16 Dec 2021
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MVC Shares National Action Plan with COPD Workgroup Attendees

December 16, 2021 | 0 Comments | , ,

The Michigan Value Collaborative (MVC) held a bi-monthly virtual workgroup recently on chronic obstructive pulmonary disease (COPD), a condition that accounts for the majority of deaths from chronic lower respiratory diseases and is continuously a leading cause of death in the United States. Notably, COPD is nearly two times as prevalent in rural areas as it is in urban areas; therefore, MVC members in rural areas may be dealing with significant inequities within their patient populations. The workgroup presentation and discussion focused on the COPD National Action Plan (CNAP). To the Coordinating Center’s surprise, many workgroup participants had not previously heard of the CNAP, making this event a great opportunity for practice sharing and discussion among members.

Overcoming barriers to prevention, early diagnosis, treatment, and management of COPD is necessary to improve quality of life and reduce mortality. To address these barriers, the U.S. Congress; National Heart, Lung, and Blood Institute; and Centers for Disease Control and Prevention convened a town hall where they asked federal and nonfederal partners to develop an action plan. These partners were tasked with identifying the efforts needed to change the course of COPD. The result was the development of the COPD National Action Plan (CNAP), which was released in 2017 and updated in 2019. It consists of five goals, which were outlined and discussed during the workgroup (see Figure 1).

Figure 1. Slide from COPD Workgroup Presentation

Goal 1 calls for promoting more public awareness and understanding of COPD, especially among patients and their caregivers. Key opportunities include patient and caregiver education that is sustainable and culturally appropriate, technological support mechanisms, and connecting patients and caregivers to local and state resources.

Goal 2 focuses on increasing the skills and education of healthcare providers so they are better equipped to provide comprehensive care. This goal is supported by the development and dissemination of patient-centric, clinical practice guidelines for care delivery, the use of technological support mechanisms, and consideration of home-based pulmonary rehabilitation programs. It’s important to note that studies have found no statistically or clinically significant differences for health-related quality of life and exercise capacity among patients who have completed home-based vs. outpatient-based pulmonary rehabilitation.

Goal 3 encourages increased data collection, analysis, and sharing to create a better understanding of disease patterns. Opportunities within this goal include supporting pharmaceutical and clinical COPD research; identifying and delivering comprehensive, evidence-based, culturally appropriate interventions; and disseminating findings to a variety of audiences (from patients to national policymakers).

Goal 4 aims to increase and sustain COPD research to improve understanding of the disease and its diagnosis and treatment. It’s vital that clinicians, researchers, and health policy experts foster research across the COPD continuum (prevention, diagnosis, treatment, management). Workgroup attendees agreed that there are opportunities to improve equity among COPD patients through more data on diagnosed and undiagnosed COPD in disadvantaged patients. Another vital component of this goal is supporting and sustaining pharmaceutical research for COPD medications since none of the existing medications for COPD have been shown to reduce the progressive decline in lung function.

Goal 5 calls for federal and nonfederal partners to collaborate to meet the objectives of the CNAP and translate its recommendations into research and action. Workgroup attendees highlighted the importance of implementing CNAP equitably among both urban and rural regions and implementing COPD strategies at all health policy levels (national, state, local). Such opportunities could improve access to cost-effective and affordable COPD support services and expand support for and access to pulmonary rehabilitation services (including home-based PR), thus reducing health inequities among COPD patients.

Each of the five CNAP goals is equally important and vital in reducing COPD health disparities. Although many of the MVC workgroup participants had not heard of the CNAP before, they were interested in sharing its goals and opportunities with others in their healthcare organization. If you would like to learn more about this patient-centered national action plan, you can read the full published report here. If your organization has addressed the CNAP goals or implemented any of the discussed opportunities, the MVC Coordinating Center would like to hear about the successes, challenges, and lessons learned. If you would like to share this information or present at an upcoming MVC workgroup, please email MVC at michiganvaluecollaborative@gmail.com.

09 Dec 2021
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Reports Identify Opportunity to Reduce Preoperative Testing

December 9, 2021 | 0 Comments |

MVC distributed its final push report of 2021 this week when the Coordinating Center distributed preoperative testing reports to members. It provided recipients with refreshed data using only Blue Cross Blue Shield of Michigan claims in order to provide the most up-to-date and granular preoperative testing information available.

