23 Feb 2023
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MVC Resources Shared During Latest Cardiac Rehab Week

MVC Resources Shared During Latest Cardiac Rehab Week

February 23, 2023 | 0 Comments

Last week, the Michigan Value Collaborative (MVC) joined others across the country in celebrating Cardiac Rehabilitation Week, a time to promote the value of this life-saving program. Now with the week-long promotional campaign complete and the end of February’s American Heart Month approaching, MVC is proud to share some of its recent activity.

Cardiac rehabilitation has been a priority for MVC since 2020 when the Coordinating Center identified it as a focus area for which it would provide dedicated data and resources. Therefore, in celebrating Cardiac Rehabilitation Week, MVC sought to educate stakeholders about the program’s benefits, current utilization rates at hospitals across the state, and initiatives currently underway to improve patient participation.

One of MVC’s key strategies was the facilitation of a special cardiac rehabilitation workgroup, which featured presentations by MVC Co-Director Mike Thompson, PhD, MPH, Assistant Professor of Cardiac Surgery at Michigan Medicine, and Haley Stolp, MPH, Health Scientist at Million Hearts®, about state-level and nationwide strategies to improve enrollment. The session summarized much of the evidence behind the value and impact of cardiac rehabilitation and helped orient attendees to the current state of patient participation in Michigan. Both speakers highlighted their organization’s goals for participation rates in the future, as well as the resources available to providers interested in implementing initiatives in their setting. A full recording of the workgroup was made available on MVC’s social media channels and was shared with all registrants (Figure 1).

This workgroup provided detailed evidence of the benefits of participating in cardiac rehabilitation while recovering from a number of cardiac events or procedures. However, one of the reasons why this program is so heavily underutilized—currently only about 30% of eligible Michigan patients enroll—is a lack of awareness about what it is and its value. Both patients and providers often don’t have a complete understanding. Therefore, MVC created an introductory video outlining the program’s components and encouraged members to spread the word by sharing the video with their colleagues and patients.

MVC also recently announced a new program structure for future cycles of the MVC Component of the Blue Cross Blue Shield of Michigan Pay-for-Performance (P4P) Program, which included the adoption of a new value metric scoring component for Program Years 2024 and 2025. Value metrics are evidence-based, actionable measures that show variability across the state; hospitals will be rewarded for high rates of high-value services or low rates of low-value services. Over one-quarter of hospitals that returned metric selections to the MVC Coordinating Center will be scored in part on their facility’s achievements and improvements for cardiac rehabilitation utilization. The MVC team hopes its adoption of a P4P metric focused on cardiac rehab will incentivize continued emphasis and growth.  Learn more.

Furthermore, all MVC hospital members will continue to receive MVC’s cardiac rehabilitation push reports as part of its work on behalf of the Michigan Cardiac Rehabilitation Network (MiCR). These reports showcase wide variability in cardiac rehabilitation participation across the collaborative, with some members meeting the recommended levels and some well below. Many members, therefore, have valuable insights that could help a peer to enroll more patients. These report findings were highlighted last week. In the coming months, MVC plans to approach high-performing members to request advice and tools for the benefit of the broader collaborative.

Hospitals interested in improving their participation rates are encouraged to also review the MiCR Best Practices Toolkit for guidance. It was developed in partnership with providers and experts across Michigan as well as the BMC2 Coordinating Center. It highlights specific interventions that support patient enrollment, continued attendance, and flexible program structures. Several pages are centered on physician referrals, which some researchers have found increases the likelihood of participation. MVC promoted this message last week (see Figure 2) to emphasize the importance of a strong physician endorsement during patient interactions. For many patients, this is the only reason they sign up.

Figure 2.

MVC is grateful to the many providers, partners, and other stakeholders who contributed to Cardiac Rehabilitation Week this year. It continues to be a high priority for the MVC team, and the Coordinating Center is excited about the growing emphasis and interest in this area of high-value care. Together, we can save lives by equitably increasing participation in cardiac rehabilitation for all eligible individuals in Michigan. Please contact the MVC team with any questions about attending future cardiac rehabilitation events or receiving related materials.

