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Breastfeeding Awareness Month: The Value of Hospital Initiatives

Breastfeeding Awareness Month: The Value of Hospital Initiatives

As August is National Breastfeeding Month, many healthcare professionals and hospitals across the country are joining in to promote its benefits. Currently, the American Academy of Pediatrics (AAP) recommends exclusive breastfeeding of infants for the first six months of life and then alongside solids as long as mutually desired by mother and child for two years and beyond. This updated recommendation – the AAP previously recommended breastfeeding through age one and beyond – acknowledges its continued benefits for mother and child.

Many experts suggest that it is an investment in the health of current and future patients, not just a lifestyle choice. In updating its guidance, the AAP clarifies that breastfeeding beyond one year and up to two years has significant benefits to the mother in particular; lower rates of diabetes, high blood pressure, and breast and ovarian cancers are associated with long-term breastfeeding. In breastfeeding infants, some studies indicate there are fewer respiratory and gastrointestinal infections, incidents of severe respiratory disease or sudden infant death syndrome (SIDS), development of chronic illnesses, doctor visits, hospitalizations, and prescriptions. The Centers for Disease Control and Prevention (CDC) estimates that an additional $3+ billion in medical costs per year can be attributed to low breastfeeding rates.

Breastfeeding is a personal choice – not everyone wants to or even can breastfeed their baby. For those who choose to, however, being successful is linked to the presence of interventions and support along the way. Evidence-based practices at the hospital level are a critical component for establishing breastfeeding.

The Agency for Healthcare Research and Quality (AHRQ) cited a systematic review of 38 randomized controlled trials that found short- and long-term increases in breastfeeding as a result of direct assistance and education across a variety of providers and settings in conjunction with structured training for health professionals. The AHRQ and the AAP also both cite increases in breastfeeding initiation and duration as a result of the Baby-Friendly Hospital Initiative, which gives a special designation to facilities that successfully complete an assessment and implement the World Health Organization’s 10 Steps to Successful Breastfeeding.

Some of the evidence-based practices linked to higher breastfeeding rates include individualized support in the first few hours and days following birth, rooming-in, and education and support. Additionally, the CDC’s 2018 national survey of Maternity Practices in Infant Nutrition and Care (mPINC) identified institutional management as an area with the widest range of scores across all states, with 45 being the lowest state score and 95 the highest state score (see Figure 1). As this category is defined by activities such as nurse training and clinical competency, record keeping, and policy setting, it is clear that some important breastfeeding initiatives extend beyond the maternity ward.

Figure 1. National score and state score ranges for mPINC subdomains in 2018

According to the AAP, there are also significant opportunities for more equitable gains in breastfeeding outcomes. The United States continues to see evidence of disparities in success rates – none of the Healthy People 2020 objectives for breastfeeding were met for non-Hispanic black mothers and infants. The rates for any breastfeeding are approximately 10% lower in non-Hispanic black mothers compared to the average for all races/ethnicities (see Figure 2). Similarly, there are disparities in mothers who are younger than 20, low income, or less educated. Hospitals interested in health equity initiatives likely have an opportunity in the realm of breastfeeding support that accounts for socioeconomic and cultural differences.

Figure 2. Rates of any breastfeeding in U.S. by race/ethnicity

A summary of recommendations, provider implementation tools, and other resources are summarized for healthcare providers in the AHRQ breastfeeding provider fact sheet. In addition, MVC would like to spotlight those members with ongoing or completed improvement efforts around breastfeeding. If your site has achieved the Baby-Friendly Hospital designation or has tools for addressing patient disparities in breastfeeding, please consider sharing your story with the Coordinating Center for the benefit of the larger collaborative.

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MVC Launches New Push Report on ED and Post-Acute Care Use

MVC Launches New Push Report on ED and Post-Acute Care Use

The emergency department (ED) is a unique and critical component of the healthcare system in the U.S., treating acute injuries or illnesses and acting as a safety net for patients who are uninsured or low income. ED visits are also very expensive, and that spending is growing according to a recent retrospective study of ED trends. This week the Michigan Value Collaborative (MVC) is distributing its newest push report on ED and post-acute care (PAC) utilization to support members' efforts in this space.

Since the ED serves as a safety net for patients experiencing barriers to healthcare access, the Coordinating Center report purposefully integrates measures tied to social determinants of health and health equity. Reports contain a patient population snapshot table showcasing several patient characteristics by payer (see Figure 1), including age, race, comorbidities, zip code, dual-eligibility status, and economic distress scores. Dual-eligible patients are those who qualify for both Medicaid and Medicare; these patients tend to have a higher prevalence rate for chronic conditions, disabilities, and other care needs that substantially increase healthcare utilization.

