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MVC Publishes its 2023 QECP Public Report as a Qualified Entity

MVC Publishes its 2023 QECP Public Report as a Qualified Entity

Today the MVC Coordinating Center published its annual Qualified Entity Certification Program (QECP) public report for 2023. One of the requirements of being a qualified entity (QE) with the Centers for Medicare & Medicaid Services (CMS) through the QECP is the annual dissemination of a public report created using claims data. MVC shared its first public report last year, making the 2023 report the second iteration.

As with last year, the 2023 MVC QECP Public Report provides unidentified aggregated data on Michigan hospitals for two measures: rates of 30-day rehospitalizations following start of home health care, and rates of outpatient follow-up received after hospitalization for congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). Both measures were created using data from episodes of care initialized by inpatient hospitalizations or surgeries between 1/1/2018 and 12/31/2021.

For 2018-2021, the overall rate of 30-day unplanned rehospitalizations from home health among MVC member hospitals in Michigan was 11.3%. Risk-adjusted rates by index hospital ranged from 1.6% to 18.5% (Figure 1). By home health provider, risk-adjusted rates ranged from 2.0% to 23.6%. Patients whose episode of care began with an index event for endocarditis, COPD, CHF, or percutaneous coronary intervention (PCI) were more likely than patients with other index conditions to experience an unplanned rehospitalization in the 30 days after they started home health care.

Figure 1. Risk-Adjusted Rates of 30-Day Unplanned Rehospitalization from Home Health, by MVC Hospital

Across the 102 MVC hospitals with attributed episodes of care data underlying this report, the unadjusted rates of patients receiving outpatient follow-up were higher following index hospitalizations for CHF than for COPD (Figures 2 and 3). This was the case whether follow-up occurred three days (16% vs. 13%), seven days (45% vs. 37%), 14 days (63% vs. 54%), or 30 days (72% vs. 64%) after discharge.

Figure 2. 30-Day Follow-Up After CHF by MVC Hospital

Figure 3. 30-Day Follow-Up After COPD by MVC Hospital

For more information and the entire set of findings, we invite you to read the full report, which is available online to any member of the public on the MVC Resources page or directly here.

QE certification status allows MVC to provide hospital members with additional data from Medicare Fee-for-Service (FFS) claims at a level of granularity not otherwise available under standard CMS data use agreements. Reports located under the “QE Data” icon on the MVC registry allow hospital registry users to see unsuppressed data that include case counts <11 as well as utilization rates and average payments based on case counts <11. In addition, on any QE Data registry report, members can click on specific data points to load a list of all episodes underlying that data point. From that episode list, it is possible to view drill-down information on any individual listed episode to learn more about the claims and price-standardized payments comprising that episode.

MVC members representing one or more MVC-participating hospitals can send an email to Michigan-Value-Collaborative@med.umich.edu to learn more about data available through MVC’s QECP reports and to receive the forms necessary to gain access to those registry reports.

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MVC Shares New COPD Report with Physician Organizations

MVC Shares New COPD Report with Physician Organizations

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

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

Figure 1.

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

Figure 2.

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

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

Figure 3.

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

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

MVC also partnered with a fellow Collaborative Quality Initiative to provide POs with a provider resource that may be relevant to their work with COPD patients. The Healthy Behavior Optimization for Michigan (HBOM) team provided its Quit Smoking Resource Guide to send alongside MVC’s report. HBOM aims to ensure that all smokers who are interested in quitting receive the support and resources they need to be successful. Read more about HBOM’s materials and efforts on the HBOM website or in MVC’s May spotlight blog.

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


MVC Shares National Action Plan with COPD Workgroup Attendees

The Michigan Value Collaborative (MVC) held a bi-monthly virtual workgroup recently on chronic obstructive pulmonary disease (COPD), a condition that accounts for the majority of deaths from chronic lower respiratory diseases and is continuously a leading cause of death in the United States. Notably, COPD is nearly two times as prevalent in rural areas as it is in urban areas; therefore, MVC members in rural areas may be dealing with significant inequities within their patient populations. The workgroup presentation and discussion focused on the COPD National Action Plan (CNAP). To the Coordinating Center’s surprise, many workgroup participants had not previously heard of the CNAP, making this event a great opportunity for practice sharing and discussion among members.

Overcoming barriers to prevention, early diagnosis, treatment, and management of COPD is necessary to improve quality of life and reduce mortality. To address these barriers, the U.S. Congress; National Heart, Lung, and Blood Institute; and Centers for Disease Control and Prevention convened a town hall where they asked federal and nonfederal partners to develop an action plan. These partners were tasked with identifying the efforts needed to change the course of COPD. The result was the development of the COPD National Action Plan (CNAP), which was released in 2017 and updated in 2019. It consists of five goals, which were outlined and discussed during the workgroup (see Figure 1).

Figure 1. Slide from COPD Workgroup Presentation

Goal 1 calls for promoting more public awareness and understanding of COPD, especially among patients and their caregivers. Key opportunities include patient and caregiver education that is sustainable and culturally appropriate, technological support mechanisms, and connecting patients and caregivers to local and state resources.