26 Jan 2023
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MVC Workgroup Planned to Support Members Focused on Cardiac Rehabilitation Rates

MVC Workgroup Planned to Support Members Focused on Cardiac Rehabilitation Rates

January 26, 2023 | 0 Comments | , ,

Next week marks the kickoff of American Heart Month, commemorating the more than 600,000 Americans who die from heart disease each year and raising awareness about strategies that support heart health. Cardiac rehabilitation (CR) is one of those critical strategies, with the second full week of February each year dedicated to promoting its role in reducing the harmful effects of heart disease. In support of efforts to promote this life-saving program, MVC will host a CR-focused workgroup on Feb. 16, from 2-3 p.m., with MVC Co-Director Mike Thompson, Ph.D., assistant professor in the Department of Cardiac Surgery at Michigan Medicine, as its guest speaker. He will highlight some recent efforts to increase patient enrollment.

This is the third time MVC has hosted a workgroup dedicated to CR utilization; the first took place during last year’s CR week in February 2022 and featured guest presenters Steven Keteyian, Ph.D., Director of Preventive Cardiology at Henry Ford Medical Group, and Greg Merritt, Ph.D., patient advocate, in a discussion about strategies for increasing CR use. The second in November 2022 featured Diane Hamilton, BAA, CEP, of Corewell Health Trenton Hospital, who discussed addressing transportation barriers as an obstacle to CR attendance.

CR is a medically supervised program encompassing exercise, education, peer support, and counseling to help patients recovering from a cardiac event, disease, or procedure. There is high-quality evidence that it saves lives and money. A 2016 meta-analysis estimated that for every 37 coronary heart disease patients who attended CR, one of their lives was saved on average. Additionally, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) and the Michigan Value Collaborative (MVC) came together recently to measure the impact attributed to CR for percutaneous coronary intervention (PCI) patients treated between 2015 and 2019, and estimated 86 lives saved, 145 readmissions avoided, and approximately $1.8 million in savings.

Despite the evidence in favor of its clinical impact and cost-effectiveness, CR remains heavily underutilized, with only one in three eligible Michiganders participating. MVC’s hospital-level cardiac rehab reports showcase similar findings (Figure 1). These reports were rebranded recently under the new Michigan Cardiac Rehabilitation Network (MiCR) umbrella in partnership with BMC2. They measure whether and when patients started CR at MVC hospitals and how long they kept going. The collaborative-wide average for PCI patients, for example, was 38.3%, with hospital rates ranging from approximately 10%-60%. Such a wide range in patient participation rates suggests MVC member hospitals would benefit from the insights of top-performing peers.

Figure 1.

MVC is pursuing several strategies to address this critical gap in utilization. The upcoming Feb. 16 workgroup will be one of several CR-focused workgroups offered throughout 2023. The Coordinating Center decided to offer workgroups on this topic in part because of its recent incorporation of a CR measure into the MVC Component of the BCBSM Pay-for-Performance (P4P) Program. MVC member hospitals were recently asked to make metric selections for the upcoming Program Year 2024-2025 cycle, and as of February 2023 just over one quarter of hospitals elected to be scored on their CR rates for the new value metric component of the MVC measure. These hospitals will receive more P4P points if their CR utilization rate improves over time or is greater relative to their peers. These hospitals are currently treating the patients who will make up their performance year data for Program Year 2024 of the MVC measure. Therefore, MVC aims to offer tailored workgroups to support those sites being scored on CR utilization, most likely incorporating some unblinded data presentations and highlighting key resources and practices for quality improvement purposes.

The MVC team hopes these efforts to facilitate peer learning within the collaborative will help hospitals across the state improve CR participation. Doing so would save the lives of patients and improve the value of healthcare in Michigan. Sites that selected CR as their value metric component of the MVC P4P measure are encouraged to attend; however, anyone interested in this area of healthcare is welcome. Those interested in attending may register here. Please contact the MVC Coordinating Center with any questions at Michigan-Value-Collaborative@med.umich.edu.

22 Dec 2022
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MVC Team Welcomes a New Site Engagement Coordinator

MVC Team Welcomes a New Site Engagement Coordinator

December 22, 2022 | 0 Comments |

I am excited to join the Michigan Value Collaborative (MVC) in the role of Site Engagement Coordinator. Through my experiences, I have developed a passion for quality improvement in the delivery of healthcare. I have engaged in the collaborative nature needed to improve health outcomes firsthand, and I am excited to foster this environment as a Site Engagement Coordinator with MVC.

