17 Sep 2025
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CQI Spotlight: Michigan Urological Surgery Improvement Collaborative

CQI Spotlight: Michigan Urological Surgery Improvement Collaborative

September 17, 2025 | 0 Comments | , , , ,

Urological surgery quality improvement is essential for enhancing patient outcomes, ensuring safety, optimizing healthcare costs, and strengthening overall healthcare system performance. To foster patient trust, reduce outcome variation, and drive continuous advancements in urological surgery practices, the Michigan Urological Surgery Improvement Collaborative (MUSIC) was established in 2011.

One of Michigan’s 21 Collaborative Quality Initiatives (CQIs) operating in partnership with Blue Cross Blue Shield of Michigan (BCBSM), MUSIC is a physician-led CQI comprised of a consortium of 44 urology practices (academic, private practice, community) across the state of Michigan, as well as four out-of-state practices. Designed to evaluate and improve the quality and cost efficiency of urologic care, MUSIC aims to improve patients’ lives by inspiring high-quality care through data-driven best practices, education, and innovation.

The initial focus of MUSIC was improving care for patients diagnosed with or at risk of prostate cancer. The earliest quality improvement (QI) initiatives MUSIC undertook focused on decreasing infectious complications following prostate biopsies and decreasing unnecessary imaging for patients with low-risk prostate cancer. Both efforts were very successful with post-biopsy infectious hospitalizations decreasing from 1.1% in 2013 to 0.2% in 2024 and unnecessary bone scans and computed tomography (CT) scans decreasing from 13% and 15% in 2012 to 5% and 4% respectively in 2018. MUSIC has also conducted four randomized clinical trials, two completed and two in-progress, utilizing the MUSIC infrastructure. Since its formation, MUSIC expanded its focus from prostate cancer (MUSIC-Prostate) to a program focused on kidney stones (MUSIC-ROCKS) in 2016 and small kidney tumors (MUSIC-KIDNEY) in 2017, with a plan to begin a new program on benign prostatic hyperplasia (BPH) in the fourth quarter of 2025 (Figure 1).

Figure 1: Michigan Urological Surgery Improvement Collaborative Programs

Graphic of MUSIC's Prostate, ROCKS, Kidney and BPH Programs

MUSIC Achievements

Over the last 14 years, MUSIC has made significant strides in urological care and surgical quality, achieving milestones that greatly advanced the field (Figure 2). Through MUSIC’s efforts, active surveillance (AS) for patients with low-risk prostate cancer – which involves monitoring prostate cancer in its localized stage until the doctor feels that further treatment is needed to halt the disease at a curable stage – increased from about 40% in 2018 to about 80% in 2024. Post-ureteroscopy emergency department (ED) visits, another area of focus, decreased from about 10% in 2016 to about 8% in 2024.

Figure 2: Impact of MUSIC

Graphic showing highlights of accomplishments of MUSIC

MUSIC initiatives also made a significant impact on the use of evidence-based guidelines for prescribing opioids after surgery. Between 2016 and 2024, the use of opioid prescriptions after kidney stone surgery dropped from about 80% to about 15%. The Michigan Value Collaborative (MVC) helped assess the impact and value of MUSIC's opioid initiatives within both the ROCKS and Prostate programs, resulting in a MUSIC-ROCKS value assessment in 2022 and a MUSIC-Prostate value assessment in 2023 (Figure 3). These MUSIC initiatives had a major impact on opioid prescribing in Michigan, helping to reduce the availability of unused opioids in the community and mitigate their potential for misuse. MVC and MUSIC frequently collaborate on analytic projects and exercises that help evaluate ongoing initiatives as well as identify opportunities for QI in the future.

Figure 3. Page 1 of MVC’s Impact and Value Delivery Assessment for MUSIC-ROCKS

Current MUSIC Initiatives

Active surveillance for prostate cancer patients continues to be a goal with additional focus on ensuring patients on AS receive proper follow-up testing. MUSIC aims to build on the successes of previous initiatives by developing updated recommendations for type and frequency of follow-up testing and conducting urologist and primary care physician (PCP) education and feedback reporting. An area of focus for MUSIC’s ROCKS program includes decreasing post-ureteroscopy infectious complications and ED visits after kidney stone surgery. To achieve these goals, MUSIC is developing more specific recommendations for pre- and post-operative antibiotic use, providing better patient education, using non-opioid post-operative pain management, and decreasing the use of ureteral stents (Figure 4).