Goal 2 focuses on increasing the skills and education of healthcare providers so they are better equipped to provide comprehensive care. This goal is supported by the development and dissemination of patient-centric, clinical practice guidelines for care delivery, the use of technological support mechanisms, and consideration of home-based pulmonary rehabilitation programs. It’s important to note that studies have found no statistically or clinically significant differences for health-related quality of life and exercise capacity among patients who have completed home-based vs. outpatient-based pulmonary rehabilitation.

Goal 3 encourages increased data collection, analysis, and sharing to create a better understanding of disease patterns. Opportunities within this goal include supporting pharmaceutical and clinical COPD research; identifying and delivering comprehensive, evidence-based, culturally appropriate interventions; and disseminating findings to a variety of audiences (from patients to national policymakers).

Goal 4 aims to increase and sustain COPD research to improve understanding of the disease and its diagnosis and treatment. It’s vital that clinicians, researchers, and health policy experts foster research across the COPD continuum (prevention, diagnosis, treatment, management). Workgroup attendees agreed that there are opportunities to improve equity among COPD patients through more data on diagnosed and undiagnosed COPD in disadvantaged patients. Another vital component of this goal is supporting and sustaining pharmaceutical research for COPD medications since none of the existing medications for COPD have been shown to reduce the progressive decline in lung function.

Goal 5 calls for federal and nonfederal partners to collaborate to meet the objectives of the CNAP and translate its recommendations into research and action. Workgroup attendees highlighted the importance of implementing CNAP equitably among both urban and rural regions and implementing COPD strategies at all health policy levels (national, state, local). Such opportunities could improve access to cost-effective and affordable COPD support services and expand support for and access to pulmonary rehabilitation services (including home-based PR), thus reducing health inequities among COPD patients.

Each of the five CNAP goals is equally important and vital in reducing COPD health disparities. Although many of the MVC workgroup participants had not heard of the CNAP before, they were interested in sharing its goals and opportunities with others in their healthcare organization. If you would like to learn more about this patient-centered national action plan, you can read the full published report here. If your organization has addressed the CNAP goals or implemented any of the discussed opportunities, the MVC Coordinating Center would like to hear about the successes, challenges, and lessons learned. If you would like to share this information or present at an upcoming MVC workgroup, please email MVC at michiganvaluecollaborative@gmail.com.


Reducing Admissions and Readmissions in the COPD Patient Population

At a recent MVC chronic obstructive pulmonary disease (COPD) workgroup, representatives from McLaren Physician Partners presented on their recent quality improvement initiative involving their COPD patient population. McLaren Physician Partners worked to identify areas for improvement within this specific patient population and found some common patient struggles consisted of higher utilization of the emergency department and in-patient settings, as well as higher readmission rates, specifically among their Medicare patients (38%). Five nurse managers were tasked with doing case reviews in order to identify possible areas for improvement. Five to ten patients that had three or more encounters in the last six months were taken from each nurse managers case load. Around 83% of those patients had other significant comorbidities (e.g. Diabetes Mellitus, Congestive Heart Failure, Hypertension.) Additionally, the reason for readmission was most often related to either respiratory insufficiency or a cancer treatment side effect.

Care managers then engaged the patients and went over a questionnaire with them. Approximately 68% of these patients had a misunderstanding of their medication, 26% had environmental barriers, 14% were not compliant with medication, and less than 15% reported an inability to afford medication/devices. Readmissions related to disease progression and inappropriate medication use were the major contributing factor to higher utilization of the in-patient setting and emergency department. Additionally, all admissions and readmissions were related to some form of respiratory insufficiency or a cancer treatment side effect.

Due to the time of implementation, COVID-19 impacted the type of intervention that could be put into place. McLaren Physician Partners opted to adopt a telephonic intervention in order to address education needs and remove barriers. Specific needs related to managing medications and compliance, triggers that led to an exacerbation, and developing a plan of action at the onset of first symptom were addressed. Additionally, the intervention sought to minimize and remove barriers where possible (e.g. cost of medications, transportation issues for visits). Lastly, a consideration was made if a patient was a candidate for palliative care.

Nurse navigators looked into possible ways to engage patients differently in order to hopefully prevent an exacerbation that caused an admission or a readmission. They were aware that what they were doing wasn't working, and needed some sort of upgrade. A toolkit was developed that was sent to the patient prior to a one to two-hour phone call scheduled in order to  help the patient understand this toolkit. The kit requires active participation and helps the patient develop specific goals and actions to take when they see signs of a potential exacerbation.

After implementation of this pilot program, all navigators came together to discuss their findings. Many things were noted, including the fact that patients did not know the difference between their inhalers (long-acting vs. rescue). Additionally, patients often didn't know that by identifying certain triggers, some symptoms may have been preventable. Of the patients who received and engaged in this telephonic intervention, the readmission rate for those who had been recently discharged decreased by more than 20%. Overall, McLaren Physician Partners saw a decrease in their hospitalizations due to the implementation of this program.