Having lived in New York my entire life, I enjoyed exploring what Michigan has to offer in my first few months here. I love being outdoors and finding new hobbies for all seasons of the year. I enjoy participating in triathlons during the summer months and skiing in the winter. I love spending time with family and friends, and my dog, Sable.

I received my undergraduate degree from the State University of New York at Geneseo, where I majored in biology and minored in Spanish. After completing my bachelor’s degree, I earned my Master of Public Health (MPH) from the State University of New York at Albany with a concentration in social behavior and community health.

While completing my MPH, I had the opportunity to work as a Graduate Student Assistant at the New York State Department of Health within the Division of Family Health and the Office of Quality and Patient Safety. Within the Division of Family Health, I provided programmatic assistance to the intervention projects of the New York State Perinatal Quality Collaborative, an initiative that aims to provide the best, safest, and most equitable care to birthing people and infants across New York State.

Within the Office of Quality and Patient Safety, as a part of an evidence-based intervention to increase colorectal cancer screening rates in the Medicaid Managed Care (MMC) population, I worked directly with MMC enrollees to provide them with necessary screening information and connections to appropriate screening resources.

In my most recent role, I served as a Community Support Specialist Team Supervisor for the New York State COVID-19 Contact Tracing Initiative. This position allowed me to be at the forefront of New York State’s efforts to control the spread of COVID-19 and support those who were in isolation and quarantine due to the pandemic.

As Site Engagement Coordinator, I look forward to developing and strengthening partnerships between MVC members and working together to improve the health of Michigan through sustainable, high-value healthcare. If you have any questions, please contact me at kdegener@med.umich.edu.

13 Oct 2022
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MVC Shares New COPD Report with Physician Organizations

MVC Shares New COPD Report with Physician Organizations

October 13, 2022 | 0 Comments | , , , ,

This week the Michigan Value Collaborative (MVC) introduced a new push report for its physician organization (PO) members focused on chronic obstructive pulmonary disease (COPD), providing a tailored version for each of MVC’s 40 PO members. This new push report was created in response to member interest in improving the quality of care for chronic diseases. It utilized 30-day claims-based COPD episodes from Medicare Fee-For-Service, Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, and BCBSM Medicare Advantage with index admissions from 1/1/19 to 6/30/21.

One feature the MVC Coordinating Center is excited to highlight is the inclusion of 30-day readmission rates by major comorbidity categories for COPD. Rates were assessed for a PO’s attributed COPD patients overall as well as for attributed patients with congestive heart failure, diabetes, and vascular disease (see Figure 1). These comorbidities are assessed using diagnosis codes on claims in the six months prior to the patient’s index hospitalization.

Figure 1.

Also featured in this report were 90-day rates of pulmonary rehabilitation utilization following COPD index hospitalizations. This is the first time MVC has included a measure of pulmonary rehabilitation utilization in a collaborative-wide report, and the Coordinating Center hopes that this metric will encourage increased use of this important program across Michigan. Across all COPD episodes in the report, the collaborative-wide rate of pulmonary rehabilitation for PO-attributed patients was 2.7% (see Figure 2).

Figure 2.

Due to the low collaborative-wide rate, the Coordinating Center assessed 90-day utilization of pulmonary rehabilitation rather than 30-day utilization. However, the American Thoracic Society recommends the initialization of pulmonary rehabilitation within three weeks following hospitalization. Click here to learn more about American Thoracic Society recommendations for pulmonary rehabilitation and other care following COPD hospitalization.

Each PO’s complete report also includes figures illustrating average price-standardized risk-adjusted 30-day total episode payments, average index hospitalization length of stay, trends in readmission rates, rates and payments of post-acute care utilization, rates of outpatient follow-up, and patient population demographics. A patient population snapshot table details several demographic variables, including a variable based on data from the Economic Innovation Group’s Distressed Communities Index (DCI). It identifies the proportion of patients living in an “at-risk” or “distressed” zip code across all payers (see Figure 3). The DCI is derived from the U.S. Census Bureau’s Business Patterns and American Community Survey.

Figure 3.

A second table provides information on index hospital locations of care for the PO’s attributed patients, comparing the percent of patients treated at each site as well as each index hospital’s average 30-day total episode payment.

The COPD PO report is also being shared with members of the newly established lung care Collaborative Quality Initiative, commonly referred to as INHALE (Inspiring Health Advances in Lung Care). INHALE focuses on patients with asthma and COPD. They disseminate strategies to improve outcomes in these patient populations and reduce the costs associated with asthma/COPD care.