In general, the report demonstrated significant variation in testing rates between members, with preoperative testing rates ranging from 20% to over 90%. The average overall testing rate was 56% when looking at only the BCBSM payers, whereas the rate was 62% when looking at all payers in the earlier version of the report from February of 2021. The report included overall testing rate (Figure 1), preoperative testing rate trends over time (Figure 1), and rates for specific tests and procedures.

Figure 1. Blinded Preoperative Testing Push Report Graphs

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.

Preoperative testing, especially in low-risk surgical procedures, often provides no clinical benefits to patients. Despite this, these services continue to be ordered regularly at hospitals across Michigan. Eliminating unnecessary and, in some cases, potentially harmful preoperative testing represents a clear opportunity to improve value in surgery. The MVC Coordinating Center uses administrative claims data and engagement with MVC members to try and reduce the use of unnecessary preoperative testing for surgical procedures to improve quality, reduce cost, and improve equity of care delivery throughout Michigan. The MVC Coordinating Center’s work on this issue is supported by a stakeholder working group to advise ongoing activity and provide insights on the best approaches to improve member awareness and practices.

This latest preoperative testing report also marked the conclusion of one year’s worth of activity in support of MVC’s Preoperative Testing Value Coalition Campaign. As part of MVC’s commitment to improve the health of Michigan through sustainable, high-value healthcare, the Coordinating Center developed specific focus areas to drive improvement. These are termed ‘Value Coalition Campaigns’ (VCCs).

In an effort to communicate progress on its Preoperative Testing VCC, the Coordinating Center recently compiled a 2021 Preoperative Testing Progress Report (see Figure 2) and included it as an attachment with the most recent report communications. Accomplishments included the development of educational flyers and resources, a published manuscript, partnerships with fellow Collaborative Quality Initiatives (CQIs), and custom analytics prepared for members. In addition, the Coordinating Center set several goals for 2022, such as developing provider-level reporting and hosting a dedicated symposium or workgroup, among others.

Figure 2. MVC 2021 Preoperative Testing VCC Progress Report

The Michigan Value Collaborative is eager to reduce unnecessary preoperative testing. If you are interested in a more customized report on preoperative testing practices at your hospital or physician organization or you want to learn more about the stakeholder working group, please contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

02 Dec 2021
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Studies Find Value in Virtual Reality for Pain Management

December 2, 2021 | 0 Comments | , ,

Pain management is a critical component of effective care for patients. Amidst the opioid epidemic, however, pain management is highly nuanced for clinicians balancing their patient’s needs and wishes with state and hospital guidelines for prescribing. Although these guidelines are designed to curb opioid misuse—over 10 million patients misused prescription opioids in 2019—they are sometimes at odds with patient-based considerations. One research article, for example, found that, “many physicians expressed appreciation for opioid prescribing guidelines and simultaneously voiced concern about opioid restrictions that obviate the application of clinical reasoning.” In addition, some studies have called into question whether policies aimed at curbing overprescribing of opioids have a meaningful effect. One study noted that joint replacement surgeries from 2014 to 2017 saw increases in the percent of patients receiving opioids without clinically meaningful improvements in post-operative pain.

Therefore, when non-opioid pain management methods emerge in the medical literature as efficacious, there is a significant potential for impact coupled with great interest in its feasibility. Around the time the opioid epidemic was declared a public health emergency by the U.S. Department of Health and Human Services, one such pain management method emerged within medical research: virtual reality therapy.

Virtual reality therapy entails wearing virtual reality goggles and participating in an immersive, three-dimensional computer environment that distracts the patient from their pain. In some instances, it was proven effective for decreasing opioid use during painful wound procedures, and in other cases for helping patients learn how to manage chronic pain and achieve decreases in reported pain scores. Amid this excitement, one research team endeavored to measure the, "cost and effectiveness thresholds [virtual reality] therapy must meet to be cost-saving as an inpatient pain management program." They found that inpatient virtual reality therapy could reduce costs for a hospital if the length of stay was reduced because of its use; reductions in opioid use and related reimbursements were not enough in isolation to overcome the costs of virtual reality. This study found cost savings achieved in 89% of the trials it investigated.