Figure 1.

Economic distress scores range from 0-100 with a higher score indicating greater economic distress. These scores come from the Economic Innovation Group’s Distressed Communities Index (DCI), which is derived from the U.S. Census Bureau’s Business Patterns and American Community Survey. The DCI combines seven complementary economic indicators (see Figure 2) to provide a single, holistic, and comparative measure of economic well-being across communities in the U.S. In MVC’s report, there is a proportion of patients living in an “at-risk” or “distressed” zip code across all payers, as classified by the DCI. However, as the literature often indicates, the Medicaid population has the highest average distress score and a larger proportion of patients living in an “at-risk” or “distressed” zip code.

Figure 2.

The bulk of MVC’s latest report aims to provide its members with more granular insights into PAC utilization in the 30-day post-discharge period than is available on the MVC registry. Using index admissions for medical conditions from 1/1/18 through 12/31/20, the report focuses predominantly on ED utilization, which is categorized as either “ED to Home” or “ED to Readmission.” ED to Home represents ED visits that do not occur on the same day as readmission, and ED to Readmission refers to those visits occurring on the same day as readmission.

The report includes figures illustrating trends in 30-day ED to Home rates between 2018 and 2020, top reasons for ED visits at a given hospital, the number of ED to Home visits within 30 days post-discharge, the number of days until the first ED visit post-discharge, the ED to Home rate and the breakdown of total PAC spending for a hospital’s three highest-volume conditions, and the average ED facility payment. MVC included the following payers in this report: Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, BCBSM Medicare Advantage (MA), Blue Care Network (BCN) HMO Commercial, BCN MA, Medicare Fee-for-Service, and Medicaid.

Overall, the MVC report confirms published findings that Medicaid patients utilize the ED at a higher rate than patients insured by other payers. The Coordinating Center also finds that ED use differs between types of providers. For acute care hospitals, for example, over half of ED visits occur on the same day as readmission, whereas these visits account for 40% at Critical Access Hospitals (CAHs).

MVC also finds that ED to Home visits most often occur once in the 30 days following discharge for most of the collaborative (see Figure 3). There are some members, however, with three or more ED to Home visits within the 30-day post-discharge period.

Figure 3.

The Coordinating Center envisions this report being of particular importance to its CAH members, whose structures, services, and patient populations make the ED and PAC a top priority. As such, MVC prepared versions of this report for both CAHs and acute care hospitals using their respective comparison groups throughout. In other words, the CAH version of the report includes comparison points for all other CAHs in the collaborative. Acute care hospitals can see their traditional collaborative-wide and regional comparison data, not including hospitals with a CAH designation.

As members review and discuss the findings in their report(s), MVC encourages providers to utilize the Michigan Emergency Department Improvement Collaborative (MEDIC), which is dedicated to improving the quality of ED care across the state of Michigan. In addition, if members wish to discuss additional custom analyses on ED and PAC utilization, please contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

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Latest MVC Preop Testing Report Features New Figures and Data

Latest MVC Preop Testing Report Features New Figures and Data

This week MVC distributed its second preoperative testing push report of 2022, providing members with another opportunity to benchmark their testing practices. MVC first introduced its preoperative testing push reports in 2021 to help members reduce the use of unnecessary testing for surgical procedures. Preoperative testing, especially for low-risk surgeries, often provides no clinical benefits to patients but is ordered regularly at hospitals across Michigan.

The report distributed this week had many similarities to the version distributed earlier this year in April, namely that members continued to see their rates across a variety of tests for three elective, low-risk procedures performed in outpatient settings: laparoscopic cholecystectomy, laparoscopic inguinal hernia repair, and lumpectomy. Claims were evaluated for the index event as well as 30 days prior to the procedures for the following common tests: electrocardiogram (ECGs), echocardiogram, cardiac stress test, complete blood count, basic metabolic panel, coagulation studies, urinalysis, chest x-ray, and pulmonary function.

The latest report has a few key differences from the spring version, the most significant of which is that it utilizes claims from Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) plans exclusively. This allows members to see MVC’s most up-to-date data; the report includes index admissions from 1/1/2019 through 12/31/2021. In addition, since the report contains BCBSM/BCN data only, there is no case count suppression, whereas members would only see their data in the spring version if they had at least 11 cases in each year of data for the three combined conditions.

The reports received by members this week included several new figures. Similar to other MVC push reports, members will now see a patient snapshot table that provides additional information about the report’s patient population. For this, MVC chose to include patient characteristics such as age, zip code, and comorbidities. Generally speaking, there were more comorbidities among patients who underwent preoperative testing compared to patients with one or no comorbidities (see Figure 1). However, the majority of patients who complete a preoperative test do not have multiple comorbidities. There were also observed differences in testing rates by age. In general, patients who had preoperative testing were older on average than patients who had no preoperative testing.