MVC also partnered with a fellow Collaborative Quality Initiative to provide POs with a provider resource that may be relevant to their work with COPD patients. The Healthy Behavior Optimization for Michigan (HBOM) team provided its Quit Smoking Resource Guide to send alongside MVC’s report. 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 on the HBOM website or in MVC’s May spotlight blog.

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 Michigan-Value-Collaborative@med.umich.edu.

06 Oct 2022
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Welcoming Fall with Quality Improvement Week

October 6, 2022 | 0 Comments | , , , , , ,

October brings celebrations of Fall – with pumpkins, trips to the orchard for apple picking, and Halloween - and also Healthcare Quality Week (October 16 – 22), a time for healthcare teams to highlight their efforts to improve the quality of care for patients and families.

Over the years, various improvement methodologies have been applied in healthcare settings to advance the quality of care, reduce costs, and improve patient outcomes. Here is a look at some of the models and how they could bring value to your organization.

Six Sigma uses statistics and data analysis to reduce errors and improve processes. Originally developed in the 1980s, Six Sigma has grown over the years into an industry standard, with training and certification programs too. The Six Sigma methodology leverages the DMAIC (Define, Measure, Analyze, Improve, Control) approach (Figure 1). Following the five steps of DMAIC provides teams with a framework for identifying, addressing, and improving processes.

Figure 1: The Six Sigma DMAIC

Lean, a methodology borrowed from the automobile industry, optimizes an organization’s people, resources, and effort to create value for customers (Figure 2). Lean’s focus is on sustaining improved levels of quality, safety, satisfaction, and morale through a consistent management system. With a goal to promote, evaluate, and implement ongoing process improvements, Lean uses Value Stream Mapping (VSM) to create a visual map of each step in a workflow, allowing teams to identify opportunities for efficiency.

Figure 2: Lean Process Improvement

Additionally, Lean encourages teams to focus on continuous improvement through the Plan Do Check Act (PDCA) model, an interactive form of problem-solving used to improve processes and implement change. In a PDCA cycle, teams work through four key steps: 1) identify the problem and create a solution plan (Plan), 2) implement a small-scale test (Do), 3) review the test performance (Check), and 4) decide to adjust or implement the test on a larger scale or adjust (Act/Adjust).

Figure 3: PDCA Cycle

Total Quality Management (TQM) is a management approach for long-term success through customer satisfaction. Originally used by the Naval Air System Command, TQM is based on the principles of behavioral sciences; qualitative and quantitative analysis; economic theories, and process analysis. Using the TQM methodology allows organizations to be customer-focused, with all employees participating and engaging in continual improvement. By utilizing strategy, data, and effective communication, TQM becomes integrated into the organizational culture and activities (Figure 4).

Figure 4: Total Quality Management

With a goal to optimize activities that generate value and reduce waste, the Kaizen approach is based on the belief that continuous, incremental improvement adds up to substantial change over time (Figure 5).

Figure 5: Kaizen (Continuous Improvement) Principles

The MVC Coordinating Center supports hospital and physician organization members across the state in identifying opportunities for improvement and facilitating a collaborative learning environment for members to exchange best practices. If you are interested in discussing improvement opportunities for your site, please contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

22 Sep 2022
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MVC Showcases Recent Work at Obesity Summit, Poster Session

MVC Showcases Recent Work at Obesity Summit, Poster Session

September 22, 2022 | 0 Comments | , , , ,

Michigan Value Collaborative data and efforts were on display this week as Coordinating Center staff attended the Learning Health System (LHS) Collaboratory Seminar Series Poster Session on Thursday and the Michigan Bariatric Surgery Collaborative (MBSC) / Blue Cross Blue Shield of Michigan 2022 Obesity Management Summit on Friday. At each event, MVC was able to highlight some of its recent work.

