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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.

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MVC Component of the BCBSM P4P Program: PY21 in Review

MVC Component of the BCBSM P4P Program: PY21 in Review

Last month the Michigan Value Collaborative (MVC) Coordinating Center distributed the final scorecards for the 2021 program year of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. The 2021 program year was the second year of a two-year cycle for which hospitals were evaluated using MVC data. Hospitals were scored on two conditions that they selected from seven options: chronic obstructive pulmonary disease (COPD), colectomy, congestive heart failure (CHF), coronary artery bypass graft (CABG), joint replacement, pneumonia, and spine surgery. Figure one shows the frequency of hospital condition selections for the two-year program cycle.

Figure 1. Distribution of Hospital Condition Selections for PY21

The MVC Component of the BCBSM P4P Program evaluates each participating hospital’s risk-adjusted, price-standardized, average 30-day episode payments for their two selected conditions through two methods. One way that hospitals earn points is by reducing their payments from the baseline period (which included index admissions in 2018) to the performance period (which included index admissions in 2020). These are termed “improvement points.” Alternatively, hospitals can earn points by being less expensive than the other hospitals in their cohort. These are referred to as “achievement points.” The MVC cohorts are groups of hospitals determined to be peers using bed size, case mix index, and teaching status.

While participants are scored on both improvement and achievement, members receive the higher of the two scores for each condition. Hospitals are also eligible to earn a bonus point for each condition provided all hospitals in their respective cohort who selected the same condition reduced spending by five percent. For the 2021 program year, the Coordinating Center added two additional bonus points that could have been earned by attending both semiannual meetings (one point) and by completing a site visit with MVC in 2021 (one point). A maximum of 10 points were awarded for participating members. Figure 2 shows the distribution of total points earned by hospitals for the 2021 program year.

Figure 2. Distribution of Total P4P Scores for PY21

On average, hospitals earned 6.8 points total, an increase of 1.3 points from the 2020 program year average of 5.5 points. A majority (88%) of hospitals earned at least one of the two possible participation bonus points. In addition, 31 cohort bonus points were distributed within COPD, CHF, and joint replacement. Consistent with previous years, the condition with the highest average point total was joint replacement at 4.5 points with CABG coming in second at 2.9 points (Figure 3).

Figure 3. Average Points by Service Line

When looking at the episode payments behind the point totals, MVC found that hospitals that selected CABG, CHF, and joint replacement saw a decrease in payments from 2018 to 2020 (see Figure 4). Taking into account case counts for all conditions in the baseline year, MVC also found that payments decreased overall for the selected P4P conditions by $7.7 million dollars in program year 2021.

Figure 4. Payment Change by P4P Condition

If you have any questions regarding the MVC Component of the BCBSM P4P Program, please reference the P4P Technical Document for Program Years 2020 and 2021 and the MVC P4P FAQ PY 2020-2021. If you would like to set up a meeting to review your hospital’s performance, please contact the Coordinating Center at michiganvaluecollaborative@gmail.com. The Coordinating Center will be evaluating and releasing a report on the 2020 and 2021 program year cycle later in 2022.

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MVC Component of the BCBSM P4P Program Year 2021 Update

MVC Component of the BCBSM P4P Program Year 2021 Update

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.

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Joint, CHF Top Members’ Selections for MVC P4P Program

Joint, CHF Top Members’ Selections for MVC P4P Program

The MVC Coordinating Center recently distributed condition selection reports for Program Years 2022 and 2023 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. The reports were provided in conjunction with details pertaining to the condition selection process, as well as changes to the scoring methodology, cohort assignments, and bonus points available. More details about those changes was published in a previous MVC Coordinating Center blog.

Eligible members were tasked with reviewing these reports and returning their condition selection form at the end of August. Each participating hospital selected two of the seven available conditions for PY22 and PY23: spine surgery, joint replacement, chronic obstructive pulmonary disease (COPD), coronary artery bypass grafting (CABG), congestive heart failure (CHF), colectomy (non-cancer), and pneumonia. The condition that was selected by the most participants was joint replacement with 41 hospitals selecting it, followed closely by CHF with 40 selections. COPD was selected by 32 hospitals. See Figure 1 for a depiction of the total selections for each condition.

Figure 1.

Although the two conditions selected most frequently were consistent across a variety of hospitals, the overall selections varied somewhat from region to region and by hospital size or type. For instance, hospitals with fewer than 100 beds were much more likely to select pneumonia as one of their two conditions than peers with more than 100 hospital beds (see Figure 2).

Figure 2.

Conversely, larger hospitals that perform more complex procedures made up the totality of selections for spinal surgery, colectomy, and CABG. Still, joint replacement and CHF were the most commonly selected conditions among all hospital sizes.

Similarly, CHF and joint replacement were popular among all hospitals regardless of location type, such as urban or rural (see Figure 3), or location within the state (see Figure 4), with the exception of Region 4 hospitals selecting COPD more frequently than joint replacement.

