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MVC Launches First Preoperative Testing Awareness Week

Prior to surgery, most Michigan patients will undergo a series of tests, such as blood draws, urinalysis, chest x-rays, or electrocardiograms (ECGs/EKGs). Many of these tests are unnecessary for healthy patients undergoing low-risk procedures, such as groin hernia repair or cholecystectomy. Routine preoperative testing is widely considered a low-value service, and yet a majority of hospitals continue to order these tests.

Last week the Michigan Value Collaborative (MVC) helped to increase awareness about low-value preoperative testing during its first-ever Preoperative Testing Awareness Week. MVC distributed press releases, published a daily cadence of social media content on Twitter and LinkedIn, and launched a new video (shown above) about preoperative testing – all in service of inspiring collaboration in this area.

MVC first focused on preoperative testing in 2020, when the Coordinating Center selected it as a priority area for its Value Coalition Campaigns. Since then, MVC has taken steps to reduce the use of unnecessary preoperative testing for surgical procedures to improve quality, reduce cost, and improve the equity of care delivery in Michigan. Throughout Preoperative Testing Week, the Coordinating Center’s goals were to describe the potential harm of unnecessary testing, showcase the variability in testing practices across the collaborative, and connect members with MVC resources that could help.

MVC primarily supports members via two key strategies. One is data analysis and reporting. MVC analysts utilize administrative claims data to calculate testing rates in the preoperative period, and then share these results with members as reports or as unblinded data at collaborative-wide meetings. More recently, MVC partnered with the Michigan Surgical Quality Collaborative (MSQC) to distribute these reports more widely, which enables both clinical and quality personnel to identify patterns, explore new strategies, and work together to reduce preoperative testing at each hospital.

These reports are an invaluable resource in benchmarking the extent of the issue statewide since MVC data can show members how their rates compare to other Michigan hospitals. By focusing on a homogeneous cohort of healthy patients undergoing common, low-risk surgical procedures, MVC benchmarks can help all hospitals understand where they have an opportunity to improve, regardless of facility size, resources, or patient population.

MVC data reveals large variability between hospitals—so much so that even high-performing hospitals have room to safely reduce testing rates. Across the collaborative, preoperative testing rates among young, healthy patients range from 10% to 97% in MVC hospitals. Even within hospitals, there is usually variation, with certain surgeries driving the overall rate.

The other key strategy MVC uses to support members is engagement events, which help facilitate collaboration and resource sharing among peer hospitals and physician organizations. The MVC team supports its member base of more than 100 hospitals and 40 physician organizations through events like stakeholder meetings and workgroups, where clinicians and quality improvement staff can discuss solutions to common challenges. Last week, MVC hosted a special, one-time workgroup on preoperative testing as part of its “Health in Action” workgroup series. The session featured guest presenter Dr. Michael Danic, DO, for a presentation titled, “Safe, Evidence-Based Reductions in Preoperative Testing: Why is it so hard to change?” Dr. Danic is a board-certified anesthesiologist at Ascension Genesys who has served in several leadership positions for quality and safety initiatives. A recording of the full workgroup is available here.

At the conclusion of the week, the MVC team helped its stakeholders connect to educational materials, data, specialists, and successful peers in this space. The Coordinating Center urges its members to take steps to understand their role in unnecessary preoperative testing and improve the patient experience.

The Coordinating Center is eager to continue this momentum in pursuit of a variety of goals for 2022 and beyond. If your hospital or physician organization would like support with reducing preoperative testing rates or has a success story that could help others, please reach out directly to MVC at michiganvaluecollaborative@gmail.com.

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MVC Registry to Soon Include Patient-Level Medicare Data

MVC Registry to Soon Include Patient-Level Medicare Data

In the coming weeks, MVC registry users will receive communications outlining several required steps related to implementing the Coordinating Center’s new data use agreement (DUA) as a qualified entity (QE) with the Centers for Medicare and Medicaid Services (CMS). The QE DUA permits MVC to display Medicare Fee-For-Service (FFS) claims data with fewer data suppression limitations than its research DUA within its online registry. As a result, authorized users of the MVC registry may gain access to identifiable Medicare beneficiary data.

