Cardiac Rehab -

19 Mar 2025

MVC Refreshes Registry Reports with New Data & Methods

March 19, 2025 | 0 Comments | Cardiac Rehab, cardiac rehabilitation, MVC registry, preoperative testing

At the end of February, MVC updated its registry with new payer data. MVC adds new data to the registry monthly upon receipt of new claims from included payers. This most recent update included the addition of two new months of Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) claims, one new quarter of Medicaid claims, and one new quarter of Medicare claims. Following these updates, the MVC registry now has the following data ranges for its data:

BCBSM PPO (Commercial and Medicare Advantage): 01/01/2015 – 12/31/2024 (index events through 09/30/2024)
BCN (Commercial and Medicare Advantage): 01/01/2015 – 12/31/2024 (index events through 09/30/2024)
Medicaid: 01/01/2015 – 12/31/2024 (index events through 09/30/2024)
Medicare FFS: 01/01/2015 – 06/30/2024 (index events through 03/31/2024)

Anytime MVC publishes new data on its registry, the newest claims for each payer are incorporated throughout the various reports and dashboards where that payer’s data is present, including the interactive multi-payer reports for cardiac rehabilitation utilization and preoperative testing.

Refreshed Multi-Payer Cardiac Rehabilitation Reports

The multi-payer cardiac rehabilitation utilization reports were added to the registry in the first half of 2024 and have replaced the static PDF hospital-level push reports MVC previously distributed biannually. The regular release of new data on the registry, therefore, gives members opportunities throughout the year to check progress on cardiac rehabilitation metrics more regularly and find opportunities for improvement. For example, current data on cardiac rehabilitation enrollment for CABG patients with episode start dates between Jan. 1, 2024, and Sept. 30, 2024, indicates wide variability among hospitals, with many sites observing rates below the recommended 70%. Across the collaborative, enrollment in cardiac rehab after CABG procedures was as low as 28% at one MVC member hospital and as high as 83% at another with a statewide average of 61% (Figure 1). Similarly, cardiac rehab utilization is much lower on average among PCI patients over the same time period (32%), and there is wide inter-hospital variation with rates ranging between 6% and 86% (Figure 2).

Figure 1. Statewide Rankings for Cardiac Rehab Utilization within 90 Days After Discharge from CABG, 1/1/2024-9/30/2024

This latest registry update also included a methodological change impacting cardiac rehabilitation reporting for attendance. These methodological improvements were meant to increase the accuracy of MVC’s reported mean number of visits attended within a selected time period. MVC noted that this change resulted in increases in the average number of completed cardiac rehabilitation visits overall, and especially among BCN and Medicaid beneficiaries. This increase in the average number of visits reflects the fact that MVC improved the capture of multiple cardiac rehabilitation visits over a longer time period billed on a single claim.

Refreshed Multi-Payer Preoperative Testing Reports

The multi-payer preoperative testing utilization reports were added to the registry at the end of 2024 and have also replaced static hospital-level push reports that were previously distributed as biannual PDF reports to members. Looking at all available 2024 claims across payers, there is evidence of a small decrease in the MVC All rate of preoperative testing prior to low-risk surgery beginning in late 2022 and continuing throughout 2023 and into 2024 (Figure 3). Those members who are working to reduce unnecessary preoperative testing are encouraged to check their updated data. MVC is also able to supplement registry data with custom analytics by an MVC analyst to meet the needs of members. One such site recently utilized MVC’s custom analytics to identify differences in preoperative testing rates by physician NPI to support conversations about intra-hospital variation by provider and service line.

Figure 3. Statewide Rate of Preoperative Testing and Relative Difference in Preoperative Testing by Quarter, 2020-2024

05 Mar 2025

Cardiac Rehab CHF MVC workgroup patient-centered care

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February Workgroups Highlight Hybrid Cardiac Rehab Delivery and Patient Journey Mapping

March 5, 2025 | 0 Comments | Cardiac Rehab, CHF, MVC workgroup, patient-centered care

In February, MVC hosted two virtual workgroup presentations – the first focused on hybrid cardiac rehab program delivery and the second a health in action session focused on patient journey mapping. The MVC Coordinating Center hosts workgroup presentations twice per month with topics rotating between post-discharge follow-up, sepsis, cardiac rehabilitation, rural health, preoperative testing, and heath in action (ad hoc focused topics). Each month, the MVC Coordinating Center publishes key highlights from the past month’s presentations to support practice sharing across the state.

February Cardiac Rehab Workgroup: Henry Ford Health

MVC’s first cardiac rehab workgroup of 2025 featured a presentation by Dr. Steven Keteyian, PhD, Director of Cardiac Rehabilitation/Preventive Cardiology at Henry Ford Health System. The presentation focused on the development and implementation of a non-traditional hybrid model of care delivery.

During the COVID-19 pandemic many healthcare facilities had to transition to virtual platforms to continue providing essential medical care to patients. Henry Ford Health’s cardiac rehabilitation programs, like many other services, pivoted to meet the needs of patients by establishing an evidence-based hybrid delivery model.

Dr. Keteyian emphasized that cardiac rehabilitation is more than just physical exercise. It is a comprehensive health improvement plan containing several core components (Figure 1) such as nutritional counseling, psychosocial management, weight management and body composition, tobacco cessation counseling, and more. All of these components are combined to establish an individualized treatment plan for the patient.

Dr. Keteyian explained that their patients begin their program in-person to establish baseline assessments and a treatment plan. Once established, cardiac rehab patients have the option to participate virtually for remaining sessions or return on-site depending on their preferences and the need to assess them in-person. Dr. Keteyian noted several factors that drive the use of hybrid cardiac rehab such as patient needs (returning to work, family care responsibilities, travel distance/transportation limitations), limited resources within the health system for a fully on-site program, and limited patient availability during the on-site hours of operation.