Figure 3.

Figure 4.

With the majority of hospitals focusing on both joint replacement and CHF, the MVC Coordinating Center hopes that continued participation at the joint and CHF workgroups will result in meaningful collaboration among members. MVC will also continue to offer events for virtual networking with facilities and physician organizations (POs) within a member’s geographic region (see Figure 5). These regional networking events provide additional opportunities to connect and share knowledge with peers who may share your hospital’s priorities. For instance, the next Coffee, Chat, and Collaborate virtual networking event takes place among hospitals and POs in Region 1 on Monday, September 13, at noon. Members from Region 1 interested in attending can register here.

Figure 5.

P4P cohorts were reassigned for PY22 and PY23. These changes were also detailed in the new technical document, and the new cohort assignments were published on the MVC website. The cohorts were not intended to group hospitals that are exactly alike; rather, they created a reasonably comparable grouping from which MVC can complete statistical analyses.

This program began in 2018, when BCBSM allocated 10% of its P4P program to an episode of care spending metric based on MVC data. This metric measures hospital performance using price-standardized, risk-adjusted 30-day episode payments for BCBSM Preferred Provider Organization (PPO), Medicare Fee-for-Service (FFS), BCBSM Medicare Advantage, Blue Care Network (BCN) Health Maintenance Organization (HMO), and BCN Medicare Advantage.

If you would like to receive notices about the MVC workgroups or have questions about any aspect of the MVC Component of the BCBSM P4P Program, please contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

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Condition Selection Process Announced for MVC Component of BCBSM P4P Program

Condition Selection Process Announced for MVC Component of BCBSM P4P Program

This week the Michigan Value Collaborative (MVC) Coordinating Center announced the condition selection process for program year (PY) 2022 and PY 2023 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) program. The timeline for each program year’s stages are detailed in Figure 1.

Figure 1.

In the announcement, hospitals were tasked with selecting two conditions for which they will be evaluated and returning their condition selection form to the Coordinating Center by Friday, August 13, 2021. The announcement also outlined changes to the scoring methodology, cohort assignments, and bonus points available.

The Coordinating Center’s recent announcement included condition selection reports with targets for each condition option that may help inform hospitals’ selection decisions. Each participating hospital will choose two of the seven available conditions for PY22 and PY23: spine surgery, joint replacement, chronic obstructive pulmonary disease (COPD), coronary artery bypass grafting (CABG), congestive heart failure (CHF), colectomy (non-cancer), and pneumonia. When selecting conditions, the Coordinating Center recommends reviewing your data in the registry and considering several factors for each condition, including case counts and identifiable areas with the greatest cost opportunities. The Coordinating Center also recommends considering where resources are currently being directed in your facility and potentially aligning with those efforts.

One notable change from prior program years is the methodology by which hospitals earn achievement and improvement points. Hospital scores will continue to be based on a hospital’s risk-adjusted, price-standardized total episode payments for two selected conditions, and they can still earn a maximum score of 10 points. However, the improvement and achievement scores will become more similar in order to be placed on the same scale. As such, the achievement equation will change from being based on rank within MVC cohort at performance year to being based on distance from MVC cohort mean at baseline year. Similarly, the improvement equation will utilize the distance from the hospital’s mean at baseline. These new equations (see Figure 2) as well as complete descriptions of the updated methodologies are reviewed at length with examples in the technical document.

Figure 2.

P4P cohorts have also been reassigned for PY22 and PY23. These changes are also detailed in the technical document, and the new cohort assignments can be found on the MVC website. The cohorts are not intended to group hospitals that are exactly alike; rather, they create a reasonably-comparable grouping from which MVC can complete statistical analysis.

The final change is to the awarding of bonus points. In place of the previous 5% cohort reduction bonus, participants can instead earn bonus points by completing two questionnaires (one per selected condition) and submitting these to the Coordinating Center by November 1st of each program year. The purpose of this is to gather examples of quality improvement initiatives in operation at MVC member hospitals to share with the Collaborative. Moving forward, this will help support members in reducing costs through collaboration.

Each of the changes mentioned above are designed to deliver a more transparent, intuitive, flexible, and fairer P4P program. The Coordinating Center will offer an explainer webinar to answer questions and walk through the details of these changes in more detail. The webinar will be offered on two dates: the first is scheduled for Thursday, July 29 from 11:00-12:00 pm, and the second is on Tuesday, August 3 from 1:00-2:00 pm. Both webinars can be accessed using the following Zoom link: https://umich.zoom.us/j/95502303999. Participants can also call +1 301 715 8592 (meeting ID #955 0230 3999). For those interested in the explainer webinar who are unavailable on both dates, a recording of the first webinar will be available. If you are interested in receiving a link to this recording, please email the MVC team at michiganvaluecollaborative@gmail.com.