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Identify potentially preventable high-cost ancillary services using powerful clinical grouping logic
The 3M™ Potentially Preventable Services (PPS) methodology helps identify high-cost ancillary services while generating actionable insights that can lower costs and decrease the use of low-value health care services.
3M PPS applies to all patients regardless of payer and helps generate actionable insights for lowering costs and decreasing the use of low-value health care services.
Overuse of imaging scans, diagnostic tests, specific procedures and other services has been well documented, exposing patients to unnecessary cost, inconvenience and risk. 3M PPS addresses the challenge by providing risk-adjusted and actionable data on the incidence and cost of overuse.
3M PPS compares services with diagnoses and performs risk adjustment based on the burden of illness in a patient population. It identifies providers and provider organizations with unusually high rates of ordering or providing potentially preventable services after considering differences in patient populations. In contrast, other approaches employ “all-or-nothing” rules that deny services or impose burdensome prior authorization, regardless of a provider’s past practices or patient population.
3M PPS applies to all patients regardless of payer. Identification of potentially preventable services relies on evidence-based guidelines. The logic is documented in a definitions manual available to any licensee. Licensees may choose to focus on specific types of potentially preventable services appropriate for their population.
The widely accepted 3M™ Clinical Risk Groups measures baseline population health status in comparing actual versus expected PPS rates. 3M PPS is one of the five 3M potentially preventable event methodologies that generate specific results for clinicians and health care managers to use in reducing cost and improving outcomes.
All about 3M PPS
3M PPS helps generate actionable insights, lower costs and decrease the use of low-value health care services.
Here are a few examples of the value 3M PPS can bring to clients:
The 3M PFP methodology is available in the following 3M products:
Available to licensees on the 3M Customer Support website:
Overuse of low-value tests, services and medications costs the American health care system $75 billion to $100 billion a year, according to a 2019 review article.¹ These figures do not include the impact on the patients who receive services of marginal utility that sometimes pose significant risk. Although overuse of specific tests, services and medications is well documented, the challenge has been what to do about it. Common approaches – such as expecting patients to second-guess their physicians, blanket denial of payment, or cumbersome authorization requirements – cause their own problems. Patients may not receive services that are medically appropriate in their circumstances, and back-and-forth authorization processes add more administrative costs of the U.S. health care system.
In 2012, 3M met this challenge by releasing the 3M™ Potentially Preventable Admission methodology as one of the three Population-focused Preventables. (The others are 3M PPS and 3M PPV).
As with all 3M PPE methodologies, three core concepts are essential. First, we recognize that not all services are potentially preventable. Second, what matters is not the individual service, but rather the overall rate of potentially preventable services. Instead of approaching quality with the mindset of “This should never happen,” we use a more realistic and meaningful approach of “This has happened too often.” Third, any comparisons across populations of patients must be risk-adjusted. In practice, that means that the actual 3M PPA experience of a population is compared with the experience that would be expected for a population with the same case mix.
3M PPS logic is divided into two phases.
Each service provided in a physician practice, outpatient hospital department (except emergency), or similar setting is assigned to one of approximately 600 3M™ Enhanced Ambulatory Patient Groups (EAPGs). The 3M PPS methodology compares the 3M EAPG with the principal diagnosis as classified by the diagnostic subgroup (DSG) component of the 3M™ Clinical Risk Groups (CRG) methodology. There are thousands of 3M EAPG/DSG pairs that indicate potentially preventable services. Examples (as of 2020) include:
Detailed output from 3M PPS allows licensees to focus on PPS categories such as imaging, lab, endoscopy or therapy.
Consider the example of two physician practices that have identical rates of ordering MRIs in the early evaluation of low back pain. If one practice’s patients are baseline healthy and the other practice’s patients have multiple comorbidities, the differences in baseline health status must be considered. This is done by calculating norms by Aggregated Clinical Risk Group (ACRG) and then comparing each practice’s actual PPS experience with its expected PPS experience. The typical result is identification of individual practices with excessive rates of ordering or providing low-value ancillary services. Addressing these concerns may be as simple as showing physicians how they differ from their peers.
3M PPS can also identify underuse. For example, when physician practices are paid by capitation (a flat rate per patient regardless of utilization), patients may be underserved. Again, comparing actual experience with expected experience (after case mix adjustment) provides actionable data for improvement.
Further information on the 3M PPS logic is available in the 3M™ Population-focused Preventables (PFP) Classification Methodology Overview (PDF, 759 KB). Detailed information is available to licensees in the online PFP definitions manual.
3M PPS clinical logic is maintained by a team of 3M clinicians, data analysts, clinical analysts, programmers and economists. The methodology is updated annually to reflect changes in the standard diagnosis and procedure code sets and make enhancements to the clinical logic.
¹Shrank WH, Rogstad TL, Parekh N. Waste in the US health care system: estimated costs and potential for savings. JAMA. 2019;322(15):1501-1509.
Learn more about 3M PPS
Please note that documents not published by 3M do not necessarily reflect 3M recommendations and have not been approved by 3M. These documents are listed here for the information of readers interested in the various ways that 3M patient classification methodologies have been applied. Also note that listing these references does not imply endorsement of 3M methodologies by individual authors, other organizations or government agencies.
Some articles and reports are available from the publishers at no charge, while others require a fee.
This manual describes the 3M PFP Methodology, a clinically-based classification system that identifies preventable hospital admissions, ED visits and ancillary services
With 3M software, you can closely examine hospitalizations, readmissions, complications and ED visits, as well as ancillary services and their associated costs.
This article details the use of comprehensive measures, referred to as potentially preventable events, and demonstrates how they are being applied to achieve health care value.
3M™ Enhanced Ambulatory Patient Groups (EAPGs) a specifically designed bundled payment appropriate for all ages of patients and the health care provided to them. 3M EAPGs are most appropriate for Medicaid and commercial populations, for example, neonate, maternity and dental care can be accommodated in 3M EAPGs.
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