The MPIRICA Quality Score: What Is It?

What is the MPIRICA Quality Score?

The MPIRICA Quality Score is an objective measure of medical performance based on documented medical outcomes. The score ranges from a low of 100 (sub-optimal care), up to a high of 800 (superior care), similar to a credit score. It individually measures hospitals and physicians, at the procedure level. Each provider may have multiple scores, based on the procedures performed.

Why should I trust the MPIRICA Quality Score?

The methodology behind the score was created by a team of doctors and statisticians at MPA Healthcare Solutions with three decades of healthcare analytics experience. The MPIRICA Quality Score is based on outcomes, not subjective reviews, and uses the most recent 3 years of the largest publicly available dataset. The score also considers hundreds of relevant risk adjustment factors. We believe it is the most comprehensive and robust score available in the industry.

Why is the MPIRICA Quality Score important to patients, their families, their physicians, and their employers?

Making good health care decisions is difficult, and interpreting healthcare data overwhelms most consumers. By summarizing a lot of very complex information into an easy-to-understand three-digit number, the MPIRICA Quality Score arms consumers with information to make healthcare purchasing decisions easier.

The score includes a set of clinically-driven, scientifically-valid, appropriately-weighted elements about what matters to patients, such as:

  • How likely am I to experience the ultimate poor outcome, death?
  • How likely am I to experience an adverse outcome during my hospitalization?
  • How likely am I to be readmitted to a hospital after I’m discharged?

The MPIRICA Quality Score gives consumers, their families, and physicians a single score to compare physicians and facilities; giving everyone the peace of mind when choosing providers for elective surgery.

What is the difference between the MPIRICA Quality Score for hospitals and that for individual physicians?

The hospital and individual physician scores are calculated using the same scoring methodology and consider the same elements of clinical performance. Each individual physician score is calculated using data specific to that physician for a procedure, while the hospital score is calculated using all the cases performed at that hospital by any physician performing that procedure.

What number range is considered to be a "good" score? What about a "bad" or "average" score?

A score of around 600 represents average care at good performing facilities. Scores of 700 and above represent superior care. Scores of less than 400 represents substandard care.

Small differences between scores may not be meaningful, but a greater difference between scores represents an increased degree of certainty that there’s a material difference in the quality of care being delivered.

A high score doesn’t guarantee a favorable outcome and a low score doesn’t guarantee a poor outcome. However, lower scores indicate, based on historical performance, there is greater risk of having an unfavorable outcome resulting from the care delivered.

How is the MPIRICA Quality Score different from hospital ratings and quality information available on other websites?

The MPIRICA Quality Score is based entirely on objective measures of actual medical outcomes supported by real data. This means the MPIRICA Quality Score is grounded in fact – not opinions.

The MPIRICA Quality Score is risk-adjusted at the patient level using sophisticated predictive modeling techniques. This ensures that the MPIRICA Quality Score reflects the actual quality of care – rather than the complexity of individual patients.

There are three components that go into the MPIRICA Quality Score:

  1. In-patient mortality rate. That's obviously of great significance to both insurers and patients.
  2. Severe complications of care while the patient is in the hospital. We weight this information with mortality rates as well as the effect of in-patient complications among live discharges.
  3. 90-day continuum of care: This component factors in events that happen within the 90 days that follow discharge. For example, did the patient survive for 90 days? Was the patient re-admitted to the hospital with a relevant problem relating to their surgery?

Hospital or physician performance on these three components are then individually weighted, scaled, and aggregated to produce a single score that consumers can use to compare different hospitals that are being evaluated.

Other ratings or measures may have differing methodologies.

What data is used to ensure that the MPIRICA Quality Score is a reliable source for surgery procedure quality?

The MPIRICA Quality Score uses data from Medicare called MedPAR (Medicare Provider and Analysis Review), one of the largest databases of healthcare records in the world; this database contains inpatient hospital final action stay records for all Medicare beneficiaries.

Here’s why we use Medicare data: all hospitals that care for Medicare patients are required by law to submit accurate data to CMS in order to receive payment for patient care. The data is audited, and misrepresentation of data is punishable by fine and prison time. The data is standardized and is more robust than most claims data available for analysis. It’s also available for virtually every hospital in the country – and that allows for a national comparison of performance.

Since Medicare is the largest single payer for services at most hospitals, the data it provides is the most comprehensive available – even if it only represents the experience of patients who are 65 years or age and older. Practice patterns are unlikely to differ significantly and risk factors and their relative influence on outcomes are very consistent across age groups. While a dataset that includes the full age spectrum would be even better, Medicare data is the best available – and we believe it is generally representative of the quality of care delivered.

Every patient's situation is different, and each physician and hospital have different patient populations. How can the MPIRICA Quality Score be a true apples-to-apples comparison of quality?

To account for patient risk, predictive models are created using more than 500 potential risk factors that may influence the outcomes. These models are used to compute predicted outcomes for each provider.

This method creates a level playing field when comparing two providers.

Say, for example, that you were comparing the performance of two hospitals – each caring for the same number of patients. Hospital A has five deaths and Hospital B has 10 deaths. After applying the predictive models that account for the severity of cases, we learn that based on the patients’ existing health conditions, three deaths should be expected for Hospital A and 15 deaths for Hospital B. Despite having more deaths, Hospital B is performing very well on a sicker population (meaning fewer deaths than predicted) than Hospital A.

Can the MPIRICA Quality Score predict which provider will be most successful and safest for my procedure?

The MPIRICA Quality Score provides an indication of which providers are most likely to deliver the best results based on recent performance. This doesn’t mean good results can’t happen with providers with low scores and bad results can’t happen with good providers.

The MPIRICA Quality Score cannot guarantee outcomes. However, assuming current performance reflects recent performance, the likelihood of good outcomes are greater when a provider has a high MPIRICA Quality Score. The score gives you a sense of who might give you the best chances for good results. Who wouldn’t want to stack the odds in their favor?

Tell me more about why the MPIRICA Quality Score is the industry leading reference for hospital and physician quality?

The quality metrics used by the MPIRICA Quality Score were developed by a team of leading healthcare analytics experts, each with decades of experience analyzing medical data and assessing clinical quality.

The idea for the score came from MPIRICA’s founder and CEO, Shakil Haroon, a veteran software entrepreneur. The methodology behind the score is the work of MPA Healthcare Solutions, whose innovations over the last 30 years have included:

  • A measure for adverse outcomes that’s more objective than reported complications
  • Separate length-of-stay indicators for effectiveness and efficiency
  • Episode-based risk adjustment for global reimbursement

Members of the team at MPA have been published in numerous journals; a selected list related to medical quality analytics can be provided upon request to quality@mpirica.com.

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