These changes are the result of years of work by the MVC team to earn its QE status through the Qualified Entity Certification Program (QECP), which is also known as the Medicare Data Sharing for Performance Measurement Program. The QE application includes multiple phases before an entity is permitted to show patient-level data. The MVC Coordinating Center has been working through the final phase (see Figure 1) of the application, which involves developing and documenting measures for public reporting.

Figure 1.

The QE Medicare data will be contained in a separate tab on the MVC registry. Authorized users will have access to both the existing Medicare FFS reports as well as the QE reports. The QE data will be available for the most recent 18 months of index admissions only and will not have any case count suppression, allowing users to see the more granular data that is censored in the Medicare FFS reports.

The QE reports also have additional patient population filters to view the data by patient comorbidities, patient age, and more granular date options. These reports also feature trend graphs that can be viewed monthly, quarterly, or annually. In addition to uncensored data, the QE data will allow for patient-level drill-down as is currently available in the Blue Cross Blue Shield of Michigan data. The drill-down includes detailed information on the patient’s comorbidities, price standardized episode payments, and claim level walk-through. Although patient drill-down is available, the provider identifiers have been removed in conjunction with the QECP regulations. Additionally, the skilled nursing facility report is not available in the QE reports to avoid identifying providers.

For those with access, the QE reports should be used when evaluating the most recent years of data. The Medicare FFS reports can still be useful for historical trends and the Coordinating Center may be able to provide custom reports to fill in information that isn’t available through the registry. The patient-level drill-down can be used in conjunction with a hospital’s clinical information to understand what led to high-cost patients. The QE data should make Medicare data more useful to hospital members. However, QE data is only to be used for quality improvement rather than for marketing purposes. Additionally, authorized users are prohibited from disclosing or redistributing data provided in these reports outside of their institution.

Next week MVC member hospitals will receive a new QE DUA to be reviewed and signed by an authorized representative from their institution. This signed DUA is a prerequisite for receiving access to the new QE pages once they are available. MVC’s current CMS research DUA will remain in effect on non-QE registry pages and will continue to utilize data suppression for fewer than 11 episodes to protect patient identities. The MVC registry will also implement multifactor authentication (MFA) upon login for all registry users regardless of QE access in order to comply with the new DUA's security and data privacy requirements.

In the coming weeks, MVC members and registry users are encouraged to be attentive to any communications containing additional details or requests. In the meantime, please contact the MVC Coordinating Center with any immediate questions at michiganvaluecollaborative@gmail.com.

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New MVC Northern Summer Meeting Planned for August

New MVC Northern Summer Meeting Planned for August

MVC will launch a new in-person event this summer when it hosts members and speakers from Northern Michigan. This new MVC Northern Summer Meeting is modeled after the collaborative-wide semi-annual meetings, but it aims to focus on unique challenges and opportunities in delivering healthcare in this part of the state. The event will take place on August 18, 2022, from 12-5 p.m. at the Great Wolf Lodge in Traverse City, MI.

As MVC has gained new members, it has also diversified with the addition of more rural and critical access hospitals. These types of sites – many of which are located in the upper peninsula or northern half of the lower peninsula – play an integral role in the health system and have a unique care delivery experience. According to the Centers for Medicare and Medicaid Services (CMS), these types of hospitals have higher performance quality measures than their urban counterparts for areas such as safety, community engagement, efficiency, and cost reduction. At the same time, however, they also face unique challenges related to low patient volumes, higher rates of chronic disease, insufficient workforce recruitment and retention, and low reimbursement rates, among others.

It is these unique strengths and challenges that will be the focus of the day’s agenda, which will include speakers representing area hospitals, rural health organizations, community agencies, and the MVC Coordinating Center. The event’s keynote speaker will be Crystal Barter, MSA, Director of Programs and Services for the Michigan Center for Rural Health. Her presentation on “Michigan’s Rural Health Landscape: Challenges and Opportunities” will set the stage for the afternoon and be followed by speakers on specific topics, such as Hospital at Home care models and the aging population.