To be eligible for participation in cardiac rehabilitation, patients need to have a qualifying event such as acute coronary syndrome (ACS), heart valve repair/replacement (TAVR), cardiac transplant, or stable heart failure (with less than 35% ejection fraction). Henry Ford uses MVC data to track the percent of eligible patients enrolled in cardiac rehab within 90 days, and compares rates across different qualifying events (e.g., AMI, CHF, TAVR, etc.) to see where cardiac rehab is being underutilized compared to averages for the state and Centers for Medicare & Medicaid Services (CMS). The Henry Ford team began incorporating virtual cardiac rehab delivery as a strategy to increase enrollment and attendance among eligible patients.

Dr. Keteyian also discussed some common questions and concerns he hears when discussing hybrid program delivery, such as needed equipment, patient safety, and program efficacy. He shared information from the iAttend randomized control trial that Henry Ford Health participated in from 2019 – 2024, which tracked cardiac patient demographic data, eligibility, participation, and outcomes for hybrid and facility-based cardiac rehab programming (Keteyian, 2024). Data showed that none of the hybrid participants were required to go on-site due to clinical concerns, no virtual visits required physician intervention, and there were no mechanical falls requiring medical attention indicated in either group. A second randomized trial, HF-ACTION, tracked 2,331 heart failure (HFrEF) patients and found that hospitalizations during or within 3 hours after exercise occurred for 2% of the hybrid participants versus 3% for on-site patients. The mortality rate for patients in both study groups was very low (approximately 0.4%) indicating safety was not an issue. Though the data did show hybrid patients not progressing as quickly through the program as on-site patients, this lag became a teaching moment for cardiac rehab staff and an opportunity for improvement.

Attendance for both programs was comparable, and patient outcomes were statistically similar with patients showing improvement in desired performance measures such as peak oxygen uptake, exercise duration, and walking distance (Keteyian, 2024). Staff burden as a result of running a hybrid program was a key concern. To mitigate the potential for burnout, Henry Ford Health aligned services and materials with how the on-site cardiac rehab program is managed.

Dr. Keteyian closed by pointing out that the number of patients who qualify for cardiac rehabilitation each year outnumbers the available spaces in on-site programs throughout the United States. Even if these programs were running at full capacity, only ~ 50% of the eligible patients could be seen. He argued, therefore, that there is a significant need to increase the number of best-practice cardiac rehabilitation programs and the methods available to patients to access them (Balady, 2011).

February Health in Action Workgroup: MVC Coordinating Center

MVC’s health in action workgroup this month included a presentation and workshop on patient journey mapping with MVC’s Associate Program Manager Jana Stewart, MS, MPH. This workshop was a continuation from the October 2024 collaborative-wide meeting’s post-discharge follow-up breakout session. Following the fall workshop, MVC collated member feedback on common barriers to follow-up for heart failure patients, which Stewart summarized as part of the February workgroup presentation. Participants of the workgroup also engaged in polls and two guided breakout discussions aimed at improving outcomes for patients with congestive heart failure.

Using Patient Journey Mapping to Improve Patient Outcomes

Stewart explained that the purpose of patient journey mapping is to understand the patient’s experience and pain points as they manage their health. This practice looks at service delivery by providers as well as the patients’ steps beyond healthcare appointments, providing useful data for root cause analyses and developing effective interventions. Stewart shared examples of patient journey maps that described what a patient might do, think, and feel as they seek healthcare services as well as maps illustrating a hospital’s workflow for enrolling eligible cardiac rehab patients. By generating maps from both the patient and provider perspective, one can identify opportunities for efficiencies and necessary interventions points.

In the first of two breakout sessions, attendees provided feedback and edits on a patient journey map for cardiac rehab enrollment following heart surgery. Attendees reimagined how the patient experience and hospital steps might change for a heart failure patient. Some interventions that were discussed included staff reviewing discharge lists frequently to keep track of patients, having a nurse navigator to help patients prepare for cardiac rehab, and keeping a consistent treatment plan between inpatient and outpatient providers.

Patient Experience – Key Barriers That Impact Patients

Stewart also outlined some key considerations regarding a patient’s experience and some of the barriers that may impact their ability to manage their health. One key barrier discussed was the limitations of our brain's processing capacity and the ways in which mental fatigue make it harder to remember and cope with information. Famed environmental psychologist George Miller once posited that a typical person is able to process and store to memory 5 – 9 pieces of information at a time. When a person is mentally fatigued (e.g., sleep deprived, burned out, cognitively burdened), their ability to understand and store information decreases.

Stewart cited a research study on patient recall after specialty care visits (Laws et al, 2018), which found only half of patients remembered the recommendations they received from a provider, and only about half of what they remembered was recalled correctly. This can have a significant impact on how well a patient follows their treatment plan after they are discharged or sent home. These recall difficulties are further exacerbated in patients with more extensive mental fatigue, such as those experiencing minority stress, unmet social needs, older age, lower health literacy, and other factors. Stewart argued that a patient’s current mental capacity and literacy are key considerations when journey mapping, as they are often the culprit for not following treatment plans.

One strategy Stewart shared that can reduce cognitive burden is the use of storytelling. Used as a framework for delivering information, stories allow patients to better understand and remember details. This can be done through patient story videos as well as case studies that demonstrate the progression of an illness or treatment plan. During one of the breakout discussions, participants brainstormed how they might use storytelling to communicate information to CHF patients. Ideas included establishing private community groups on social media for patients to share their stories, patient story pamphlets, and videos to play on hospital televisions or linked in patient discharge materials.