Figure 1.

Another new figure showcased the overall preoperative testing rates by year. This trend graph showed members how their overall rate for any preoperative testing compared in 2019, 2020, and 2021, and it included data points for the MVC average and regional comparison groups (see Figure 2). The key finding for this figure was that there has been very little change in testing rates over time when looking at overall preoperative testing practices. This means that, in general, the prevalence of low-value preoperative testing has remained consistently high overall across the collaborative for three years and likely longer.

Figure 2.

The latest report also included a new figure for absolute change in any preoperative testing from 2019 to 2021. For each hospital, this appears as a caterpillar plot of absolute change percentages for their highest-volume procedure among the three low-risk surgeries in the report. Members can see the percentage change—positive or negative—in their testing rate for that surgical condition, as well as how their absolute change compares to the rest of the collaborative. For example, hospitals that perform more cholecystectomies than hernia repairs or lumpectomies saw a wide range of both increases and decreases in preoperative testing rates from 2019 to 2021 (see Figure 3).

Figure 3.

The blinded hospital in this example observed very little change in its testing rate for cholecystectomy (-1.6%), and the MVC average was similar (-2.2%). This showcases that although the collaborative is not seeing much change to overall rates for any testing over time, individual members might see greater variability over time for specific tests or procedures, especially in instances of low case counts.

Members will be able to take those deeper dives into their rates for specific tests in the figures that make up the remaining pages of the report. Viewing one’s preoperative testing rates for each specific test can help members understand if any specific tests are driving their overall testing rate. One area of opportunity, for example, could be to reduce one's rate of cardiac testing, specifically ECGs; the rate of ECGs is very variable across the collaborative (see Figure 4) and could lead to a cascade of care.

Figure 4.

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

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Ambulatory Surgical Centers Transforming Surgery Market

Ambulatory Surgical Centers Transforming Surgery Market

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.

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Reflecting on MVC’s Accomplishments: January-June 2022

Reflecting on MVC’s Accomplishments: January-June 2022

As we start the second half of 2022, the MVC Coordinating Center is taking a moment to pause and reflect on the tremendous work that has been accomplished over the past six months. Here is a look back at some of the highlights.

JANUARY

MVC Workgroups consist of a diverse group of representatives from Michigan hospitals and POs that meet virtually to collaborate and share ideas related to various topics. January kicked off with the launch of MVC’s new Health Equity Workgroup! The inaugural meeting featured speakers from the Michigan Social Health Interventions to Eliminate Disparities (MSHIELD) Collaborative. The Health Equity Workgroup has two more meetings in 2022 and we’d love to see you there! Visit the MVC 2022 Events Calendar to register and check the calendar for additional Workgroup offerings focused on Chronic Disease Management, Diabetes, Health in Action, Joint Replacement, and Sepsis.

FEBRUARY

MVC launched two new push reports in February, with the release of the new Physician Organization (PO) Colectomy Report, shared with 35 of MVC’s PO members, and the first-ever Pneumonia Push Report, distributed to 89 MVC hospital members[1]. To meet the needs of MVC’s growing hospital members, a subset of the Pneumonia Push Reports was tailored to meet the specific data needs of our Critical Access Hospital members.

MARCH

After completing 58 hospital site visits in 2021, MVC announced the creation of a robust quality improvement (QI) initiatives database, developed to track QI initiatives across the collaborative. The database, searchable by QI focus area and project status, allows MVC to understand common themes and challenges among all its members as well as within subgroups such as hospital size or region. In 2022, the MVC team is hosting site visits with our PO members and will be gathering QI initiatives to add to the QI initiatives database. The database is being used as a resource for custom analytic requests and a library of practice standards for members. If you are an MVC PO interested in participating in a virtual site visit, please contact the MVC Coordinating Center to schedule.

APRIL

In April, MVC distributed a refreshed Sepsis Push Report, developed in collaboration with the Michigan Hospital Medicine Safety Consortium. These customized reports provide hospitals with new insight on demographics for their sepsis patients, including the percentage of COVID-positive patients to illustrate how COVID has impacted their sepsis data, along with race, top comorbidities, and most common zip codes, stratified by payer.

MAY

MVC held its first collaborative-wide meeting of 2022 in May, with a focus on “Turning Data into Action.” Held virtually, a total of 158 leaders representing 68 different hospitals and 15 physician organizations (POs) from across the state of Michigan participated in the event. Save the Date for our next in-person collaborative-wide meeting, scheduled for Friday, October 28th at the Radisson Hotel Lansing!