The other speakers include Stephanie Pins, MSA, Director of Quality Management, Risk, and Compliance, and Kristine Boyer, MSN, RN, Clinical Quality Manager, of MyMichigan Medical Center - Sault; Dr. Aditya Neravetla, MD, Chief Medical Officer at Munson Healthcare Grayling Hospital; and Jenna Lindholm, RN, CCM, Clinical Quality Supervisor at the Region 9 Area Agency on Aging.

The MVC Coordinating Center will also provide its latest updates as well as unblinded data to encourage member collaboration. The event includes dedicated networking sessions at the start and end of the day’s agenda when members can compare notes and glean ideas from peers.

MVC distributed invitations to northern members at the beginning of June and plans to share the full agenda with additional event specifics in the coming weeks. Those members who received invitations are encouraged to RSVP now.

If you have any questions about the upcoming event, contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

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MVC’s Latest CDM Push Report Reframes Focus to Follow-Up Care

MVC’s Latest CDM Push Report Reframes Focus to Follow-Up Care

The Michigan Value Collaborative (MVC) distributed its chronic disease management (CDM) push report recently, which has been refreshed and reframed from its previous iterations. Originally termed the CDM congestive heart failure (CHF) report and the CDM chronic obstructive pulmonary disease (COPD) report, the new “CDM follow-up report” focuses more specifically on follow-up care after hospitalization for the two conditions.

The newest version aims to provide additional granularity into follow-up care at member hospitals by showcasing variability across different windows of time, across payers, and by type. MVC defines follow-up as episodes where a patient had an outpatient follow-up visit (in person or by telehealth) within 30 days or before a readmission, inpatient procedure, emergency department visit, skilled nursing facility admission, or visit for inpatient rehabilitation.

The report features a new patient population snapshot table that highlights demographic data. These tables (see Figure 1) provide each hospital with demographics for their CHF/COPD patient populations, including race, mean age, the average number of comorbidities, and the proportion of patients who are dual-eligible.

Figure 1.

MVC hospitals will see comparisons to their peers on 7-day, 14-day, and 30-day outpatient follow-up rates, as well as 30-day risk-adjusted total episode payments and 30-day outpatient follow-up rates stratified by payer. Members will also see their individual hospital’s breakdown of follow-up types at 30 days, and trends over six months for 3-, 7- and 14-day rates.

Each figure presented reflects index admissions from 1/1/18 – 12/31/20 for Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, Blue Care Network (BCN) Commercial, BCBSM PPO Medicare Advantage, BCN Medicare Advantage, Medicare Fee-For-Service, and Medicaid. Hospitals received report pages for each condition if they met the threshold of at least 11 episodes in each year of data for that condition.

There was wide variation in follow-up rates across the collaborative, with member follow-up rates ranging from less than 40% after 30 days to approximately 80% (see Figure 2). In addition, 30-day follow-up rates were lowest within the Medicaid patient population with an MVC average of 58% (see Figure 3); the collaborative-wide averages for 30-day follow-up among BCBSM/BCN and Medicare patients were 76% and 73%, respectively. It was also the case that most patients (92% on average) received follow-up care in person as opposed to a remote or hybrid option (see Figure 4).

Figure 2.

Figure 3.

Figure 4.

The CDM follow-up report was distributed in partnership with the Integrated Michigan Patient-Centered Alliance in Care Transitions (I-MPACT) Collaborative Quality Initiative (CQI). I-MPACT is a unique patient-centered, data-driven collaborative that engages hospitals and provider organizations throughout Michigan in developing and implementing innovative approaches for improving care transitions. They work to improve the transition of patients between care settings with the goal of bettering outcomes and reducing readmissions.

In addition to partnering with I-MPACT to expand the report’s reach, MVC also partnered with a CQI to provide members with supplemental materials that may be relevant to their work with CHF/COPD patients. The Healthy Behavior Optimization for Michigan (HBOM) CQI provided tobacco cessation materials that were shared alongside the MVC report, including a Quit Smoking Resource Guide and Quit Smoking Medication Guide. HBOM aims to ensure that all smokers who are interested in quitting receive the support and resources they need to be successful. Read more about HBOM’s materials and efforts in MVC’s May CQI spotlight blog.