The feedback and ideas generated by participants during February's health in action workgroup will be used to draft resources for MVC member sites. MVC plans to bring those draft materials to future meetings or workgroups to gather feedback prior to dissemination. Participants also received a copy of the patient journey mapping template so they can utilize this approach at their site(s).

04 Dec 2024

Cardiac Rehab Michigan Cardiac Rehabilitation Network MVC workgroup preoperative testing rite-size

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November Workgroups Highlight Preop Testing Project and Cardiac Rehab Access Initiative

December 4, 2024 | 0 Comments | Cardiac Rehab, Michigan Cardiac Rehabilitation Network, MVC workgroup, preoperative testing, rite-size

In November, MVC hosted two virtual workgroup presentations – the first on preoperative testing was led by a fellow Collaborative Quality Initiative (CQI), and the second on cardiac rehabilitation was delivered by an MVC member hospital. MVC hosts two virtual workgroups per month with topics rotating between post-discharge follow-up, sepsis, cardiac rehabilitation, rural health, preoperative testing, and health in action (ad hoc focused topics). Each month, the MVC Coordinating Center publishes key highlights from these presentations to support resource and best practice sharing across the state.

November Preoperative Testing Workgroup: Michigan Surgical Quality Collaborative (MSQC)

The first workgroup of November focused on preoperative testing and featured a presentation by Pamela Racchi, Clinical Site Coordinator with the Michigan Surgical Quality Collaborative (MSQC), and Susanna Fortney, Clinical Quality Specialist at ProMedica Charles and Virginia Hickman Hospital. To start, Racchi’s presentation provided an update on MSQC’s Preoperative Testing for Low-Risk Surgeries Project, including updated findings for 2024 and plans for 2025. Fortney then presented on ProMedica Charles and Virginia Hickman’s progress with reducing preoperative testing through the lens of participating in both the MSQC preop testing project and the RITE-Size pilot.

MSQC’s preoperative testing project is a continuation of a pilot started in 2022. The goals of the project include:

To define the extent of routine preoperative testing in low-risk surgeries,
To identify underlying reasons for overuse of preoperative testing in low-risk surgeries, and
To implement interventions to heighten awareness and reduce variation among hospitals

Their project varies slightly from MVC’s preoperative testing offerings in that MSQC includes a slightly broader range of low-risk surgeries. The MSQC preop testing project includes abstraction for cases of minor hernia (abdominal hernias <3 cm and all inguinal/ femoral hernia repairs), laparoscopic cholecystectomy, and breast lumpectomy.

During the pilot, MSQC included all ASA classes in their analysis. Based on feedback from site participants, however, MSQC has since limited their evaluated cases to only ASA class I and II, elective cases, and low-risk surgeries identified as the intended primary procedure (based on CPT codes) for 2024. Patients falling into ASA classes I and II are expected to be stable with their comorbid conditions and therefore require less frequent testing.

Overall, results since September 2024 suggest ASA I and II cases are all trending in the right direction; abstracted data currently indicates preop testing rates of 18% among ASA I cases (with a goal of 25% or less) and 31% among ASA II cases (with a goal of 32% or less), as shown in Figure 1.

Racchi also noted that the success of reducing preoperative testing is dependent on there being no further increases in unnecessary testing on the day of surgery. Historically, MSQC has calculated preoperative testing rates like MVC, up to 30 days prior to a surgery but not including the day of surgery. However, MSQC’s abstractors can additionally identify testing completed on the day of surgery. In 2024, MSQC abstractors are assessing cases that received testing on the day of surgery as well as those that received testing in the 30 days prior to a surgery. Preliminary performance results suggested there was an increase in day of preoperative testing when compared to baseline for both ASA I and II cases. Racchi noted that these analyses help determine whether testing was clinically necessary versus a result of physician habit.

Racchi and Fortney both spoke to the benefits of increasing engagement between surgery and anesthesiology to streamline preoperative testing protocols and processes. Between 2022 and 2023, ProMedica Charles and Virginia Hickman was able to reduce their preoperative testing rate by nearly 20% with just a few modifications to their testing protocol and additional onboarding of the anesthesiology providers.

A recent review of preoperative testing cases at ProMedica Hickman that were labeled unnecessary revealed nearly 40% were, in fact, medically justified and another 42% were due to protocol misinterpretation. Interestingly, the greatest rate of unnecessary preoperative testing was found to derive from ProMedica Hickman’s preadmission testing department. Fortney noted they had success embedding an adapted version of the RITE-Size program’s decision aid (Figure 2) within their anesthesiology preoperative protocols, and this helped to provide a more robust visual for their providers to reference when completing preop documentation.

ProMedica Hickman additionally implemented a process for one-on-one training with preadmission testing (PAT) nursing staff, re-education, and the inclusion of case studies. The PAT nurses have also been included in MSQC/RITE-Size project update meetings and are given access to push reports so they can better understand their progress and impact.

The RITE-Size project is a collaboration between several CQI organizations – the Michigan Program on Value Enhancement (MPrOVE), the Michigan Value Collaborative (MVC), MSQC, and the Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE). Each organization has individual projects underway to address unnecessary preoperative testing, but also collaborate under the umbrella of RITE-Size to support de-implementation with additional customized support and coaching. Learn more about RITE-Size by visiting the program website here.

November Cardiac Rehab Workgroup: Marshfield Medical Center – Dickinson

The second November workgroup focused on cardiac rehabilitation – another of MVC’s value-based initiatives. This workgroup featured a joint presentation by Carolyn Hoy, BSN, Director of Quality; Courtney Swanson, BSN, RN, Heart Care Clinic and Cardiopulmonary Rehab Manager; and Lacey Schjoth, BS, Cardiac Rehab Coordinator at Marshfield Medical Center – Dickinson. Hoy, Swanson, and Schjoth’s presentation introduced Marshfield – Dickinson’s cardiac rehab Patient Access Improvement Project, an initiative rooted in one of their core values of patient-centered care.

