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Michigan Value Collaborative Value Coalition Campaign. Introducing the Preoperative Testing VCC and Report Series.

Michigan Value Collaborative Value Coalition Campaign. Introducing the Preoperative Testing VCC and Report Series.

In 2020, the Michigan Value Collaborative (MVC) introduced the Preoperative Testing Value Coalition Campaign (VCC) with the aim of reducing the use of unnecessary preoperative testing for surgical procedures.  As part of this new campaign to improve quality, reduce cost, and improve the equity of care delivery in Michigan, the Coordinating Center developed and distributed preoperative testing reports to collaborative members earlier this week. The goal of these reports is to introduce the VCC and provide benchmarking data for some of the common preoperative tests to members.

Currently, the VCC is focused on three elective, outpatient, low-risk surgeries. This includes cholecystectomy, lumpectomy, and inguinal hernia repair. These surgeries were chosen to identify a population unlikely to require much, if any preoperative testing. Metrics included in the reports evaluate hospital testing rates for electrocardiography (EKG), trans-thoracic echocardiography (TTE), cardiac stress tests, chest X-ray (CXR), urinalysis, complete blood count (CBC), basic metabolic panel, coagulation tests, and pulmonary function tests (PFT).  As shown in Figure 1, there is wide variation across the collaborative for overall preoperative testing rates, ranging from 20% to 96%.

Whilst the report provides the MVC all and regional averages as benchmarks, the variation suggests that there is significant room for improvement among Michigan hospitals, and even facilities that are average likely have the possibility to reduce preoperative testing. Furthermore, to allow hospitals to identify areas of opportunity, a more granular grouping of laboratory testing including CBC, basic metabolic panel, coagulation tests, and urinalysis for the three low-risk surgeries is depicted in Figure 2.  To allow hospitals and physician organizations to view more comprehensive preoperative testing data, the MVC Coordinating Center is in the preliminary stages of developing a new preoperative testing report for the MVC registry.

Although many preoperative tests are relatively low cost, large-scale overuse when not necessary can increase episode costs. For these three low-risk procedures, an annual preoperative testing payment of $3.2 million dollars was noted in 2019 across MVC hospitals and according to MVC data, annual preoperative testing payments for these conditions has increased steadily over the last 5 years. In addition, overuse of preoperative testing has the potential to harm patients. Patients with borderline or false positive tests may be subjected to additional testing, have their surgeries postponed, or even experience unnecessary harm from invasive follow up tests.  Questions about appropriate preoperative testing  guidelines can be answered at the Choosing Wisely website.

Please provide us with your feedback on the utilization of these or any other MVC reports, or if you would be interested in joining the MVC Preoperative Testing Stakeholder Group, please reach out to MichiganValueCollaborative@gmail.com.

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MVC Component of the BCBSM P4P Program: PY20 in Review

MVC Component of the BCBSM P4P Program: PY20 in Review

In early January, the Michigan Value Collaborative (MVC) distributed 2020 Program Year (PY) scores to hospitals for the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay for Performance (P4P) program. This marked the completion of the first year of a two-year cycle for which hospitals have selected two service lines (out of seven) to be scored on their episode spending using MVC data. These service lines include chronic obstructive pulmonary disease (COPD), colectomy, congestive heart failure (CHF), coronary artery bypass graft (CABG), joint replacement, pneumonia, and spine surgery. Figure 1 shows the frequency of hospital service line selections for the two-year program cycle.

Figure 1.

The program evaluates 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 in the program is by reducing their payments from the baseline period (index admissions in 2017) to the performance period (index admissions in 2019). These are termed ‘improvement points’. Alternatively, hospitals are able to 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 service line. Hospitals are also eligible to earn a bonus point for each service line provided all hospitals in their respective cohort who selected the same condition reduce spending by five percent. A maximum of ten points can be awarded for participating members. Figure 2 shows the distribution of total points earned by hospitals for Program Year 2020.

Figure 2.

On average, hospitals earned six points, an increase of around one point from the 2019 program year average. Twenty-four hospitals received bonus points within the COPD, colectomy, joint replacement, and pneumonia service lines. Consistent with previous years, joint replacement had the average points, with pneumonia coming in a close second (see Figure 3).

Figure 3.

If you have any questions regarding the MVC Component of the BCBSM P4P program, please refer to 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.