In addition to continuing to offer its CDM push report, the MVC Coordinating Center offers a bimonthly CDM workgroup. The next workgroup will take place on Tuesday, July 12 from 1-2 p.m., and will feature a presentation about the Sparrow Pain Management Center’s Care Management Program. Please register today to join the MVC Coordinating Center for this presentation and discussion.

If you have any suggestions on how these reports can be improved or the data made more actionable, the Coordinating Center would love to hear from you. MVC is also seeking feedback on how collaborative members are using this information in their quality improvement projects. Please reach out at michiganvaluecollaborative@gmail.com.

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HBOM Resources Help CQIs, Providers Reduce Smoking

HBOM Resources Help CQIs, Providers Reduce Smoking

Today, the leading preventable cause of death, disease, and disability in the United States is tobacco use. National studies show that 70% of smokers want to quit, but in Michigan only about 15% receive treatment. This critical gap is the current focus of one of the newest population health Collaborative Quality Initiatives (CQIs) in the Blue Cross Blue Shield of Michigan (BCBSM) Value Partnerships portfolio. The Healthy Behavior Optimization for Michigan (HBOM) CQI aims to ensure that all smokers who are interested in quitting receive the support and resources they need to be successful.

HBOM’s mission is to make “the healthy choice the easy choice,” which is accomplished in this case by providing tobacco cessation support throughout the state of Michigan through value-based reimbursement (VBR). In 2022, nine CQIs committed to working with HBOM to provide targeted, just-in-time tobacco cessation support to seize on their “teachable moment.” This approach draws on evidence-based behavior change strategies that leverage unique shifts in patient motivation around major health events, when they may find new motivation to commit to positive health behaviors like smoking cessation.

HBOM works with hospitals, clinics, and care teams across the state of Michigan through its partner CQIs to promote healthy behaviors among patients. They also provide partner CQIs and their respective members with the infrastructure and metrics to measure the impact of these changes. Although HBOM is primarily concerned with three health behaviors (smoking cessation, healthy eating, and physical activity), smoking cessation is their current focal point.

HBOM’s smoking cessation tools and resources are available in both paper and electronic formats to ensure equitable access, and are being shared widely at the patient, physician, and organization levels. Clinicians can share these materials with patients to increase access, awareness, and utilization of smoking cessation opportunities. One example includes a “Tap for Support” near-field communication (NFC) badge (see Figure 1) that clinicians and healthcare staff can wear for patients to scan with their phone, providing them with instantaneous online smoking cessation tools and resources.

Figure 1.

Another example is the Tobacco Cessation Box that HBOM tailored to meet the needs of those wishing to quit smoking. In addition to the badges, it includes HBOM’s Quit Smoking Resource Guide Tear Off Pad (see Figure 2), which providers can use as a discussion tool for Nicotine Replacement Therapy options. The box also includes a reference guide containing a high-level overview of tobacco cessation prescription medication options and HBOM’s VBR toolkit.

Figure 2.

When CQIs and their members wish to learn more or provide support beyond the resources mentioned above, they can connect with HBOM to discuss state-wide smoking cessation metrics, best practices, challenges, and collaboration opportunities. The HBOM collaborative meets regularly with participants and partnering CQIs to address challenges and improve population health. The team is also closely connected with the Michigan Tobacco Quitline and resource recommendations delivered by text message for anyone who wishes to quit smoking.

The MVC and HBOM teams have discussed plans to include HBOM resources in future relevant MVC report communications, such as those chronic conditions that are related to tobacco use. In the meantime, hospitals and physicians can request their own tobacco cessation boxes (see Figure 3).

Figure 3.

For more information on HBOM, visit their website.

As the Michigan Value Collaborative (MVC) continues to build its offerings for members, the Coordinating Center is cognizant that many other CQIs also partner with hospitals and providers throughout Michigan. Throughout 2022, MVC will post a series of blogs about some of its peer CQIs to showcase their activities and highlight collaborations with MVC. Please reach out to the MVC Coordinating Center with any suggestions or questions.