Although part of a much larger system, Marshfield Medical Center – Dickinson is a relatively small hospital with about 49 general med/surgical beds. To support a significantly rural population in the Upper Peninsula, the Marshfield – Dickinson team identified the need to modify their cardiac rehab program to improve access. Their three main goals included:

Increase the volume of patients seen,
Accurately track referrals,
Expand services to include a supervised exercise therapy (SET) peripheral artery disease (PAD) program

Swanson and Schjoth described how the Northern Michigan landscape and weather contributed to some of the barriers patients faced in accessing cardiac rehab care. Outside of Marshfield – Dickinson’s cardiac rehab center, the next rehabilitation facility is nearly 45 miles away. To support patients driving a long distance to receive cardiac rehab, the team worked to coordinate with their patient’s other appointments. They also flexed their schedules to accommodate earlier or later availability and were willing to shift the appointment times as needed pending weather conditions.

Ultimately, the team was able to increase their class size to five patients per class and increased their class offerings by one cardiac rehab (and one pulmonary rehab) class per day by December 2023. They saw a nearly 27% increase in patient enrollment between 2022 and 2023 (Figure 3). Thus far in 2024, their patient volumes are on track to match or exceed 2023.

Since Marshfield – Dickinson is unable to support a Phase 1 cardiac rehab program, most of their referrals come from outside facilities located in Wisconsin. Connecting with patients quickly after referrals are received is helpful to reduce the duration of time between referral and enrollment. With adjustments to their workflow, the team was able to reduce the average time from referral to initial contact to an average of just 3.5 days as of November 2024. The team also observed a corresponding reduction in the time to first cardiac rehab visit of just 16.5 days on average.

However, rectifying referral documentation from multiple outside sources can slow down this process. Additionally, surveyed patients reported that one of the largest barriers to starting cardiac rehab was a lack of insurance coverage or high copays, with nearly 9% of patients identifying this as the primary reason they did not schedule their initial cardiac rehab appointment in 2024. The team has recently brought on a financial counselor to assist in contacting insurance companies and ensuring adequate and accurate referrals documentation.

Lastly, the Marshfield – Dickinson cardiac rehab team worked to develop close partnerships with local cardiology providers. Ensuring local cardiology providers are aware of and supportive of cardiac rehab is a critical step that generates additional opportunities for program endorsement and patient education by the provider. Marshfield – Dickinson has additionally added Dr. Massabni, an interventional cardiologist specializing in peripheral artery disease, to their staff. This allowed them to further develop their SET PAD program in January 2024 and they are seeing increasing enrollment in this specialized vascular program.

Much of MVC’s work with its members and partners in the space of cardiac rehab is delivered under the umbrella of the Michigan Cardiac Rehab network (MiCR), a collaborative partnership with the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). You can see the MiCR website and offerings here. MVC also offers a robust registry of medical insurance claims data and data specialists that can help navigate and create custom analytic reports on cardiac rehab utilization metrics. Please reach out to the Coordinating Center by email if you would like to learn more about MVC data or engagement offerings.

To learn more about the efforts showcased by November’s workgroup presenters, or other past workgroup presentations, please visit MVC’s YouTube Channel here.

December’s workgroups will feature a post-discharge follow-up presentation on December 3 led by Crystal Young of Corewell Health Trenton and Natalie Holland of MDHHS. Additionally, on December 12, Toni Moriarty-Smith of McLaren Northern Michigan will present a rural health presentation. The complete 2024 and 2025 MVC event calendars and workgroup registration links are available here.

04 Sep 2024

Cardiac Rehab Michigan Cardiac Rehabilitation Network MiCR NewBeat

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MVC, BMC2, HBOM Announce New Cardiac Rehab Materials & Opportunities at MiCR Meeting

September 4, 2024 | 0 Comments | Cardiac Rehab, Michigan Cardiac Rehabilitation Network, MiCR, NewBeat

In partnership with BMC2 and HBOM, the Michigan Value Collaborative recently co-hosted the Michigan Cardiac Rehab network (MiCR) virtual summer meeting, which brought together providers, quality improvement staff, rehab staff, and patients with a shared interest in improving participation in cardiac rehabilitation. Over 70 attendees from across the state joined the meeting on Aug. 9, where they heard updates from the MiCR leadership, previewed new MiCR resources, and heard from a panel of hospital representatives who discussed their experience using the MiCR NewBeat materials.

NewBeat Success and Re-Orders

One key announcement from the meeting included the launch of a second round for placing NewBeat material print orders [ORDER FORM LINK]. The MiCR team will accept submitted order forms through Tues., Sept. 24. Those who request the free printed materials can either pick them up at the fall in-person MiCR meeting in Midland or have them mailed to an address they designate. Early survey evidence suggests that implementation of the NewBeat program is associated with an increase in confidence across a number of metrics (Figure 1).

Speaking to the value of these materials was a panel of representatives from Corewell Health South, Holland Hospital, and Michigan Medicine—three sites who ordered NewBeat materials in the first round at the start of 2024. Each shared their experience using the materials and advice on their integration. HBOM also recorded virtual interviews with the Corewell Health and Holland Hospital site contacts for use in a NewBeat success story video (Figure 2), which was played for the meeting’s attendees.

