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Cardiac Rehab Stakeholder Meeting Motivates Improvements in Care

Cardiac Rehab Stakeholder Meeting Motivates Improvements in Care

On Monday, March 22, 2021, a “stakeholder meeting” was hosted by the Michigan Value Collaborative (MVC) Coordinating Center with multiple key players in cardiac rehabilitation (CR) from around Michigan. As MVC has written about before, cardiac rehabilitation is a highly valuable but underutilized service and is the focus of one of MVC’s ongoing value coalition campaigns. The goal of the stakeholder meetings is to bring together key constituents to work towards solving the problem of underutilization. Attendees included managers of cardiac and pulmonary rehab facilities, quality improvement leaders and executives from  several MVC members, our payer partners from Blue Cross Blue Shield of Michigan, and representatives from the Michigan Society for Thoracic and Cardiovascular Surgeons (MSTCVS), the Michigan Society for Cardiovascular and Pulmonary Rehab (MSCVPR), and the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2).

The stakeholder meeting occurred the week after MVC distributed new Master Cardiac Rehab reports, which detail several metrics on cardiac rehabilitation after percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), transcatheter aortic valve replacement (TAVR), and surgical aortic valve replacement (SAVR) procedures. The collaborative-wide average cardiac rehab utilization varied by procedure: 52.6% for SAVR, 30.1% for TAVR, 56.3% for CABG, and 32.3% for PCI (see Figure 1). The mean days to first cardiac rehab visit also varied by procedure: 46 days for SAVR patients, 43 days for TAVR patients, 45 days for CABG patients, and 34 days for PCI patients (see Figure 2).

Figure 1

Figure 2

The Master Cardiac Rehab reports were also distributed by our partners at MSTCVS and BMC2. The aim is to increase awareness of hospital-level CR utilization and encourage as many players as possible (cardiologists, cardiac surgeons, cardiac rehab staff, quality improvement staff, and executive leadership) to work together to increase CR utilization at every hospital. These reports were well-received at the March 22nd stakeholder meeting, with one attendee emphasizing that the information contained in the reports was “the envy of other states,” speaking to the utility of MVC data and the success of BCBSM Value Partnerships. Attendees also provided excellent suggestions for improvement which will be taken into account during the next report refresh later this year.

The data is distributed, and the stakeholder meeting is over, but the value coalition campaign is just getting started.  There’s still a lot of work to do in order to equitably increase cardiac rehabilitation use in our state, including studying barriers to entry, exploring the intricacies of benefit design, and making various operational changes hospital by hospital, health system by health system. Nevertheless, that Monday afternoon showed that sometimes, when you have the right people around the same (virtual) table, everyone can walk away connected, motivated, and ready to carry out their respective roles to improve health care.

The next cardiac rehab stakeholder meeting is scheduled for Monday, June 28, 2021 from 4:00-5:00pm. If you have an interest in joining this group, or if you have not received your Master Cardiac Rehab report, please email michiganvaluecollaborative@gmail.com.

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The Michigan Value Collaborative’s Refreshed Cardiac Service Line Reports

The Michigan Value Collaborative’s Refreshed Cardiac Service Line Reports

The Michigan Value Collaborative (MVC) Coordinating Center disseminated it’s long-running customized cardiac service line report to hospital and physician organization (PO) members on February 23, 2021. These reports provide hospital-level information on congestive heart failure (CHF), acute myocardial infarction (AMI), and coronary artery bypass graft (CABG) conditions. To receive information on any one of these conditions, a hospital must have at least 20 cases per year over the three-year reporting period (1/1/17 – 12/31/19).

Since the last iteration of the cardiac service line report sent in June 2020, the Coordinating Center has defined four distinct regions within Michigan, allowing members to make regional comparisons. These comparisons have been incorporated into the 30-day risk-adjusted total episode payment trend chart, the post-acute care utilization bar graph, and the 30-day readmission rate trend chart of the reports as shown in the following AMI figures for a fictional institution, Hospital A.

Acute Myocardial Infarction Figures. Hospital A

Figure 1 shows the 30-day risk-adjusted total episode payments broken up into six-month intervals, illustrating that episode payments for AMI hold steady across the Collaborative at an average of around $22,000. Please note that as with all MVC reports, this represents price standardized dollars to allow for fair comparisons between hospitals. The price standardized dollars can be thought of as a measure of utilization as opposed to true dollar amounts.

Figure 2 displays the percentage of AMI patients who utilized home health (15.0% across MVC), rehab (14.1% across MVC), or skilled nursing facilities (9.9% across MVC). Figure 3 illustrates that, between 2017 and 2019, approximately 14% of AMI patients were readmitted within 30 days. Finally, Figure 4 shows Hospital A that based on the most recent claim before a readmission occurred, 90.9% of readmitted patients were coming from home, 8.8% were coming from Skilled Nursing Facilities (SNF), and very few were coming from inpatient rehabilitation (0.3%). Hospitals can use this information to observe if they are an outlier in any of the categories and where they may have an opportunity to improve, to benchmark themselves against the MVC all and regional averages, and to notice trends in their performance

These combined-payer push reports are distributed twice a year, meaning the next iteration is likely to be sent out in the summer of 2021. In the meantime, single-payer information is always available on the MVC registry, allowing for continued monitoring of these metrics. Data is added every month for Blue Cross payers and quarterly for Medicare. Michigan Medicaid data will be live on the registry at the start of Q2 this year.

If you need registry access, if you have ideas on how these reports can be made more versatile, or if you are using these data for a quality improvement project at your institution, please contact michiganvaluecollaborative@gmail.com. Additionally, please reach out if you want further information in the way of custom analytics.