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MVC, BMC2 Launch Michigan Cardiac Rehab Network & Toolkit

MVC, BMC2 Launch Michigan Cardiac Rehab Network & Toolkit

This year in the United States, cardiovascular disease will be responsible for one in every four deaths. Despite its prevalence, few cardiac patients eligible for cardiac rehabilitation utilize this life-changing program. In response, the Michigan Value Collaborative (MVC) and the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) recently established the new Michigan Cardiac Rehab Network (MiCR) to collaborate on efforts that heighten awareness of these programs and support meaningful improvement in Michigan.

Cardiac rehabilitation (CR) is a comprehensive program encompassing supervised exercise, nutrition education, smoking cessation, mental health resources, skills training for heart-healthy lifestyles, and peer support from others who are experiencing a similar life event. It has a Class IA indication for recent cardiac-related events or procedures, meaning there is high-quality evidence that it is beneficial to patients. In fact, individuals who complete the full program of 36 sessions have a 47% lower risk of death and a 31% lower risk of heart attack than those who attend only one session. The evidence is clear that CR extends life and improves quality of life for patients with a recent cardiac-related event or procedure. Unfortunately, only one in three eligible Michiganders participates—a rate well below the Million Hearts nationwide goal of 70% participation.

Using claims data, MVC can assess both initiation and adherence – whether and when someone starts CR, and how long they keep going. There is wide variability in CR rates between MVC’s member hospitals (see Figure 1 for a sample plot from a recent blinded report). The site with the highest rate of cardiac rehab after coronary artery bypass graft surgery (CABG), for example, succeeds at sending 75% of their CABG patients to CR, while another only sends 28% of their CABG patients. This variation shows that it is possible to reach high CR rates, and hospitals can learn from each other to make improvements that save lives and reduce costs.

Figure 1. Collaborative-Wide CR Use Following CABG Discharge

MiCR was developed for this reason and will work to equitably increase CR participation for all eligible individuals in Michigan. Serving as Co-Directors of MiCR are Mike Thompson, Co-Director of MVC, and Dr. Devraj Sukul, Associate Director of BMC2 PCI. MiCR will distribute regular CR utilization summaries to relevant providers, convene regular meetings with its stakeholder and advisory groups, create resources that help hospitals and CR facilities optimize CR utilization, and continue to leverage the expertise of both CQIs.

In one of its first coordinated efforts, MiCR worked with CR providers and content experts to create a Cardiac Rehab Best Practices Toolkit, which was launched in April. It outlines initiation, maintenance, and innovation strategies for increasing the utilization of CR (see Figure 2 for a sample page). MVC encourages members to turn to this tool as they work to encourage the enrollment of more patients.

Figure 2. Sample Page from MiCR Best Practices Toolkit

The partner CQIs behind MiCR also released new statewide goals for improved CR utilization. Currently, 30% of patients utilize CR following transcatheter aortic valve replacement (TAVR), surgical aortic valve replacement (SAVR), coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI), and acute myocardial infarction (AMI). The first goal is to reach 40% CR utilization for TAVR, SAVR, CABG, PCI, and AMI patients. In addition, only about 3% of congestive heart failure (CHF) patients currently utilize CR. The second statewide goal is a collaborative-wide utilization rate of 10% for CHF patients. Progress on these goals will be shared by MVC in its CR reports sent every six months.

The two CQIs will also continue with their respective activities in the CR space. MVC supports CR participation in two primary ways. One is providing opportunities for MVC members to collaborate, and the second is the preparation of reports using its unique multi-payer data sources. The MVC team supports collaboration through stakeholder meetings and workgroups, which allow sites and clinicians to share solutions for common challenges. The reports MVC prepares analyze member claims data with time-specific hospital-level information on CR enrollment and completed visits within one year of discharge. This allows hospitals to benchmark their performance against peers and identify areas for improvement. MVC will also share unblinded data on CR rates with members at its May semi-annual meeting in one week, which is meant to drive conversation and encourage best practice sharing across the collaborative. The MVC team hopes that its outreach and resources help members to save lives by providing strong endorsements for CR and addressing barriers that may limit patient participation.

For more information on MVC’s CR efforts, visit MVC’s Value Coalition Campaign webpage. For more information about CR, view this MVC video or visit the Million Hearts website. If you have questions about any of the above activities or resources, reach out to the Coordinating Center at michiganvaluecollaborative@gmail.com.