At the LHS Collaboratory poster session, MVC presented on behalf of the Michigan Cardiac Rehabilitation Network (MiCR), a partnership recently established by MVC and the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) with the aim to equitably increase cardiac rehabilitation participation for all eligible individuals in Michigan. Cardiac rehabilitation is highly beneficial to patients and cost-saving for the healthcare system, yet it is significantly underutilized in Michigan with only about 30% of eligible patients enrolling following a cardiac procedure. Using claims data, MVC can assess whether and when someone enrolls, and how long they keep going. There is wide variability in enrollment between MVC’s member hospitals as well as across cardiac conditions. The focus of the poster (see Figure 1) was a recent publication co-authored by MVC and BMC2 staff, which evaluated the feasibility of a statewide collaboration to improve cardiac rehabilitation participation. The poster summarized the key services provided by the MiCR collaboration and some of the lessons learned thus far about barriers to and facilitators of improvement. It also promoted the new statewide goal of 40% cardiac rehabilitation participation by 2024 for all eligible conditions - a goal set by MVC and BMC2. More details on this statewide goal and MiCR’s activities are summarized here.

Figure 1.

For Friday’s Obesity Summit, several MVC products were on display, including two recent analyses performed in partnership with MBSC. The two CQIs recently collaborated on a statewide improvement assessment about the impact of bariatric surgery on prescription fills for diabetes medications. Much of the evidence in the literature suggests that bariatric surgery may resolve or improve Type 2 diabetes symptoms in a large proportion of patients. MVC used its claims data to compare pre- and post-surgery receipt of diabetes medications, as well as the estimated cost savings to health insurance providers that could be attributed to a decrease in post-surgery diabetes medication prescription fills. There was a significant decrease in prescription fills for any diabetes medication (p<.001) from the 120 days pre-surgery to the 120 days post-surgery (see Figure 2).

Figure 2.

Furthermore, insurance providers in Michigan saved an estimated $76.5 million on diabetes medications in the 360 days following bariatric surgeries in 2015-2021, based on the average decrease in diabetes prescription payments per patient, the number of bariatric surgeries performed in that timeframe, and the proportion of bariatric surgery patients who have diabetes. These results provided evidence of statewide clinical outcome improvement and cost savings for Type 2 diabetes patients following bariatric surgery. The full summary of this analysis is available here.

MVC partnered with MBSC on a similar analysis of opioid medication use that was also highlighted at the 2022 Obesity Summit. MBSC has been working to reduce opioid utilization and prescribing following bariatric surgeries across Michigan for the past five years. Some of their strategies include an opioid value-based metric and a voluntary enhanced recovery initiative that incorporates evidence-based guidelines for pre-, peri-, post-operative, and post-discharge care of bariatric surgery patients. This includes a recommendation of prescribing no more than 75 morphine milligram equivalents (MME) of oral opiate following surgery - a recommendation consistent with surgery-specific guidelines set by the Michigan Opioid Prescribing Engagement Network (OPEN).

In evaluating the impact of MBSC’s opioid reduction work, analysts identified that the average amount of opioids received in 30-day post-surgery outpatient prescriptions decreased from 297.0 MME in 2015 to 65.4 MME in 2021. The percentage of patients receiving more than the recommended threshold of 75 MME decreased from 75.8% to 17.9% of bariatric surgery patients. Furthermore, hospitals that participated in MBSC’s enhanced recovery initiative saw the rate of patients receiving opioid amounts above 75 MME decrease more sharply than the rate at other hospitals (p=0.02) (see Figure 3). Given these findings, MVC estimated that MBSC’s efforts resulted in $12.5 million in cost savings because of reduced opioid prescribing after bariatric surgery. The full summary of this analysis is available here.

Figure 3.

MVC will continue to leverage its robust claims data to further the goals of fellow Collaborative Quality Initiatives as well as MVC member hospitals and physician organizations. To stay informed about newly released analyses, resources, or projects, follow MVC Coordinating Center updates on Twitter or LinkedIn. To learn more about these projects or MVC’s reporting capabilities, contact the Coordinating Center at michiganvaluecollaborative@gmail.com.

01 Sep 2022
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Hospitals Receive PY22 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

Hospitals Receive PY22 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

September 1, 2022 | 0 Comments |

This week the Michigan Value Collaborative (MVC) Coordinating Center distributed the Mid-Year Scorecards for Program Year (PY) 2022 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. These were the first scorecards for the new two-year program cycle for PYs 2022 and 2023.

PY2022 evaluates the index admissions from 2021 as the performance year against admissions in 2019 as the baseline year. MVC is using an improved z-score methodology to calculate both improvement and achievement scores. Hospitals will continue to receive the better of the two scores for each of their two selected conditions. For a description of how the program has changed from the last two-year cycle see the Change Document.