Once studies have determined that a treatment is effective, the next question is whether it is effective for a more heterogeneous population—often, the patients included in medical research are white, relatively advantaged patients with higher-than-average education and literacy. With a growing focus in healthcare on health equity, it is important to determine whether virtual reality therapy also has potential in diverse patient populations. Just two months ago, a study from UC San Francisco was published that investigated the use of virtual reality among frontline pain management clinicians, particularly those in safety-net healthcare settings. The study found that clinicians and leadership in these healthcare settings were very interested in virtual reality therapy as a safer alternative to opioids. However, they also noted a need for significant tailoring for various cultures, languages, and technical abilities. They also expressed concerns about obtaining reimbursements and integrating the technology into complex workflows.

Virtual reality may offer potential savings as well as greater patient satisfaction for some hospitals and health systems right now. For others, it may take time and collaboration before virtual reality therapy is a feasible pain management alternative. The MVC Coordinating Center is interested in documenting how its members are approaching pain management and rising technologies like virtual reality. If your hospital or physician organization has found success in offering virtual reality therapy to patients or implemented other successful opioid-reduction interventions, please share your story with the MVC Coordinating Center (michiganvaluecollaborative@gmail.com) so other MVC members may benefit from your experience.

25 Nov 2021
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Happy Thanksgiving!

Happy Thanksgiving!

November 25, 2021 | 0 Comments

The Michigan Value Collaborative wishes you a happy Thanksgiving holiday. Thank you to our partners and members for working tirelessly every day to improve healthcare quality across Michigan.

18 Nov 2021
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CHF Workgroup Discusses Value of Outpatient Intravenous Diuresis

November 18, 2021 | 0 Comments | , ,

The Michigan Value Collaborative (MVC) holds bi-monthly virtual workgroups on six different clinical areas of focus. The goal of these workgroups is to bring collaborative members together to discuss current quality improvement initiatives and challenges. These six different clinical areas include chronic disease management (CDM), chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes, joint, and sepsis. At the most recent MVC CHF workgroup, the discussion centered around inpatient versus outpatient intravenous diuresis for the acute exacerbation of CHF.

The prevalence of heart failure in the United States is increasing, with one study indicating it affects more than 5.7 million people. The study reports that up to 80% of patients with acute decompensated heart failure (ADHF) visit their emergency departments and that 91.5% of those patients were thereafter readmitted to the hospital for diuresis.

With increasing prevalence comes greater direct and indirect healthcare costs associated with CHF, accounting for approximately $40 billion annually in the United States. For patients over the age of 65, it is a leading cause of hospitalization with annual costs of $11 billion.

Despite significant costs and healthcare burden associated with this condition, the same study finds that no official guidance exists regarding an appropriate location for therapy. Since hospital readmission reduction programs seek to incentivize reductions in readmissions, it is important to simultaneously provide guidance to providers and patients on safe and effective options for outpatient treatment and therapy.

To address this concern, the workgroup discussed the benefits and safety of outpatient intravenous (IV) diuresis and how the outpatient administration of furosemide can be safe and effective. MVC members shared their experiences with setting up these clinics, their inclusion criteria, and other protocols. A standard diuretic protocol could include each patient being given an IV furosemide bolus with continuous infusion within the most appropriate outpatient setting, which could include the patient’s home or in a mobile clinic.

While in the outpatient setting, patients undergoing this treatment would be monitored via cardiac telemetry and appropriate blood panels before and after the infusion. Patients on maintenance medications are instructed to continue their standard dose in the outpatient setting as appropriate based on their individualized treatment protocol. Patients should follow up with their cardiology and primary care teams to maintain their treatment and care maintenance plans. Following the outpatient IV diuresis encounter, the study reported patients had lower costs, fewer hospital stays, and lower mortality risk than CHF patients who did not receive outpatient IV diuresis.