Those who wish to place an order for NewBeat materials in the current round will again have the opportunity to request the MiCR patient/provider educational handout (available in English, Spanish, and Arabic), the cardiac rehab liaison postcard, and the cardiac care cards. Some customizations are possible to the handout and postcard design to include local hospital or rehab center contact information. Additionally, there is a new offering included in this round of ordering that was launched at the meeting: a new discharge packet sticker. These new sticker designs (Figures 3 and 4) can be affixed to the outside of a patient’s discharge folder and are meant to stand out to patients and families who are often inundated with discharge paperwork. They alert the patient that their discharge paperwork includes a referral to cardiac rehab as the next step in their care.

MiCR Mini Grant RFP Opens for Second Round

The summer meeting also included an announcement that MiCR’s mini grant program to fund small, local cardiac rehab quality improvement projects will similarly be re-opened for a second round of submissions. The first round resulted in the funding of projects at MyMichigan Midland, DMC Huron Valley Sinai, and Ascension Rochester. MiCR is accepting new submissions through Fri., Sept. 13 for up to $5,000 per project. Full details on the RFP and application are available on the MiCR website.

MiCR Updates & Meeting Materials

Finally, the MiCR leadership team announced the development of a neutrally-branded, customizable patient education video that can be shared with hospitals or rehab programs to play on their own websites or waiting room monitors. The video was developed in response to feedback from partner sites that online materials need to be improved and that neutral video content about the value of cardiac rehab is limited. MiCR developed a video for use by network partners and also identified several existing videos published by MillionHearts, Mayo Clinic, and others.

The MVC and BMC2 teams are looking forward to the Michigan Cardiac Rehab Network's fall in-person meeting on Fri., Nov. 8, from 10 a.m. to 3 p.m., at the H Hotel in Midland. MyMichigan is serving as co-host for the event in collaboration with MiCR. Additional event details will be shared in the coming weeks. Those who were unable to attend the summer meeting can view the meeting recording [LINK] or meeting slides [LINK]. Please reach out to info@michigancr.org with any questions.

12 Jun 2024

Cardiac Rehab Michigan Cardiac Rehabilitation Network MVC Coordinating Center MVC registry

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MVC Introduces New Multi-Payer Cardiac Rehab Registry Reports

June 12, 2024 | 0 Comments | Cardiac Rehab, Michigan Cardiac Rehabilitation Network, MVC Coordinating Center, MVC registry

The MVC Coordinating Center added four new multi-payer reports to its online registry in April. These new reports evaluate cardiac rehabilitation utilization and encompass all metrics previously provided annually in MVC’s hospital-level cardiac rehab push report for acute myocardial infarction (AMI), percutaneous coronary intervention (PCI), heart valve repair or replacement (SAVR or TAVR), coronary artery bypass graft (CABG), and congestive heart failure (CHF). Each report reflects the most up-to-date available claims data from Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, BCBSM PPO Medicare Advantage (MA), Blue Care Network (BCN) HMO Commercial, BCN MA, Medicare Fee-for-Service, and Medicaid insurance plans. Users may select any combination of cardiac conditions and insurance plans to assess in each report.

In addition to allowing dynamic selection of cardiac conditions and payers, the reports allow for customization of report date range (the span of episode start dates), episode length (the time period following each index event), and index place of service (e.g., inpatient, outpatient, emergency department). Users may also filter by patient characteristics including gender, age, and comorbidities (diagnoses prior to the index event). Other patient-level characteristics related to the reflected episode can also be filtered, including whether the patient was transferred during their index event, was diagnosed with COVID-19 during the index event or within 30 days post-discharge, and by certain diagnoses during the index event or within 90 days. Up to four comparison groups are offered for each figure: the collaborative-wide measure, MVC All; the measure among other hospitals in the region, Hospital Region; the measure among only hospitals of the same type, Acute Care/Critical Access Cohort; and the measure among other rural hospitals (if applicable), MHA Rural Hospital Cohort.

Cardiac Rehab Utilization Rates

The first of the four new report provides data on cardiac rehab utilization rates (Figure 1). This report includes a description of cardiac rehab benefits followed by two figures reflecting utilization rates among episodes of the desired condition and payer combinations after all selected filters have been applied. The first figure shows the overall rate of cardiac rehab compared to utilization goals set by the Michigan Cardiac Rehab network (MiCR) and Million Hearts®. The second figure shows utilization trends over time at the user’s hospital(s) and a selected comparison group. This full report and all other reports can be downloaded as a ready-to-print PDF or image file.

Cardiac Rehab Utilization Rankings

The next report provides data on cardiac rehab utilization rankings, showcasing the ranked order of hospital-level utilization rates for a selected comparison group. For example, in Figure 2 there are data points for cardiac rehab utilization rates during AMI, CABG, PCI, SAVR, and TAVR episodes originating at MVC Hospitals A, B, and C between December 1, 2018, and November 30, 2023 compared to all other MVC general acute care hospitals. The average rate across all comparison hospitals is about 31%, and each point outlined in orange represents the rate at an individual comparison hospital. Again, this report and all others may be downloaded in a ready-to-share format.

The remaining new cardiac rehab registry reports provide visual hospital rankings in the same format as the utilization rankings report, but for two other measures: 1) mean days to first cardiac rehab visit, which ranks the average number of days from index discharge to patients’ first cardiac rehab visit (up to 365 days); and 2), mean number of cardiac rehab visits, which ranks the average number of cardiac rehab visits completed within a selected episode length. These reports offer the same dynamic filters and output capabilities.

All MVC registry users will have access to these reports to view the data for their site(s). If you do not have registry access and are interested in using the registry to view these data, you should complete MVC’s user access request form. If you have any questions or feedback about the new registry reports, please contact the Coordinating Center.

