About the Medical Group Ratings


Summary Rating: Quality of Medical Care


Each year, all of the participating medical groups who have commercial HMO health plan members are measured by the Integrated Healthcare Association (IHA) to determine if the medical care provided meets national standards for using treatments proven to be effective. The care provided to the medical group’s HMO member’s during 2016 is documented in medical charts and in HMO billing records for medical services and prescription drugs.

The ‘Quality of Medical’ rating is a summary clinical rating developed from 5 different health topics or conditions, like ’Checking For Cancer’. Each health topic is made from related quality measures. For example, the quality measures "Breast Cancer Screening", "Cervical Cancer Screening" and "Colorectal Screening" make up the health topic called ‘Checking For Cancer’. Twenty-one quality measures are reported; fifteen of the measures are combined into five health topics.

A quality measure gives the percent of patients who got the right care for an important health care goal. These goals were set to make sure that medical group patients are getting quality preventive care and treatment services. Scoring requires several steps:

  • First, scores are calculated for important quality measures of recommended medical care. For example, providers ordered a mammogram for their female patients 50-74 years of age every two years.
  • Second, measures related to a similar health area like "Checking For Cancer" care are combined into a health condition or topic rating. The measures are combined by giving them equal weight and calculating an average score that is converted to a star rating.
  • Third, the condition or topic scores are combined into a single summary star rating using the "same equal weight and average score formula".

The medical groups are rated using one of four performance grades that are displayed as stars in the Report Card:

Star Rating Category

Score*: Performance marks vary for each of the six quality patient experience ratings reported – all are based on comparison to the average scores across all reported medical groups for each specified quality measure

Excellent

Comparable to the top 90 percent of scores for all the medical groups across the specific quality measure

Good

Comparable to scores between 50 and 89 percent of ratings across all the medical groups for the specific quality measure

Fair

Comparable to scores between 25 and 49 percent of ratings across all the medical groups for the specific quality measure

Poor

Comparable to scores below the bottom 24 percent of ratings across all the medical groups for the specific quality measure

*The percentages in each rating category are rounded up to account for medical groups whose score falls just below a performance mark.

There are times when a medical group does not have enough patients to calculate a score for a quality measure or other reasons why a score is not shown. In these cases, the medical group does not receive a score for that quality measure. When calculating the star rating for the health topic that includes the quality measure, a formula is used to estimate a score for the missing information. The formula assumes that the medical group result for the missing measure would be similar to the difference between that medical group’s available scores and the average scores for all medical groups.

To understand how data is reported in these situations see explanations for the following labels: “Too few patients", “Not enough data to score reliably”, “Not rated” and “Not willing to report”.

For more detailed information on OPA's scoring methodology for the ‘Quality of Medical Care’ measures, see: Medical Group – Commercial Report Card, 2017-18 Edition Scoring Documentation for Public Reporting on Clinical Care document.

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Summary Rating: Patients Rate Overall Experience


Each year, a sample of medical group patients, who are members of commercial HMO health plans, is contacted by mail, phone or email to complete a survey called the Patient Assessment Survey (PAS). This survey collects information about patients’ experiences of care and service with their doctors and medical group. The surveys are completed by adults, ages 18-64, who had at least one doctor visit during the year. Usually, about 33% of members who are contacted complete the survey.

Patient experience ratings of the medical groups show PAS survey responses to the care provided by the medical groups in 2016.

The following six patient experience measures are reported in the Medical Group - Commercial Report Card

  • Rating of Doctor and Care
  • Communicating with Patients
  • Timely Care and Service
  • Helpful Office Staff
  • Coordinating Patient Care
  • Health Promotion

Scores for these six topics are based on the most positive choices for each survey question such as:

  • “Always” on a scale of “never to always”
  • “Definitely” on a scale of “definite to definitely not”
  • “Yes” on a scale of “yes or no”
  • “9” or “10” on a scale of “0 to 10” with “10” being most favorable

The score is calculated as a percentage of members who responded using the most positive responses for each quality measure. That score is then translated and displayed as a star rating using one of the four performance grades below:

Rating Category and Number of Stars

Score*: Performance marks vary for each of the six quality patient experience ratings reported – all are based on comparison to the average scores across all reported medical groups for each specified quality measure

Excellent

Comparable to the top 90 percent of scores for all the medical groups across the specific quality measure

Good

Comparable to scores between 50 and 89 percent of ratings across all the medical groups for the specific quality measure

Fair

Comparable to scores between 10 and 49 percent of ratings across all the medical groups for the specific quality measure

Poor

Comparable to scores below the bottom 9 percent of ratings across all the medical groups for the specific quality measure

*The percentages in each rating category are rounded up to account for medical groups whose score falls just below a performance mark.

Five of the topic scores above are then combined into a single summary star rating, called “Patients Rate Overall Experience.”

