medicare certified.10 Forty-two (66.6 percent) programs are nonprofit; 13 (20.6 percent) are designated city, county, or hospital district government; and 8 (12.7 percent) are for profit.11 Of all Medicare certified hospice programs in Minnesota, 30.2 percent in Minnesota are super rural, 30.2 percent are rural, and 39.7 percent are urban. Minnesota’s hospice programs are represented by the Minnesota Network of Hospice and Palliative Care.

Minnesota and United States Medicare Hospice Utilization Minnesota U.S. Total Patients 15,868 1,090,976 Total Days 945,429 77,822,911 Total Covered Hours 28,588 26,982,884 Total Covered Procedures 6,255 1,381,718 Average Days Per Patient 60 71 Total Payments $145,371,311 $12,085,785,062 Average Payment Per Patient $9,161 $11,078 Source: 2010 CMS Data Compendium (2009 data)

Resources For questions or comments about the Profile of Medicare in Minnesota, contact Stratis Health, www.stratishealth.org, 952-854-3306.

Medicare Resources Many additional resources about Medicare services and the health of Medicare beneficiaries are available to the public. CMS provides information on quality measures for every Medicare-certified home health agency, Medicare and Medicaid-certified nursing home, and hospital in the U.S. This information is available at: www.medicare.gov (select Facilities & Doctors and Compare Home Health Agencies, Compare Nursing Homes, or Compare Hospitals), or from a toll-free help line, 1-800- MEDICARE (1-800-633-4227).

Minnesota Resources for Seniors AARP www.aarp.org Minnesota Board on Aging www.mnaging.org Minnesota Department of Health www.health.state.mn.us Minnesota Department of Human Services www.dhs.state.mn.us Senior Linkage Line www.mnaging.org/advisor/SLL.htm Social Security Administration www.ssa.gov



http://www.medicare.gov/�

http://www.aarp.org/�

http://www.mnaging.org/�

http://www.health.state.mn.us/�

http://www.dhs.state.mn.us/�

http://www.mnaging.org/advisor/SLL.htm�

http://www.ssa.gov/�

Documents

Profile of Medicare in Minnesota Report April 2012 · 2014-07-17 · Profile of Medicare in Minnesota 1 Stratis Health Purpose Stratis Health is pleased to provide this report on