Figure 4: Decreasing Unplanned Healthcare Encounters after Ureteroscopy (URS)

Graphic depicting how MUSIC achieved positive outcomes for unplanned healthcare encounters after ureteroscopy

Services and Benefits for MUSIC Members

MUSIC hosts multiple collaborative-wide meetings and workshops each year to support its ongoing mission to improve urologic care. Other ways MUSIC supports its initiatives and advances QI is by conducting annual site visits to urologists, other providers, and hospitals to review their performance across various metrics, offer provider education, and discuss opportunities for improvement to ensure all patients in Michigan have access to the same quality of care. MUSIC members also receive support for American Board of Urology maintenance of certification.

Jay Hollander, MD testimonial quoted

For patients, MUSIC provides patient education materials that build trust and help improve outcomes, which are often developed with direct input from patients. When asked to comment on the patient education materials and MUSIC program, MUSIC Patient Advocate James Humphries said,

“Guidance provided by my urologist and the MUSIC materials allowed me to make an informed treatment decision regarding my kidney mass and confidently select active surveillance. I am grateful for the continuing opportunity to participate in MUSIC collaborative meetings and provide commentary on patient educational materials. I sincerely believe other patients will benefit if this document is shared. Ultimately, I attribute my improved health and successful surgical outcome to these collaborative efforts.”

MVC is proud to partner with MUSIC in advancing urological care across Michigan. The BCBSM-funded CQIs play a crucial role in driving healthcare quality improvement, and MVC is excited to continue showcasing the innovative contributions of individual CQIs and the ways in which MVC’s data support high-value care initiatives across the portfolio. Please reach out to MVC by email if you are interested in learning more.

03 Nov 2023
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MVC, MUSIC Estimate Significant Reduction in Opioid Spending After Kidney Stone Surgery

MVC, MUSIC Estimate Significant Reduction in Opioid Spending After Kidney Stone Surgery

November 3, 2023 | 0 Comments | , , ,

In 2019, more than 71,000 people died from drug overdoses, making it a leading cause of injury-related death in the United States. Nearly 70% of those overdoses involved a prescription or illicit opioid. The economic cost of the U.S. opioid epidemic was estimated to be $1,021 billion as of 2017 and rising. It is for this reason that clinicians and health systems have adopted evidence-based practices for reducing the number and amount of opioid prescriptions ordered for their patients. It is both clinically and economically significant, then, that the Michigan Value Collaborative (MVC) was recently part of an analysis that estimated over $4.8 million in avoided opioid prescription spending after kidney stone surgery.

MVC identified these savings in partnership with the Michigan Urological Surgery Improvement Collaborative (MUSIC), a physician-led quality improvement collaborative comprised of urology practices across the state of Michigan. MUSIC works to evaluate and improve the quality and cost-efficiency of urologic care. Since 2011, the MUSIC team has led prostate-related quality improvement activities such as improving patterns of care in the radiographic staging of men with newly diagnosed prostate cancer, reducing prostate biopsy-related hospitalizations, and enhancing the appropriateness of treatment decisions. In 2016, MUSIC expanded its scope of work to kidney stone surgery and in 2017 to small renal masses.

With kidney stone incidence on the rise affecting both men and women, MUSIC created a program focused on Reducing Operative Complications from Kidney Stones (ROCKS). It focuses on improving the quality of care for kidney stone patients, particularly by decreasing modifiable emergency department (ED) visits for expected symptoms and side effects of ureteroscopy (URS) or shockwave lithotripsy (SWL) surgeries that are typically avoidable. MUSIC ROCKS aims to minimize these by developing resources that help patients manage their pain and urinary tract symptoms following kidney stone surgery.

Since its formation, the MUSIC ROCKS initiative led to the development of stent omission appropriateness criteria, a URS vs. SWL patient-provider shared decision aid, standardized patient education, and recommendations for postoperative pain control regimens. The ROCKS pain control optimization (POP) guidelines were developed in 2019 and recommended prescribing no opioids following kidney stone surgery. The goal of these guidelines is to minimize opioid use in patients undergoing kidney stone surgery while maintaining patient safety and satisfaction.

The MUSIC Coordinating Center reached out to MVC in 2022 to help assess the impact of its ROCKS initiative on opioid prescription use following surgery. The goal was to estimate MUSIC ROCK's impact on opioid utilization and prescribing rates following URS or SWL kidney surgeries in Michigan, as well as the related impact on the value of care.