Overall, studies indicate that outpatient CHF IV diuresis treatment is a safe and effective method of relieving CHF symptoms with a low risk of adverse events. The MVC members in attendance had positive thoughts and experiences regarding outpatient IV diuresis clinics and would recommend further discussion on them. The outpatient mobile CHF diuresis clinic was of notable interest to the MVC members in attendance and will be considered for a specialty topic in future workgroups and blog posts.

The MVC Coordinating Center is interested in hearing how your organization is improving CHF patient care and reducing CHF hospital readmissions. If you would like to present at or attend an upcoming MVC workgroup, please contact the MVC Coordinating Center at the michiganvaluecollaborative@gmail.com.

11 Nov 2021
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Healthcare Leaders Issue Support for Climate Change Mitigation

November 11, 2021 | 0 Comments | ,

The past year forced healthcare to grapple with never-before-seen challenges. In response, facilities and clinicians found ways to think creatively, adapt, and find common ground with peers to best steward the health and safety of our communities. But the pandemic isn’t the only challenge requiring that kind of response. The healthcare industry is placing greater emphasis than ever before on the issue of climate change amidst the news and commitments coming out of the 2021 United Nations Climate Change Conference, also known as COP26.

The greater emphasis following this year’s conference is perhaps related to an increased overall focus on direct impacts to public health as well as the looming presence of a global pandemic that nearly all countries have struggled to manage. Countries like Britain are looking to reduce emissions by piloting a first-of-its-kind zero-emissions ambulance, citing that air pollution contributes to one out of every 20 deaths in the United Kingdom. The new vehicle was parked and promoted at the events in Glasgow. It is also notable that the healthcare industry has been increasingly concerned with variability in health outcomes due to social determinants of health; the impacts to human health by climate change and environmental pollution are also felt disproportionately by vulnerable communities.

The COP26 commitments included one from the U.S. Biden Administration to halve the United States’ greenhouse gas emissions by 2030. According to Health Care Without Harm (HCWH), an international nongovernmental organization concerned with mitigating healthcare’s impact on environmental health, “the U.S. health sector is responsible for 8.5% of U.S. greenhouse gas emissions and 27% of the global health care emissions… Addressing the climate crisis as a core driver of disease must be central to the health sectors’ mission today and in the future. As a fundamental sector in our society, and the only sector with healing as its mission, it makes sense for health care to lead the way to kick our addiction to fossil fuels, improve public health, and save billions of dollars in health costs in the process.”

They posited that healthcare has a unique relationship with climate change because of healthcare's role in bearing the financial costs and human health burden (see Figure 1 from the Centers for Disease Control and Prevention) from “increased disease spread and more frequent extreme weather events.”

This belief is shared by at least 45 million healthcare workers (which represents 75% of the health professionals in the world) associated with letters urging immediate action on climate change. There are already leaders in these efforts throughout the U.S. The Healthcare Climate Council created a playbook (see Figure 2) for operationalizing climate solutions in areas such as energy, food, leadership, operating rooms, purchasing, infrastructure, transportation, and waste.

The playbook contains success stories of facilities that have made meaningful changes, such as one about the Cleveland Clinic saving more than $4 million in 2019 by reducing air changes per hour during non-surgical periods as part of their Operating Room Setback Plan. They save 25 million kWh/year in energy use and $2.5 million annually. Similarly, Ascension deployed a data dashboard to report facility operations (energy, water, temperature, humidity, and air changes) on a real-time basis, and they implemented a pulse oximeter collection project that resulted in 664,000 medical devices collected and 66.4 tons of landfill waste avoided. They reported that this effort required collaboration between green teams, the purchasing department, environmental services, clinicians, facility managers, and the medical device reprocessing vendor.

Quality improvement efforts in healthcare have always been multifaceted, seeking to systematically reduce variation and improve outcomes by standardizing processes and structures. Quality professionals look at technology, personnel, culture, physical capital, leadership, training, operations, and procedures, among other areas. This means that healthcare’s quality improvement teams are uniquely positioned to support their leadership in identifying and implementing climate solutions. These changes that help mitigate climate impacts also often lead to more efficient, sustainable care delivery.