The scores are adjusted for a set of patient characteristics—age, gender, mental health status, education, overall health status, race/ethnicity, language spoken and number of chronic conditions. These characteristics have been shown to influence patients’ ratings of their care experience. Scores are also adjusted for the specialty of the physician seen by the patient and by the type of survey—answered in print, online or by phone. These adjustments allow similar comparisons across groups whose patients may differ. Through the adjustments, the groups’ results can be represented as if they all had a similar mix of patients.

For more information on the scoring methods for Patients Rate Overall Experience see: Medical Group - Commercial Report Card 2017-18 Edition Scoring Documentation for Public Reporting on Patient Experience document.

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“Too Few Patients,” “Not Enough Data to Score Reliably,” “Not Rated,” and “Not Willing to Report”


On the Medical Group - Commercial Report Card, scores range from one to four stars, with four stars being the highest rating. Sometimes, instead of a star rating or a score on a bar chart, you will see a brief note indicating that the medical group does not have a score. In those cases, you will see one of the following labels:

  • Too few patients: This means that based on statistical reliability measures the medical group did not have enough patients who had the experience to be scored.
  • Not rated: This means that a given measure is not applicable to a particular group. This could be because their patient population does not match the question, or because the group did not participate in the Patient Assessment Survey.
  • Not willing to report: This means that the medical group would not report its results.
  • Not enough data to score reliably: This means that the medical group results were not reported because the data available were not complete or reliable enough to score.

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How Reliable Are the Scores?


Enough patient records were checked to give a clear picture of how well each medical group is doing. However, anyone can have different experiences with their medical group. Your experiences may be the same as or different from the ratings shown here.

The ratings 'Quality of Medical Care‘ and ‘Patients Rate Overall Experience’ tell an important story about how well the medical group and its doctors do in meeting national standards for good care. This includes ensuring patients get the right care and that they don’t receive unnecessary care or services and that doctors and their staff provide good customer service, listen carefully, explain things clearly and treat patients with respect. These ratings cover only certain health conditions and topics and do not cover all aspects of medical care.

For additional information on the patient experience PAS scoring methodology refer to this document.

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Medical Group and HMO and PPO Ratings are not comparable


HMOs and PPOs are types of health insurance. The medical groups in the Report Card are groups of doctors who work with the HMOs listed in the Health Plan Report Card as well as other health plans to give medical care to patients. The ratings for HMOs, PPOs and medical groups cannot be compared because:

  • The quality of the care of HMOs, PPOs and medical groups are measured and rated in different ways.
  • HMOs, PPOs and medical groups keep different kinds of records. This means that the information we get from them is different.
  • We did not look at the same members when we looked at information from medical groups, HMOs and PPOs, even when we were looking at medical care for the same health topic. For example, a person whose diabetes care was reviewed for her medical group may not have had her diabetes care reviewed for her HMO.

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Where did the data for the Medical Group - Commercial Report Card come from?

Integrated Healthcare Association (IHA)


The Integrated Healthcare Association (IHA) is a non-profit, multi-stakeholder leadership group that promotes healthcare quality improvement, accountability, and affordability for the benefit of all Californians. As a regional healthcare improvement collaborative, IHA convenes diverse, cross-sector organizations to collaborate on challenging healthcare issues. IHA membership includes industry-leading health plans, physician groups, and hospital systems, plus academic, consumer, purchaser, pharmaceutical and technology representatives. Principal projects and activities include the California Value Based Pay for Performance (VBP4P) Program, performance measurement, payment innovation, administrative simplification, and promoting the use of health information technology and integrated care delivery. The VBP4P Program generates the clinical performance measures used in the ‘Quality of Medical Care’ and ‘Total Cost of Care’ ratings.

The Medical Group – Commercial Report Card also includes information about the winners of IHA’s annual Excellence in Healthcare Awards, which recognize medical groups that achieve strong quality and patient experience results while effectively managing costs. IHA determines the award-winning medical groups using the P4P Program’s clinical quality, patient experience, and cost data.

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California Healthcare Performance Information System (CHPI)


The ‘California Healthcare Performance Information System' (CHPI) is a non-profit, public benefit corporation whose mission is to serve as a trusted source of healthcare data by accurately measuring the quality and cost of care, reporting performance ratings, educating the public about healthcare value, and helping to drive improvements in healthcare in California. CHPI combines administrative claims and encounter data from three major health plans in California and Medicare. CHPI was designated as a Qualified Entity (QE) through the Medicare Data Sharing Program in February 2013. This collaborative works to provide trustworthy information to help the public and healthcare purchasers find high quality, high value healthcare.

CHPI administers the Patient Assessment Survey (PAS), which measures patients’ experience with their medical groups, and develops the methodology for displaying PAS ratings. This information is published annually to help consumers choose a doctor. PAS is also used in the IHA P4P Program, as well as in the Medical Group – Commercial Report Card.


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