07 Jun 2023
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MVC Uses New ED-Based Episode Data in Latest Push Report

MVC Uses New ED-Based Episode Data in Latest Push Report

June 7, 2023 | 0 Comments | , ,

The MVC Coordinating Center recently distributed its first-ever report based on new emergency department-based episodes (“ED-based episodes”), sharing versions with site coordinators and quality improvement staff at 102 participating MVC member hospitals across Michigan. Reports featured each hospital’s own attributed ED-based episode data for five high-volume ED conditions: chest pain, abdominal pain, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and cellulitis.

ED-based episodes are a new episode of care data structure developed this past year by MVC in collaboration with the Michigan Emergency Department Improvement Collaborative (MEDIC), a BCBSM-funded Collaborative Quality Initiative with the goal of improving care and patient outcomes in Michigan emergency departments. MVC and MEDIC team members worked closely to develop 30-day episodes of care initialized by a patient’s visit to the ED and including all claims-documented care received in the 30 days following a patient’s index ED visit. MEDIC program director Dr. Keith Kocher, MD, talks more about the collaboration as well as advice on leveraging this data from an emergency medicine perspective in the video below.

These ED-based episodes are built using medical claims data from Medicare Fee-for-Service, Blue Cross Blue Shield of Michigan PPO Commercial and Medicare Advantage plans, and Blue Care Network HMO Commercial and Medicare Advantage plans. MVC’s ED-based episodes of care include both adult and pediatric patients, providing new opportunities for quality improvement insights at Michigan hospitals. Though this report provides metrics for five specific index conditions, MVC currently offers data for 15 ED-based index conditions, including abdominal pain, asthma, atrial fibrillation, cellulitis, unspecified chest pain, COPD, CHF, deep venous thrombosis, diabetes mellitus (short- and long-term complications), gastrointestinal bleed, pneumonia, pulmonary embolism, pyelonephritis/urinary tract infections, and syncope.

For each of the five index conditions included in the recent reports, hospitals received information on risk-adjusted and price-standardized 30-day total episode payments, same-day inpatient admission rates over time, utilization of healthcare services across the patient’s 30-day episode of care, and each hospital’s most frequent reasons for inpatient readmissions. Patient claims data were included for adult patients aged 18 and older who had an ED visit at a given hospital between 1/1/21 and 8/31/22, were insured by one of the insurance plans mentioned above, and had a primary diagnosis on their index claim matching standardized definitions for the five included conditions.

Among general acute care hospitals receiving a report, the average risk-adjusted, price-standardized 30-day total episode payments (Figure 1) for the five reported conditions were highest for CHF ED-based episodes ($17,455) followed by COPD ED-based episodes ($11,001), and lowest for unspecified chest pain ($3,792). Within each condition, MVC 30-day total episode payments were consistently higher for episodes in which the patient had a same-day inpatient admission compared to episodes in which the patient did not have an inpatient stay begin on the date of their ED visit. With that information in mind, hospital members can also use their individualized reports to track their same-day inpatient admission rate by six-month intervals using trend graphs for each included ED-based condition (Figure 2).

Figure 1.

Figure 2.

A key goal for these ED-based episode reports was to provide insight into healthcare utilization following index ED visits. Therefore, reports included a dot plot (Figure 3) comparing their own hospital’s patient post-ED utilization to that of the appropriate general acute care hospital or Critical Access Hospital MVC comparison group. Dot plots provided information on what percent of episodes had a same-day inpatient admission, what percent did not have a same-day inpatient admission but did see the patient admitted in the 1 to 30 days following the index ED visit, and what percent of patients had two or more inpatient admissions (thus, at least one readmission) during the episode of care. Also provided are rates of subsequent ED visits, receipt of outpatient services, home health, and skilled nursing facility care.

Figure 3.

Please share your feedback with the MVC team if certain report measures were helpful or if you’d be interested in seeing future ED-based episode reporting for certain conditions and metrics. MVC is now also accepting custom report requests using its new ED-based data. Contact MVC to learn more.

04 Aug 2022
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MVC Launches New Push Report on ED and Post-Acute Care Use

August 4, 2022 | 0 Comments | , , ,

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

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

Figure 1.

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

Figure 2.

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

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

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

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

Figure 3.

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

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