There are a number of professional organizations ready to assist and offer guidelines for practice improvement, including Health Care Without Harm, its sister organization Practice Greenhealth, the Alliance of Nurses for Healthy Environments, the American Society of Anesthesiologists, the Association of American PeriOperative Registered Nurses, and the American Academy of Family Physicians, among others.

Much like with the COVID-19 pandemic, the actions and decisions of one facility, community, or country ultimately have an impact on everyone else, which means a culture of collaboration is a prerequisite for the successful integration of climate change mitigation in healthcare. If your hospital or physician organization has achieved value or outcome improvements that relate to environmental health or sustainability, the MVC Coordinating Center can help share your story. Please contact the MVC team at michiganvaluecollaborative@gmail.com.

04 Nov 2021
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Introducing MVC Engagement Associate Chelsea Andrews, MPH

Introducing MVC Engagement Associate Chelsea Andrews, MPH

November 4, 2021 | 0 Comments

I would like to take this opportunity to introduce myself as the Michigan Value Collaborative’s (MVC) new Engagement Associate. As the Engagement Associate, I will work closely with the Site Engagement Manager and Site Engagement Coordinator to foster collaboration among members and other stakeholders and drive outreach efforts that facilitate statewide cross-institutional learning. I am excited to join the MVC Coordinating Center and look forward to getting to know our sites and members.

Colleagues would call me a well-versed health and wellness leader with an authentic and collaborative approach to program management who creates a positive and high-performing culture. I have worked in healthcare and health research in various capacities over the past 11 years, ranging from direct patient care to administration, and have co-authored multiple medical encyclopedia entries and actively contributed to NIH research. I’m a Michigan State University alumna with a pre-medical Bachelor of Science in human biology; a specialization in bioethics, humanities, and society; and a Spanish minor. After working as a nurse assistant in various specialties, I left the state of Michigan to earn my Master’s in Public Health in health systems, management and policy at the University of Colorado. While in Colorado, I was part of the administrative team for Colorado Medicine’s Department of Obstetrics and Gynecology - Division of Maternal Fetal Medicine. Since my return to Michigan in 2019 and prior to joining the MVC, I worked at the University of Michigan School of Nursing as Program Coordinator for the Alliance to Advance Patient-Centered Cancer Care, where I defined and executed project goals and acted as a liaison between the national program office teams, grantees, and board members.

I am passionate about comprehensive patient-centric operational procedures, community engagement, and reducing healthcare disparities. When I’m not working, you can find me playing with my dog and three cats, adventuring outside, working on cars, or reading next to a fire (I’m always accepting book recommendations). If you have any questions, please reach out to me at andreche@umich.edu.

07 Oct 2021
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MVC Component of the BCBSM P4P Program Year 2021 Update

MVC Component of the BCBSM P4P Program Year 2021 Update

October 7, 2021 | 0 Comments

The COVID-19 pandemic impacted hospitals throughout the state in 2020 and the MVC Coordinating Center deemed it necessary to evaluate the effect of COVID-19 on the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) program. The goal was to determine if adjustments needed to be made to maintain fairness across the collaborative for index admissions in the calendar year of 2020, which will be used to score the 2021 program year.

The MVC Coordinating Center found that 223 of the 25,627 (0.9%) episodes included in the P4P conditions from the first half of 2020 had a code for confirmed COVID-19 infection in the index event or other inpatient settings. Pneumonia and congestive heart failure (CHF) were the most common conditions to have a COVID-19 diagnosis.

The MVC Component of the BCBSM P4P program rewards hospitals for either making improvements over their baseline episode payment or for being less expensive than peer hospitals. The MVC Coordinating Center has also found that episodes of COVID-19 patients are generally more expensive than typical episodes. Additionally, COVID-19 was not present in the baseline year of 2018 that hospitals will be evaluated against and hospitals were impacted differently.

Therefore, with approval from BCBSM, the MVC Coordinating Center will remove any 2020 episode with a COVID-19 diagnosis on an inpatient facility claim during the 30-day episode if the COVID-19 ICD code is one of the first three diagnosis codes on the claim. Please contact the MVC Coordinating Center with any questions at michiganvaluecollaborative@gmail.com.