16 Feb 2024

BMC2 Cardiac Rehab MiCR

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MVC Celebrates Heart Month, Annual Cardiac Rehab Week

February 16, 2024 | 0 Comments | BMC2, Cardiac Rehab, MiCR

Throughout February’s American Heart Month, the Michigan Value Collaborative (MVC) has and will continue to provide cardiac rehab resources and information on behalf of the Michigan Cardiac Rehab Network (MiCR). This week, MVC also shared content as part of National Cardiac Rehabilitation Week, joining other organizations across the country to promote the benefits of the program and share information on statewide initiatives. As cardiac rehab week comes to a close, MVC is proud to highlight recent activity.

The MiCR partnership was established by MVC and the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2), who have partnered in recent years to support quality improvement and innovation around cardiac rehabilitation participation. Although the strategies and initiatives have changed and expanded over time, the key goal remains: to equitably increase cardiac rehabilitation utilization among eligible patients across the state of Michigan. This week, MiCR sought to educate providers within the BMC2 and MVC collaborative about the benefits of the program, current statewide participation rates, and novel initiatives in place to support improvement.

One product highlighted this week was the MiCR cardiac rehab hospital-level push reports, which benchmark cardiac rehabilitation participation across the collaborative. The 2023 report highlighted significant variation in performance and also demonstrated that several hospitals in Michigan are already successfully reaching or exceeding goals for utilization (Figure 1).

Current MiCR resources, including both hospital-level cardiac rehab benchmarking reports and the MiCR Best Practices Toolkit, were designed to serve members in tracking hospital cardiac rehabilitation utilization and provide guidance to improve enrollment and adherence to the program; however, neither resource specifically investigated patient barriers to participation. To bolster successful referrals to cardiac rehabilitation in Michigan, MiCR recently partnered with Healthy Behavior Optimization for Michigan (HBOM) to launch a new program titled NewBeat. Designed to deliver heartfelt, pragmatic support to new cardiac rehabilitation patients, NewBeat is a multi-component intervention designed to address three common barriers to patient enrollment and participation: lack of education, unclear physician endorsements, and transportation access.

To address the first barrier, MiCR recently launched its website, which houses patient and provider-facing resources, MiCR event dates, and publications in one convenient location. The website already includes features such as a cardiac rehabilitation location finder and unified cardiac rehabilitation resources, but over the coming months will continue to expand.

There is research evidence that strong, personal physician referrals increase the likelihood of cardiac rehabilitation participation. For many patients, in fact, a personal referral is the only reason they sign up. Following the data, NewBeat’s second intervention component is its Cardiac Care Cards, which leverage the influence of cardiovascular providers in encouraging cardiac rehabilitation enrollment in a memorable and personal way. The cards, which can be saved and displayed on kitchen tables and refrigerators, serve as a reminder to patients that the care team understands their recovery process and supports them as they enter cardiac rehabilitation as the next step in their recovery (Figure 2). Hospitals and rehab program staff can request on the MiCR website.

As the initiative continues to develop, NewBeat will grow to include patient success stories, provider-facing videos, and an informational handout on transportation resources.

One of MiCR’s key strategies in promoting the benefits of cardiac rehabilitation is fostering collaboration between providers and program staff. One of these opportunities is through an MVC workgroup series focused on cardiac rehabilitation, with the next session taking place at noon on Thurs., Feb. 22 (Figure 3). The workgroup will include a guest presentation by Devraj Sukul, MD, MSc, Co-Director of MiCR and Associate Director of BMC2 PCI. The presentation will feature recent findings about cardiac rehabilitation liaisons and their impact on patient enrollment. Register here to participate. MiCR also recently sent a save the date for its next stakeholder meeting, which will take place virtually on Fri., April 5, 10-11 a.m.

MVC would like to thank everyone who contributed to Cardiac Rehabilitation Week this year. Advocating for cardiac rehabilitation continues to be a high priority for the MVC team, and the Coordinating Center is inspired by the recent growth and interest in this endeavor. Collectively, by promoting cardiac rehabilitation we can save lives and help patients in Michigan get back on their feet faster. Please contact the MVC team with any questions about attending future cardiac rehabilitation events or receiving related materials.

30 Nov 2023

Cardiac Rehab Michigan Cardiac Rehabilitation Network

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Michigan Cardiac Rehab Network Hosts In-Person Stakeholder Meeting at Trinity Health

November 30, 2023 | 0 Comments | Cardiac Rehab, Michigan Cardiac Rehabilitation Network

The Michigan Value Collaborative (MVC) and the Blue Cross Blue Shield Cardiovascular Consortium (BMC2) recently held a successful 2023 Fall Michigan Cardiac Rehab Network (MiCR) Stakeholder Meeting on Fri., Nov. 17. This was the second in-person MiCR Stakeholder Meeting since MVC and BMC2 founded the MiCR partnership in 2022. The meeting brought together 63 individuals representing 28 organizations and was co-hosted by Trinity Health Ann Arbor’s cardiac rehab team.

The day’s agenda accounted for a variety of topics, including updates and material releases by the MiCR team, presentations and panel discussions about the new MVC and BMC2 pay-for-performance measures for cardiac rehab (see slides), advice and updates about cardiac rehab billing (see slides), recent findings about liaison-mediated referrals and their impact on cardiac rehab participation after percutaneous coronary intervention (see slides), and breakout groups to help brainstorm opportunities within various focus areas.