Additionally, this cycle offers hospitals bonus points for completing and submitting a survey for each selected condition by November 1, 2022. These surveys will be used by the MVC Coordinating Center to improve the program for future years and elicit improved best practice sharing between members. The full methodology for the new program can be found in the PY2022-2023 Technical Document.

Figure 1 below illustrates the distribution of total hospital points out of 10. The average points scored for the Mid-Year Scorecards was 5.9/10 before including the survey bonus points. This is 0.9 points higher than the average points scored at the conclusion of PY21 excluding all bonus points.

Figure 1.

Figure 2 below illustrates the breakdown of average points by condition out of five. Consistent with previous years, joint replacement was the highest scoring condition with an average of 4.5 points earned. The success of the joint replacement condition can be attributed to the shift from post-acute care in skilled nursing facilities (SNF) to home health and the move towards outpatient surgeries. Pneumonia was the lowest scoring condition with hospitals earning less than one point on average. The MVC average payment for a 30-day pneumonia episode increased by $792 from the baseline in 2019 to the performance year in 2021. The largest contributors to this increase were the base payment and readmission payments.

Figure 2.

The Mid-Year P4P scores are subject to change as new data is added. The final scorecards will be distributed after all 2021 claims have been added to the data in quarter one of 2023. Hospitals can track their score through the new P4P PY2022-2023 reports on the MVC registry. These new reports provide all relevant scoring information for both improvement and achievement points in one place except for the survey bonus points. They can be filtered by selected conditions to make the tracking of P4P points easier. For a walkthrough of your hospital’s Mid-Year P4P Scorecard or P4P registry reports, please contact the MVC Coordinating Center.

18 Aug 2022
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Roll Up Your Sleeve to Save a Life

August 18, 2022 | 0 Comments | , ,

After declaring the nation’s first-ever blood crisis in early 2022 and the worst shortage in over a decade, the American Red Cross and other blood donation organizations continue to plea for blood donors. In Michigan, blood donations fell with the start of COVID-19 and continue to lag pre-pandemic levels.

Based on data from the Red Cross, someone in the United States needs blood or platelets every two seconds, resulting in approximately 29,000 units of red blood cells, 5,000 units of platelets, and 6,500 units of plasma required daily. And, while an estimated 6.8 million people in the U.S., or 3% of eligible individuals, donate blood each year, more donors are always needed!

Figure 1.

According to the Association for the Advancement of Blood and Biotherapies, donating blood is a safe, simple, and rewarding experience that usually only takes 45-60 minutes. During a typical whole blood donation, approximately 0.5 liters of blood is collected. For donations of other blood products, such as platelet or plasma, the amount collected is based on the donor’s height, weight, and platelet count.

Along with helping others in need, blood donation also has some surprising health benefits, including:

  • A free mini health screening: before donating, potential blood donors receive a brief physical exam that includes taking blood pressure, body temperature, and pulse to ensure they are fit for donation.
  • A healthier heart and vascular system: in hypertensive individuals, regular blood donation has been linked to lower blood pressure and may lower the risk for heart attacks.
  • A happier, longer life: people usually donate because it feels good to help others and altruism has been linked to positive health outcomes, including a lower risk for depression and greater longevity.

Figure 2.

Alternatively, to help protect the limited supply of blood, reduce costs associated with the collection and administration of blood products, and reduce patient complications of allergic, febrile, and hemolytic reactions, restrictive transfusion practice or conservative blood use can be considered. This practice, recommended by the National Institute for Health and Care Excellence and the Choosing Wisely campaigns, uses the two major clinical decision points of hemoglobin concentration when transfusion should be considered and the number of units being transfused.

Whilst evidence suggests there is no increase in morbidity or mortality by following restrictive transfusion practices, outcomes related to the quality of life, symptoms of anemia, and length of hospital stay are not as well studied.

Some examples of multimodal interventions to reduce unnecessary blood transfusions include the START (Screening by Technologists and Auditing to Reduce Transfusions) study which produced guideline development, education for clinicians, prospective order screening, and immediate feedback to physicians for potentially inappropriate orders, and monthly feedback to the clinical teams on appropriateness. Secondly, an Australian system-wide initiative focusing on education, practice audits, and feedback for individuals and a policy promoting single-unit red blood cell transfusions showed success. Other blood management approaches including anemia prevention, iron supplementation for iron deficiency, and a reduction in blood loss during procedures are other methods that can be used.