30 Sep 2021
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Fall Semi-Annual Meeting Agenda Highlights Health Equity Topics

Fall Semi-Annual Meeting Agenda Highlights Health Equity Topics

September 30, 2021 | 0 Comments | ,

The MVC Coordinating Center recently released the full agenda for its forthcoming fall Semi-Annual Meeting on Friday, October 22, 2021, from 10:00-11:30 am. The MVC Coordinating Center holds collaborative-wide meetings twice each year to bring together quality leaders and clinicians from across the state. This year’s theme of “the social risk and health equity dilemma” is reflective of a growing priority within the healthcare system generally, as well as newer activities within the MVC Coordinating Center.

Speakers at semi-annual events are often members who share their stories of success, challenges, barriers, and solutions in pursuing a higher value and quality of care. The speakers outlined on October’s agenda showcase the breadth and depth of knowledge that exists within the collaborative in the health equity space. They also represent a variety of stakeholder groups, including hospitals, physician organizations (POs), Collaborative Quality Improvement (CQIs) programs, and of course MVC Coordinating Center leadership.

The first guest speaker will be Carol Gray, Program Manager of the new Michigan Social Health Interventions to Eliminate Disparities (MSHIELD) CQI. She leads the overall management, performance, and coordination of the MSHIELD program and Coordinating Center team. She has extensive experience managing public health research teams, communicating across and coordinating with multiple partnerships, and linking and engaging with community-based organizations in Detroit and academic faculty at the University of Michigan. Her presentation on, “Aligning Partnerships to Achieve Health Equity,” will speak to that expertise.

The meeting also features the expertise of Dr. Nicole J. Franklin, Assistant Medical Director at the McLaren Bariatric and Metabolic Institute. She provides psychological support to bariatric patients before and after weight loss surgery. In addition, Dr. Franklin is the chair of the Diversity and Inclusion Committee at McLaren Flint and has co-facilitated the Diversity Committee within all three local hospitals’ psychology training programs for the last 10 years. She is an Air Force veteran and a graduate of Wright State University’s School of Professional Psychology. Referencing her work within the greater Flint community, her session will address, “The Health Gap: An Exploration of how one hospital is working to bridge the gaps between health care and social care.”

Another perspective will be brought by Leah Corneail, Director of Utilization and Population Health at the Integrated Healthcare Association (IHA). In this role, she is responsible for leading utilization and cost improvement efforts, ensuring success in risk-based contracts and CMS demonstration programs, and collaborating with community partners to improve population health. Corneail has several years of experience in population health and health policy. Prior to joining IHA, she served as a Senior Project Manager in the Michigan Medicine Population Health Office, where she managed Michigan Medicine’s portfolio of value-based payment models and partnered with operations to implement care transformation initiatives. Leah received her Master of Public Health degree from The George Washington University’s Milken Institute School of Public Health. She will speak to, “IHA Efforts to Screen and Address Patient Social Influencers of Health (SIOH).”

Also representing the approach of a PO will be Melissa Gary, Community Liaison with the Great Lakes Physician Organization (GLPO). In this role, Melissa is responsible for bridging the gap between healthcare providers of GLPO and the local community agencies to better align the mission of GLPO. Utilizing her several years of experience in healthcare and nonprofit organizations, she has built the GLPO social determinants of health process. She is a passionate community servant with the ability to motivate and inspire individuals to identify their own potential and shares in the passion to serve others. Melissa is a graduate from Ferris State University where she studied nuclear medicine and healthcare administration. She has minors in science, biology, pre-pharmacy and paralegal.

Attendees can also expect to hear from MVC Coordinating Center leadership and staff about MVC’s Medicaid data, the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program, and general program updates.

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

  • MVC Hospital Site Coordinators and Champions
  • MVC Physician Organization Site Coordinators
  • Quality Leadership
  • Clinicians
  • Managers and front-line staff in the following clinical areas:
    • Population health
    • Chronic disease management
    • Post-acute care
    • Value-based care
    • Care coordination
    • Discharge planning
    • Social work
    • Others whose work addresses health equity or social risk factors

In addition, hospitals that have attended both of MVC's 2021 Semi-Annual Events (May 2021 and October 2021) will be eligible for one additional bonus point toward Program Year 2021 of the MVC Component of the BCBSM P4P Program.