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Sepsis Push Reports Include Demographics, COVID Patients

Sepsis Push Reports Include Demographics, COVID Patients

For the last two years, the Michigan Value Collaborative (MVC) Coordinating Center has offered a sepsis service line developed in partnership with the Michigan Hospital Medicine Safety Consortium (HMS). In conjunction with this work, reports customized to each member hospital are distributed each year. The most recent iteration shared with members this week features several updates from the 2021 versions.

A new patient population snapshot table is one new feature that the MVC Coordinating Center added in order to integrate its demographic data. These tables (see Figure 1 for a sample table of a blinded acute-care hospital) provide each hospital with demographics for their sepsis patient population, including race, mean age, top patient zip codes, the most frequent and average number of comorbidities, the proportion of dual-eligible patients, and the proportion of patients with a confirmed diagnosis of COVID-19. Furthermore, this data is stratified by payer, providing additional insights into specific groups of patients.

Figure 1.

The inclusion of COVID-positive patient percentages is an important statistic since this iteration of the sepsis push report includes COVID patients, whereas the Coordinating Center removed these patients in previous versions. This final row of the patient population snapshot table will help hospitals understand the extent to which their data is driven (or not) by patients with a confirmed COVID diagnosis code. Across the collaborative, 90-day total episode payments increased in 2020, which can likely be attributed to episodes with a COVID diagnosis; however, the 2020 average is not much higher than the average from 2018 through early 2019 (see Figure 2). Since the COVID-19 pandemic hit regions of Michigan at different times, regional comparisons for select measures will be particularly useful in understanding one’s data. Different versions of the report were created for acute-care and critical access hospitals, which allowed for tailored comparison groups.

Figure 2.

The complete report compares MVC hospitals on 90-day risk-adjusted total episode payments, inpatient length of stay, Intensive Care Unit (ICU)/Cardiac Care Unit (CCU) utilization, inpatient mortality and discharge to hospice, 90-day post-acute care utilization, and 90-day readmission rates. Each figure presented reflects index admissions from 1/1/18 – 12/31/20 for Medicare FFS, Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, Blue Care Network (BCN) Commercial, BCBSM PPO Medicare Advantage, BCN Medicare Advantage, and Medicaid.

In addition to continuing to offer its sepsis push reports, the MVC Coordinating Center also offers a bimonthly sepsis workgroup. The next workgroup will take place on Thursday, May 26 from 2-3 p.m., and will feature a presentation about successes in sepsis-bundle compliance. Register today to join the MVC Coordinating Center for this presentation and discussion.

If you have any suggestions on how these reports can be improved or the data made more actionable, the Coordinating Center would love to hear from you. We are also seeking feedback on how collaborative members are using this information in their quality improvement projects. Please reach out at michiganvaluecollaborative@gmail.com.

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MVC Integrates Surgeon-Level Data in Latest Preop Reports

MVC Integrates Surgeon-Level Data in Latest Preop Reports

In 2020, the Michigan Value Collaborative (MVC) introduced the Preoperative Testing Value Coalition Campaign (VCC) with the aim of reducing the use of unnecessary preoperative testing for surgical procedures. Preoperative testing, especially in low-risk surgical procedures, often provides no clinical benefits to patients but is ordered regularly at hospitals across Michigan. As part of MVC’s campaign to eliminate unnecessary and potentially harmful preoperative testing, the Coordinating Center developed a related push report, the latest version of which was shared earlier this week to help members benchmark data for common preoperative tests. MVC and the Michigan Surgical Quality Collaborative (MSQC) partnered to distribute these reports more widely and to encourage clinical and quality personnel to work together in identifying patterns and exploring new strategies.

This iteration of the report is the first to include blinded surgeon-level reporting, which will allow for a more nuanced understanding of variation within a given hospital. To include this, the Coordinating Center attributed one surgeon per episode based on condition-specific BETOS codes and NPI specialty information, with the understanding that the attributed surgeon may not be the individual ordering the preoperative test for that procedure. If their MVC data indicates wide variation between specific providers, hospitals may choose to drill down into their own data to investigate further. For hospitals that have several surgeons with enough cases for these procedures, there was significant variation in testing rates (see Figure 1).