To implement strategies for reducing the unnecessary use of transfusions, individuals should assess their own practice against evidence-based standards. Additionally creating a multidisciplinary team to discuss and set guidelines and protocols based on evidence, auditing practices against identified evidence-based standards and tailoring interventions to the institutional setting and context can help with the implementation of restrictive transfusion practices.

Until we can find an alternative source or increase supply, we will continue to need people to step up and donate.

If you plan to donate blood, a few helpful tips can make for a better experience:

  • Drink plenty of water. Staying hydrated makes it easier to find your veins and prevents you from becoming light-headed after donating
  • Eat well beforehand and be sure to eat snacks offered to you.
  • Get a good night’s sleep and, if you are planning to exercise, do so before donating, not after.
  • Take iron tablets. The American Red Cross recommends individuals who donate blood frequently take an iron supplement or a multivitamin with iron.

Typically, donors are eligible to donate blood every 56 days or up to six times per year. To find a blood donation site near you, visit the American Red Cross or your local donation center. Every drop helps!

21 Jul 2022
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Ambulatory Surgical Centers Transforming Surgery Market

July 21, 2022 | 0 Comments | ,

Surgery in the United States is transforming, with as many as 70% of surgeries currently performed in an outpatient setting. Ambulatory Surgical Centers (ASCs) have grown significantly over the past decade and are now a critical part of the healthcare system. The Ambulatory Surgery Center Association now represents more than 6,000 centers across the United States. ASCs account for more than half of the outpatient surgery market with roughly 23 million procedures per year. The growth of these centers has had a significant impact on hospitals. As the number of ASCs has grown and hospital outpatient departments (HOPDs) have taken on fewer cases, many hospitals have elected to set up ASCs as part of their business.

This growth has been driven in part by greater scheduling flexibility and lower costs. Since most surgeries performed in outpatient settings are elective, patients are enabled to “shop” for their facility of choice prior to treatment. ASCs exclusively provide same-day surgical services that do not exceed 24 hours or require hospitalization. They are often – but not always – specialty-specific. Some of the most common specialties serviced by ASCs are orthopedics, pain, and ophthalmology (see Figure 1).

Figure 1.

A recent study of Medicare patients evaluated the scope of practice, number of patients treated, number of procedures, and revenue for ASCs. The study found that across the United States there was a 7% increase in the number of ASCs certified to service Medicare patients. In 2018 there was an 11% increase in the number of services performed and a 6.5% increase in patients. The median number of surgeries performed at each ASC was 1,050 per year. Payments collected rose from $3.6 billion in 2012 to $5.1 billion in 2018, with cataract surgery accounting for 24% of all payments. The study concluded that the increased revenue was most likely due to the increasing complexity of procedures being performed and, thus, higher reimbursement.

The increase in more complex surgeries at ASCs can most likely be attributed to better anesthesiology methods that allow for improved pain control and reduced post-operative recovery time, as well as new technologies and techniques that make surgeries safer and more comfortable. The Leapfrog Group identified over 50 different procedures performed across 10 disciplines in their 2022 ASC outpatient surgery fact sheet (see Figure 2).

Figure 2.

Associated with this rise in complexity is the need for ASC staff to accurately identify high-risk patients who are not appropriate candidates for ASCs. Many ASCs have created their own methods for identifying these high-risk candidates since there are no universal or ready-to-use published criteria. Although no preoperative screening system is perfect, the average national ASC transfer rate to an inpatient facility is just 0.42%, and in one study the use of a criteria checklist (see Figure 3) helped the facility achieve a 0.17% transfer rate.

Figure 3.

To assist the growing number of patients in their selection of a surgical provider, several organizations now publish evaluations about the quality and safety of various ASC facilities. For example, Newsweek published their rankings of "America's Best Ambulatory Surgical Centers" earlier this year in partnership with the global research firm Statista. The list spotlights 470 facilities in the 25 states with the most ASCs, with up to 10 ranked centers by state. Michigan's highlighted ASCs (see Figure 4) received scores of 74% - 83%, which was based on a "reputation score" and KPI data score.

Figure 4.

As ASCs continue to have a transformative impact on the surgery market, the Michigan Value Collaborative is interested in learning more about the metrics and data being utilized by these stand-alone or hospital-affiliated centers. If you have any information to share, please reach out to the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

30 Jun 2022
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MVC Launches First Preoperative Testing Awareness Week

June 30, 2022 | 0 Comments

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.