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!

23 Sep 2021
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Staffing Shortage Challenges Hospitals Across Michigan

September 23, 2021 | 0 Comments | ,

The past 18 months of the pandemic forced healthcare to be creative and responsive to the needs of the moment, and in that time the MVC Coordinating Center heard from members about how they are working to maintain a high quality of care. The challenges and pivots shared by members vary significantly because facilities were impacted at different points in time and with varying levels of severity. However, one challenge echoes loudly and consistently for hospitals big, small, urban, or rural: the staffing shortage. This problem isn’t specific to Michigan. Across the United States, hospitals don’t have enough staff to keep up with their normal standards of care, with many having to turn away patients and ration care.

Health professionals are the lifeblood of healthcare delivery, so attaining or maintaining a high quality of care is only achievable with appropriate staffing levels. The Institute of Medicine framework defines quality care with six aims: that it be safe, effective, patient-centered, timely, efficient, and equitable. Some of those aims have been directly exacerbated by the pandemic—such as health equity or safety—while many have been at least indirectly impeded by the strains on frontline workers.

An article published by the Detroit Free Press this month titled, “Michigan hospital staffing shortage nears crisis point as COVID-19 patients rise,” paints the current situation as dire. The article quotes Brian Peters, the CEO of the Michigan Health & Hospital Association, as saying, “I have never heard a consistent theme from across our entire membership like I have on this staffing issue." He adds that the shortage affects multiple sectors of the workforce, such as nurses, physicians, housekeeping, technicians, and food service personnel. These new staffing issues occur within an industry that was already concerned about an expected shortage of primary care physicians (PCPs). The Association of American Medical Colleges (AAMC) published data that predicts an estimated shortage of between 21,400 and 55,200 PCPs by 2033 (see Figure 1), in part due to a population that continues to grow and age.

Figure 1.

Some hospitals suggest burnout as the main culprit for the current staffing shortages. A literature review on the effect of burnout on quality of care defines burnout as a state of fatigue and frustration manifested as physical and emotional exhaustion characterized by dissatisfaction and stress, with symptoms such as, “physical fatigue, cognitive weariness, and emotional exhaustion.” Anyone in that condition cannot perform at their best. So as quality teams try to find treatment efficiencies for conditions such as chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF), the elephant in the room is that they may not be able to provide treatment if nurses, technicians, and physicians aren’t adequately staffed.

The industry is expecting the shortages to increase slightly in the coming weeks as vaccination mandate deadlines approach. Currently, those health systems requiring COVID-19 vaccination include Henry Ford, Michigan Medicine, Beaumont Health, Trinity Health, Spectrum Health, OSF HealthCare, Ascension Health, and Bronson Healthcare, along with Veterans Health Administration facilities.

A variety of strategies are being proposed to lessen the burden felt by the shortage. Since it takes time to recruit new people into medical fields, these approaches generally fall into one of two categories: 1) retain current staff, and 2) deploy current staff as efficiently as possible.

The approaches that hospitals have mentioned for retaining staff are short-term in nature, ranging from approval of overtime and bonuses to instituting new staff well-being programs and sharing mental health resources. Efficient staffing is a more complex approach, but long-term with the potential to reduce the expected burden from future PCP shortages. The Harvard Business Review published an article that outlines strategies for efficient staffing in response to the PCP shortage, which could be repurposed and applied to other healthcare workforces. Among their suggestions, they highlight Advisory Board research that proposes the threefold answer is, “better use of PCPs targeted at specific populations, greater use of non-physician labor where appropriate, and much broader deployment of technology to increase access to primary care.” These suggestions align with several other priorities often voiced to the MVC Coordinating Center by members, including equitable access to care, expanded telehealth offerings, and improved care coordination utilizing nurse practitioners and physician assistants.

The work ahead will be challenging, as it often is in healthcare. Hospitals will continue to shoulder a shared burden in the months ahead. MVC encourages all members and partners to share resources that may help a peer institution improve the quality of care for Michigan residents. Please continue to bring these ideas to future workgroups and networking events, and contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.