Figure 1. Rate of Any Preoperative Test by Surgeon (Blinded Report)

Included in the report were patients undergoing elective and outpatient laparoscopic cholecystectomy, laparoscopic inguinal hernia repair, and lumpectomy. It incorporated index admissions between 1/1/2018 – 12/31/2020 for Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, BCBSM Medicare Advantage, Blue Care Network (BCN) HMO Commercial, BCN Medicare Advantage, Medicare Fee-For-Service (FFS), and Michigan Medicaid. Hospitals only received a report if they had 11 or more cases in at least one of the three conditions and at least 11 cases per year in the three procedures combined. The analysis evaluated the use of the following tests using CPT codes: electrocardiogram, echocardiogram, cardiac stress test, complete blood count, basic metabolic panel, coagulation studies, urinalysis, chest x-ray, and pulmonary function.

In general, the report demonstrated significant variation in testing rates between members, with some testing rates ranging from 20% to over 90%. Due to the amount of variation, MVC suspects that preoperative testing is overused at the state level such that even hospitals that are average or below average may still have significant opportunities to safely reduce preoperative testing. The report included a table with each hospitals’ rates for each procedure and test, with accompanying comparisons to the rates of regional peers and the collaborative as a whole (see Figure 2).

Figure 2. Preoperative Testing Rates Table (Blinded Report)

The report also included figures for preoperative testing rates by specific tests, by payer, and by procedure. The variety of figures is meant to help hospitals better understand its variability in utilization, since specific procedures or tests may be driving their overall testing rate. One figure, for example, presents a hospital's three procedure-specific testing rates alongside their overall or “combined procedures” rate. To more easily identify areas of opportunity to reduce their overall testing rate, a hospital can compare their procedure-specific rates to determine which is driving their average, as well as compare their average to those of their regional peers and the collaborative as a whole (see Figure 3).

Figure 3. Rate of Any Preoperative Test by Procedure (Blinded)

In the case of the blinded example above, this hospital is more frequently ordering preoperative testing in cholecystectomy patients but is ordering fewer tests on average than their peers for all procedures combined. This finding is atypical since lumpectomy was found to have a higher testing rate in general; cholecystectomy testing rates were generally lower. In addition, MVC found that electrocardiography and blood tests (complete blood count, basic metabolic panel, coagulation studies) had the highest testing rates across all procedures.

Helping MVC members to make internal and external data comparisons is core to MVC reporting and is critical to its efforts to reduce unnecessary testing. As part of MVC's continued efforts in this area, the Coordinating Center will share hospital-level preoperative testing data at its upcoming semi-annual meeting in order to foster continued awareness of wide practice variation and encourage best practice sharing between members.

MVC is eager to drive improvement in this area. For more information on how MVC is working to reduce unnecessary preoperative testing, visit its Value Coalition Campaign webpage here. If you are interested in a more customized report or would like information about MVC’s preop testing stakeholder working group, please contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

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MVC Releases Agenda, Speakers for May Semi-Annual Meeting

MVC Releases Agenda, Speakers for May Semi-Annual Meeting

The MVC Coordinating Center recently released the full agenda for its forthcoming spring Semi-Annual Meeting on Friday, May 13, 2022, from 10-11:30 a.m. The MVC Coordinating Center holds collaborative-wide meetings twice each year to bring together quality leaders and clinicians from across the state. This meeting’s theme of “turning data and collaboration into action” reflects how members often balance multiple internal and external data sets in addition to a broad portfolio of resources from MVC and other CQIs.

Speakers at semi-annual events are often members who share their successes, challenges, barriers, and solutions in pursuing a higher value and quality of care. The speakers outlined on May’s meeting agenda will share examples of quality initiatives that successfully leveraged data or collaboration to bring about improvements in healthcare. The speakers also represent a variety of stakeholder groups, including hospitals, physician organizations (POs), payers, and of course MVC Coordinating Center leadership.