One unique and memorable aspect of the day was the ability to learn from the meeting’s hosts, Trinity Health Ann Arbor. Professional representatives from the site included Frank Smith, MD, Medical Director of the Intensive Cardiac Rehabilitation Program for the Ann Arbor and Livingston locations, and Mansoor Qureshi, MD, Medical Director of the Cardiac Catheterization Lab and Structural Heart Program for Ann Arbor, who provided opening remarks about the importance of facilitating provider buy-in and referrals. They emphasized cardiac rehab as a key high-value service to improve patient lives. Their slides can be viewed here.

They were also joined by Amy Preston, BS, CEP, Cardiac Rehab Manager and Exercise Physiologist, who organized optional tours of the Trinity Ann Arbor rehab space. Nearly all the meeting’s attendees opted to participate in the tours to learn about the unique spaces and strategies utilized at Trinity.

The MiCR team was also thrilled to announce the launch of New Beat, a multi-component intervention developed in partnership with the Healthy Behavior Optimization for Michigan (HBOM) team (see slides). The New Beat program’s interventions address specific barriers to patient participation, such as gaps in patient or physician knowledge about benefits, the need for stronger physician endorsement, and access issues resulting from transportation barriers. The offerings developed by MiCR and HBOM to support these New Beat strategies include MiCR’s new website (MichiganCR.org), patient- and provider-facing educational materials, cardiac care cards that can be signed by providers and delivered to patient rooms prior to discharge (Figure 1), and an Uber Health pilot. In particular, please note that the interest form on the MiCR website is now open for those interested in accessing these resources or requesting others.

01 Jun 2023

Cardiac Rehab Michigan Cardiac Rehabilitation Network MVC Push Reports

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MVC’s 2023 Cardiac Rehabilitation Reports Shared with Hospitals

June 1, 2023 | 0 Comments | Cardiac Rehab, Michigan Cardiac Rehabilitation Network, MVC Push Reports

Participation in cardiac rehabilitation (CR) programs is a crucial strategy for improving cardiac health outcomes. Participation reduces the risk of all-cause and cardiovascular-specific mortality, reduces readmissions, and enhances the patient’s quality of life. Despite the identifiable benefits, Michigan patients underutilize this high-value program, falling well below the 70% participation goal set by the Million Hearts Initiative. Therefore, the Michigan Value Collaborative (MVC) and several of its partners have identified CR as a high-value service for which they endeavor to drive improvement.

In support of this effort, MVC recently distributed the 2023 version of its CR reports to members with data on CR-eligible patients following discharge for heart attack (AMI), heart valve repair or replacement (TAVR or SAVR), coronary artery bypass procedure (CABG), percutaneous coronary intervention (PCI), and congestive heart failure (CHF). These reports were generated using MVC claims-based episodes of care with patient index admissions between 1/1/19-12/31/21 for multiple insurance plans, including Blue Care Network (BCN) HMO Commercial, BCN Medicare Advantage, Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, BCBSM Medicare Advantage, and Medicare Fee-for-Service.

Hospitals received data on a specific procedure or condition if they had no fewer than 20 cases in the reporting period for that condition/procedure. The report pages include figures for a variety of CR metrics, including participation rates after discharge, quarterly trends in participation between 2019-2021, mean days to first CR visit among participating patients, and the mean number of visits completed among participating patients.

MVC generates these hospital-level reports as a product of the Michigan Cardiac Rehabilitation (MiCR) Network, a partnership between MVC, Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2), and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC). The MiCR Network strives to increase participation in CR for all eligible individuals in Michigan.

Given the current status of CR participation across the state, the MiCR Network is tracking progress toward two utilization goals: 1) for 40% of all eligible AMI, TAVR, SAVR, CABG, and PCI (referred to as the “Main 5”) patients to attend at least one CR session within 90 days of their hospital discharge, and 2) for 10% of all eligible CHF patients to attend a single CR session within one year of a CHF-related hospitalization.

In developing these reports, MVC found that the collaborative-wide average participation rate within 90 days of discharge for the "Main 5" procedures was approximately 36%, below the statewide goal of 40%. Similarly, MVC’s analysis found 3.2% of eligible CHF patients participated within 365 days of discharge, 6.8% below the statewide MiCR goal of 10%.

The report also offers patient population demographics intended to help hospitals identify disparities in participation. Research evidence suggests that white males are more likely to utilize CR than women or patients of color, likely due to several socioeconomic and cultural factors. Hospitals are encouraged to consider any gaps showcased in their demographic snapshot and consider the provision of additional, tailored strategies that increase referral and participation among those patients.

Other high-level findings from the report included varying averages in CR participation by the procedure type. CABG and SAVR, more clinically invasive procedures, had the highest utilization rates at 54.9% and 51.3% respectively, whereas patients being treated for the chronic condition of CHF were the least likely to attend (3.2%). There is also wide interhospital variation in utilization rates for each procedure. For example, the collaborative-wide CR utilization rate after PCI is 32%, but hospital rates range from just above 10% to nearly 60% (Figure 1).

This variation aligns with published research on hospital-level variation in CR referral, even after accounting for patient characteristics, insurance status, and clustering within operators and hospitals. It also demonstrates that quality improvement is possible, with multiple sites in the collaborative excelling.

Several of the Collaborative’s top-performing sites and experts worked together last year to develop the MiCR Best Practices Toolkit. It includes several evidence-based strategies for increasing enrollment and participation, with step-by-step guidance and resources. Among the various best practices, there are pages dedicated to automating inpatient referrals, early and flexible scheduling approaches, and strategies that help reduce participation barriers for patients (e.g., lack of transportation, lack of reimbursement for CR sessions, etc.).

MVC encourages those working in this space to save the date for the MiCR Fall Stakeholder Meeting in Ann Arbor on Friday, October 27, from 10 a.m. to 3 p.m. It is a valuable opportunity to connect with peers and experts who can offer support or resources. Please contact the MVC Coordinating Center if you are interested in attending and haven't received the event's Save the Date, or if you would like more details on this report and other upcoming CR events.