METHODOLOGY

Data Sources & Study Population

MVC kidney stone surgery episodes were used for this analysis, which compared outcomes between URS and SWL procedures for MUSIC and non-MUSIC providers. It was restricted to kidney stone surgery claims for Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) Commercial and Medicare Advantage plans between Jan. 1, 2015 and July 31, 2022. The cohort was further restricted to BCBSM/BCN-insured patients with no opioid prescription fills in the 90 days prior to their surgery who were continuously enrolled in a prescription sub-plan 90 days prior to surgery through 30 days post-surgery. The final cohort used in the opioid analysis included 14,967 Michigan patients.

Methodological Approach

The study population was identified using professional claims for MVC kidney stone surgery episodes that occurred within the index dates of the surgery. All professional claims missing a provider NPI on the claim were excluded. The remaining NPIs were characterized by information derived from the National Plan and Provider Enumeration System (NPPES) data set. Claims of providers or facilities outside of the state of Michigan were also excluded. The remaining NPIs were then categorized into MUSIC and non-MUSIC categories. Opioid utilization was assessed through the presence of paid outpatient opioid prescription claims in the 30 days following surgery.

Limitations

Approximately 90% of Michigan urologists participate in MUSIC. However, only 58% of all MVC kidney stone surgery episodes were identified as being performed by a MUSIC provider via National Provider Identifier (NPI). Some MUSIC providers may be performing these procedures on patients with an insurance plan not reflected in MVC data. It could also be related to MVC's episode structure. Episodes are mutually exclusive; therefore, if a patient were to have a hospitalization prior to their surgery that resulted in an MVC episode creation, their care would not be classified as a kidney stone surgery episode. It is also possible that billing NPI was not always a reliable field.

Second, MVC only has outpatient prescription claims for BCBSM and BCN patients with a prescription sub-plan. For this analysis, only BCBSM-insured patients were assessed. As a result, only about 35% of MVC's URS and SWL episodes were included in assessing opioid utilization. Furthermore, the analysis is of opioid utilization, not provider prescribing patterns. Given that a claim is only generated once a prescription is filled, this analysis cannot provide a full picture of changes in provider prescribing patterns.

FINDINGS & NEXT STEPS

Among the BCBSM/BCN-insured patients who underwent kidney stone surgery between 2015 and 2021, 50.3% of patients on average filled an opioid prescription within 30 days of surgery, with a higher average opioid utilization rate among SWL patients (54.9%) than among URS patients (47.4%). There was a strong decline in opioid utilization after 2017 across Michigan for both types of procedures (Figure 1), with lower utilization following URS.

 

Figure 1.

Notably, the rate of opioid utilization after kidney stone surgeries performed by MUSIC providers is consistently lower than those performed by non-MUSIC providers (Figure 2). For example, among URS procedures performed by MUSIC providers after 2016, 43.8% resulted in an opioid fill on average, whereas an average of 53.8% of procedures performed by non-MUSIC providers resulted in an opioid fill. In addition, the absolute decrease in opioid prescription fill rates was greater for MUSIC providers. These trends were similar for SWL surgeries, with consistently lower average opioid utilization rates among patients treated by MUSIC providers (52.1%) vs. non-MUSIC providers (60.9%).

Figure 2.

MVC further estimated cost savings from the reduction in opioid prescription fills by examining differences in 365-day prescription payments among the MUSIC cohort. The changes in opioid prescribing resulted in an estimated yearly average savings of $2,712 per patient from reduced opioid prescription fills post-surgery. Using this estimated savings, MVC multiplied the number of URS procedures performed each year by MUSIC providers combined with the yearly percent reduction from baseline in opioid prescribing to further estimate a savings of over $4.8 million from avoided opioid prescription payments since 2016.

The notable decreases in both prescribing rates and prescription payments demonstrate the substantial impact of the MUSIC ROCKS initiative on opioid utilization after kidney stone surgery, including a likely reduction in the total number of filled opioids circulating in the Michigan community as a result of fewer patients receiving prescriptions. MVC completed a similar analysis in partnership with MUSIC looking at prescribing patterns after prostate surgery, and estimated that MUSIC providers helped avert an estimated $1.6 million in avoided opioid prescription spending.

MVC’s expertise and data frequently result in partner projects like this; MVC completed several CQI impact assessments last year, as well as several more so far in 2024. MVC also participates in collaborative activities with peer CQIs through new condition and report development, data analysis and metric consultation, and data matching exercises that pair clinical and claims-based data. To request a copy of any of MVC’s completed CQI impact assessments, please contact the MVC Coordinating Center.