The first guest presentation will be from hospital leaders at McLaren Port Huron’s Quality Improvement and Organizational Excellence team. Regional Director Mary Pool and Manager Holly Gould will discuss partnering for clinical efficiency and effectiveness. This presentation will be followed by Michelle Marchese, Director of Care Delivery Analytics at Blue Cross Blue Shield of Michigan (BCBSM), who will present about how BCBSM’s Physician Group Incentive Program (PGIP) supports value-based care. The final guest presentation of the day will feature PO members and comes from leaders at the MyMichigan Collaborative Care Organization. Dr. Shannon Martin, Primary Care Council of MyMichigan Medical Group, will present on affecting medication overload in seniors.

Attendees can also expect to hear from MVC Coordinating Center leadership and staff about the MVC Component of the BCBSM Pay-for-Performance (P4P) Program, as well as insights on how performance in the areas of preoperative testing and cardiac rehabilitation utilization compares across the collaborative.

At the conclusion of the meeting, attendees will be able to identify the value of a variety of data sources and collaboration opportunities to assist with implementing and evaluating quality improvement projects. The full agenda can be accessed online here.

These presentations would be informative and applicable for any of the following stakeholders who are welcome to attend:

  • MVC Hospital Site Coordinators
  • MVC Physician Organization Site Coordinators
  • Quality Leadership
  • Clinicians
  • Healthcare abstractors, analysts, and statisticians
  • CQI staff

Those interested in attending this informative and collaborative meeting should register here. The MVC Coordinating Center looks forward to a fantastic meeting. See you there!

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MVC Distributes New Push Report Dedicated to P4P Conditions

MVC Distributes New Push Report Dedicated to P4P Conditions

MVC launched a new push report this week dedicated to the MVC P4P conditions. Its purpose is to support hospitals in identifying areas of opportunity within past and present conditions of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. The conditions currently included in P4P and in this report are chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), colectomy (non-cancer), coronary artery bypass graft (CABG), joint replacement (hip and knee), pneumonia, and spine surgery. Acute myocardial infarction (AMI) is also included in this report as a historical P4P condition. Hospitals received a page for each condition if they met a case count threshold of 11 episodes in 2019 and 2020.

This report was limited to episodes included in the P4P program with index admissions in 2019 and 2020, and thus included the following payers: BCBSM Preferred Provider Organization (PPO), BCBSM Medicare Advantage, Blue Care Network (BCN) Health Maintenance Organization (HMO), BCN Medicare Advantage, and Medicare Fee-For-Service (FFS). To align with the P4P program, MVC excluded patients with a discharge disposition of inpatient death or transfer to hospice, episodes that started with an inpatient transfer, and episodes with a COVID-19 diagnosis on a facility claim in the inpatient setting. To fully exclude COVID-19 patients, pneumonia episodes in March 2020 were also excluded.

The reports provided data on hospital trends in episode payments, readmission rates, post-acute care utilization, and emergency department utilization for P4P patients. Data from the push report can be used in conjunction with the registry reports to inform areas of opportunity in the P4P conditions. The push reports also provided a snapshot of each hospital’s P4P patient population (see Figure 1), including race, mean age, and the average number of comorbidities.

Figure 1. Patient Population Snapshot for Blinded Hospital

For Critical Access Hospitals (CAHs), the report also included index length of stay. For acute care hospitals, the report included a “reasons for readmissions” table that identified the top five reasons a P4P patient was readmitted. However, this table was removed from the report’s joint replacement page due to low readmission rates among joint replacement surgeries. In its place, acute care hospitals received their ratio of outpatient to inpatient surgeries.

As with other push reports, hospitals were compared to other members in the collaborative for select measures. For acute care hospitals, each hospital’s report includes a comparison point for all MVC episodes (“MVC All”) as well as for episodes at hospitals in the same geographic region (“Your Region”). These reference points do not include episodes that occurred at hospitals with a CAH designation. Similarly, the reports distributed to CAHs included comparison points for MVC episodes at all CAHs in the collaborative (“CAH Average”).

This report takes the place of the cardiac service line reports, which included data on CHF, AMI, and CABG. The new P4P conditions push report uses many of the same measures and figures from the cardiac service line reports, but for the complete list of P4P conditions.

For more information on the MVC Component of the P4P Program, see the MVC P4P Technical Document. Please share your feedback on the newest P4P conditions push report with the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.