JUNE

In June, the MVC Coordinating Center hosted its first in-person event since 2019, with a Regional Networking Dinner for our Eastern Michigan sites (Region 3). The dinner provided an opportunity for MVC hospital and PO members to come together to network, share ideas and discuss key priorities, including health equity initiatives. MVC’s next Regional Networking Event for Southeast Michigan (Region 4) is scheduled for Tuesday, September 27th. For identification of your MVC designated region, please see the MVC Regions Map here.

AND COMING SOON…

Along the way, the MVC team has been hard at work preparing for two new exciting developments:

  • MVC’s first Northern Summer Meeting (RSVP here) is scheduled for Thursday, August 18th at Traverse City’s Great Wolf Lodge. The agenda is tailored to highlight unique opportunities and challenges facing the Northern Michigan healthcare community. Interested MVC members serving Northern Michigan, the Upper Peninsula, and small/rural communities are encouraged to The University of Michigan Medical School designates this live activity for a maximum of 3.75 AMA PRA Category 1 Credit(s)™.  This meeting will feature presentations from:
    • Michigan Center for Rural Health
    • MyMichigan Medical Center – Sault
    • Munson Healthcare Grayling Hospital
    • Region 9 Area Agency on Aging

To learn more about these initiatives and other MVC happenings, visit the MVC blog!

Footnote

[1] Hospitals and POs not meeting case count thresholds did not receive a report.

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MVC Coordinating Center Team Volunteers at Member Hospital

MVC Coordinating Center Team Volunteers at Member Hospital

As employers and managers endeavor to invest in their company’s culture, there is one often overlooked activity that can positively impact job satisfaction: volunteering. According to a study from Deloitte, cultivating a culture that encourages volunteerism can boost employee morale, workplace atmosphere, and brand perception. It found that 89% of employees believe companies with sponsored volunteer activities offer a better overall work environment and that 70% felt volunteering was a stronger boost to morale than company-sponsored happy hours. Since team culture and the retention of skilled employees have become increasingly important in the current job market, there has never been a better time to help staff feel connected to their community and teammates.

The Michigan Value Collaborative (MVC) experienced some of these benefits recently when the Coordinating Center team spent several hours volunteering together at a local MVC member hospital. This was the first time MVC had organized an official service day for its team. It took place at the Farm at Trinity Health, located at the Trinity Health St. Joseph Mercy Ann Arbor Hospital in Ypsilanti, MI. The MVC team spent several hours weeding, planting, and harvesting vegetables. After harvesting, the MVC team helped wash and pack fresh greens, salad mix, kale, and radishes for the Farm’s community-supported agriculture (CSA) program and patient produce boxes.

Selecting the Farm at Trinity Health as MVC’s service day location was an exciting opportunity due to its many connections to MVC’s priorities. The produce boxes distributed by the Farm help feed members of the community who experience food insecurity or hunger, as well as hospital patients who participate in programs like cardiac rehabilitation (CR). MVC has identified health equity as a strategic priority for 2022 and beyond, and also currently has a Value Coalition Campaign that encourages members to increase patient utilization of CR programs. The MVC team was excited to learn about this direct connection to CR patients and the program’s overall impact on community health. In addition, the Farm at Trinity Health is a participating site in the Washtenaw County Health Department’s Prescription for Health Program, which was a featured topic at MVC’s health equity workgroup earlier this year.

This service day also coincided with an overall shift in how MVC staff members interact. As MVC grew over the past two years, multiple new employees had only ever interacted with coworkers virtually because of the pandemic’s impact on in-person activities. That changed this past spring with MVC’s part-time return to in-person work and some in-person team-building events. The service day was intended to bring teammates together after many months apart to get to know one another, connect, and give back to the wider community.

If you have a story about an impactful program that could be shared with the Collaborative or wish to connect your team with local community volunteering, contact the MVC Coordinating Center for assistance at michiganvaluecollaborative@gmail.com. Learn more about the Farm at Trinity Health (formerly the Farm at St. Joe’s) here.

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MVC Launches First Preoperative Testing Awareness Week

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

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

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

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

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

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

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

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

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

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MVC Registry to Soon Include Patient-Level Medicare Data

MVC Registry to Soon Include Patient-Level Medicare Data

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

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

Figure 1.

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

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

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

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

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

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New MVC Northern Summer Meeting Planned for August

New MVC Northern Summer Meeting Planned for August

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

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

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

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

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

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

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

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

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

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

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

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

Figure 1.

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

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

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

Figure 2.

Figure 3.

Figure 4.

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

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

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

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