26 Jan 2023

Cardiac Rehab MVC P4P MVC workgroup

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MVC Workgroup Planned to Support Members Focused on Cardiac Rehabilitation Rates

January 26, 2023 | 0 Comments | Cardiac Rehab, MVC P4P, MVC workgroup

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.

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.

01 Dec 2022

Cardiac Rehab MVC P4P MVC Push Reports P4P preoperative testing

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PY 2024-2025 Selection Reports Sent for MVC Component of BCBSM P4P Program

December 1, 2022 | 0 Comments | Cardiac Rehab, MVC P4P, MVC Push Reports, P4P, preoperative testing

Beginning in 2018, Blue Cross Blue Shield of Michigan (BCBSM) allocated 10% of its Pay-For-Performance (P4P) Program to a metric based on Michigan Value Collaborative (MVC) claims data. In 2022, the BCBSM P4P Quarterly Workgroup approved changes to how hospitals are evaluated in future program cycles. The upcoming two-year cycle including Program Years (PYs) 2024 and 2025 will be the first impacted by these changes, with performance years in 2023 and 2024, respectively (see Figure 1). Hospitals received selection reports for the next cycle this week to aid in their decision-making on metrics within the new program structure.

What is staying the same?

The program will continue to be scored out of 10 points maximum, and hospitals will continue to be evaluated on their risk-adjusted, price-standardized total episode payment, though this will make up a smaller component of the overall program. In addition, most conditions hospitals could select previously for episode payment scoring will still be available for that component of the program. Those include chronic obstructive pulmonary disease (COPD), colectomy (non-cancer), congestive heart failure (CHF), coronary artery bypass grafting (CABG), joint replacement, and pneumonia. Additionally, a hospital’s metric selections will continue to be scored on improvement compared to the hospital’s own past performance and scored on achievement related to an MVC cohort. Each hospital will continue to be awarded the greater of the two scores, either improvement or achievement, which are calculated using Z-scores. Cohort designation is still based on bed size, critical access status, and case mix index.

What is changing?

The PY 2022-2023 program was scored out of 10 points, but 12 points could be earned (10 points from episode spending plus two bonus points). In PYs 2024-2025, the overall program structure (Figure 2) will change so that the maximum score will be 10 points, made up of a maximum of four points from an episode spending metric, a maximum of four points from a value metric (a new component), and a maximum of two points from engagement activities completed in the program year (the calendar year following the performance year). This means that rather than selecting two conditions as in previous program cycles, hospitals will now select one condition for the episode spending metric and select one value metric. In order to be eligible to select a payment condition or value metric, a hospital must be projected to have at least 20 cases in the full baseline year of 2021. No bonus points will be available for PYs 2024-2025.

Brand new in PYs 2024-2025 will be value metrics, which 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. Seven value metrics are available for hospitals to choose from: cardiac rehabilitation after CABG, cardiac rehabilitation after percutaneous coronary intervention (PCI), seven-day follow-up after CHF, 14-day follow-up after COPD, seven-day follow-up after pneumonia, preoperative testing, and risk-adjusted readmission after sepsis. The preoperative testing value metric is composed of a group of three low-risk procedures: cholecystectomy, hernia repair, and lumpectomy. Each procedure will be scored separately, and points for this value metric will be awarded based on the highest points achieved for a hospital’s eligible procedures.

Finally, engagement in MVC activities will be built into the program’s scoring structure, rather than being offered as “bonus” points. Hospitals will be eligible to earn up to two points by attending and participating in MVC activities throughout each program year. These points are intended to increase engagement with other hospitals and the MVC Coordinating Center. Hospitals may select their own combination of activities but must include at least one activity from each of the attendance and participation categories to earn any points.

The P4P selection reports distributed this week include tables for the various episode spending and value metrics that identify projected case counts, the hospital’s average payment or rate of utilization, the cohort and MVC All average payments or rates, and the projected changes necessary for the hospital to earn 1 – 4 points. Accompanying the reports was an interpretation guide to walk recipients through a blinded sample report. It includes guidance on how to interpret the tables with suggestions for how this data could be used to inform a hospital’s P4P selections. The guide can be viewed here.

A complete summary of changes to PYs 2024 and 2025 is available here. These changes will not be retroactively applied to PYs 2022-2023. For complete details about PYs 2024-2025, please refer to the P4P Technical Document. Contact the MVC Coordinating Center with any questions. MVC requests that member hospitals complete and submit their PY 2024-2025 selections by December 23, 2022.

Archive

February Cardiac Rehab Workgroup: Henry Ford Health

Figure 1. AACVPR/AHA Cardiac Rehab Performance Measures

Feb. 11, 2025: MVC Cardiac Rehab Workgroup

February Health in Action Workgroup: MVC Coordinating Center

Figure 2. Sample Patient Journey Map for Enrollment in Cardiac Rehab Following a Heart Procedure

Feb. 27, 2025: Health in Action Workgroup

November Preoperative Testing Workgroup: Michigan Surgical Quality Collaborative (MSQC)

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November 5 Preoperative Testing Workgroup

November Cardiac Rehab Workgroup: Marshfield Medical Center – Dickinson

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November 21 Cardiac Rehab Workgroup

Figure 1. NewBeat Survey Results Pre- and Post-Implementation

Figure 2. Implementing NewBeat Feedback Video

Figure 3. NewBeat Sticker Journey Design

Figure 4. NewBeat Sticker Golden Ticket Design

Figure 1. Cardiac Rehab Utilization Rates Report

Figure 2. Cardiac Rehab Utilization Rankings Report

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