17 Nov 2022
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Latest Sepsis Report Compares Medicare Advantage and Medicare FFS Patient Outcomes

Latest Sepsis Report Compares Medicare Advantage and Medicare FFS Patient Outcomes

November 17, 2022 | 0 Comments | , ,

The Michigan Value Collaborative distributed refreshed push reports this week for its sepsis service line, providing hospital members with updated figures and measures since the last refresh in April.

The version shared with members this week compares MVC hospitals on 90-day risk-adjusted total episode payments, inpatient length of stay, Intensive Care Unit (ICU)/Cardiac Care Unit (CCU) utilization, inpatient mortality and discharge to hospice, 90-day post-acute care utilization, and 90-day readmission rates. Each figure presented reflects 90-day episodes with index admissions from 7/1/18 – 6/30/21 for Medicare Fee-For-Service (FFS), Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, Blue Care Network (BCN) Commercial, BCBSM PPO Medicare Advantage (MA), and BCN MA. Most of the measures also include comparison groups for the "MVC All” average across the collaborative as well as the average for each hospital’s assigned geographic region of Michigan.

This week’s reports stratified many measures by BCBSM/BCN Medicare Advantage and traditional Medicare FFS to investigate differences in outcomes and utilization between these two patient groups. MA saw large increases in yearly enrollment over the last decade, resulting in a growing interest in the difference in quality and cost measures compared to traditional Medicare FFS. Recent research suggested that MA patients experience better outcomes and cost less. This held true for some of the measures in MVC’s latest report. Despite the fact that the MA population is older (77 years) than the Medicare FFS population (72 years), the 90-day readmission rate (see Figure 1) among Medicare FFS sepsis patients was higher (33%) than that of MA sepsis patients (27%).

Figure 1.

Other noticeable differences between the patient populations included disease burden and social barriers. The Medicare FFS population had a greater comorbidity burden than the MA population; 57% of MA patients had three or more comorbidities whereas 61% of the Medicare FFS population had three or more comorbidities. The Medicare FFS population was also more likely to reside in an at-risk or distressed Zip code according to the Distressed Communities Index (37% vs. 31%).

Interestingly, the average 90-day risk-adjusted total episode spending payment among sepsis patients was higher for MA ($38,314) than Medicare FFS ($34,434) (see Figure 2). However, the claims data used in MVC’s report were both price standardized and risk adjusted, so dollars are actually a proxy for healthcare utilization. When taking into account patient factors and payer, BCBSM/BCN MA sepsis patients used more resources than Medicare FFS sepsis patients. Without taking patient factors and payer into account, Medicare FFS sepsis patients used more resources than BCBSM/BCN MA sepsis patients.

Figure 2.

Hospitals can learn more about the differing demographics of these two populations and their BCBSM/BCN commercial counterparts in their patient population snapshot table, a figure that was carried forward from the April reports. The latest reports included additional rows for the rate of septic shock and for the percentage of patients living in an “at-risk” or “distressed” Zip code. The latter is determined by the Economic Innovation Group’s Distressed Communities Index (DCI) data set, which incorporates economic indicators such as education, employment, and income to categorize patient Zip codes as prosperous, comfortable, mid-tier, at-risk, or distressed. The population snapshot table was intended to help hospitals better understand their sepsis patient population. The other demographics included were race, mean age, top three patient Zip codes, the most frequent and average number of comorbidities, and the proportion of patients with a confirmed diagnosis of COVID-19.

The inclusion of COVID-positive patient percentages is an important statistic in the patient population snapshot table since the report included COVID patients. Knowing this percentage could help hospitals understand the extent to which their data is driven (or not) by patients with a confirmed COVID-19 diagnosis.

The latest sepsis reports were also distributed to members of the Michigan Hospital Medicine Safety Consortium (HMS), which partnered with MVC on the original development of this service line for MVC’s registry. MVC plans to provide system-level versions of the latest sepsis report in the coming weeks.

If you have suggestions on how these reports can be improved or the data made more actionable, the Coordinating Center would love to hear from you. We are 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.

23 Jun 2022
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MVC Registry to Soon Include Patient-Level Medicare Data

MVC Registry to Soon Include Patient-Level Medicare Data

June 23, 2022 | 0 Comments | ,

In the coming weeks, MVC registry users will receive communications outlining several required steps related to implementing the Coordinating Center’s new data use agreement (DUA) as a qualified entity (QE) with the Centers for Medicare and Medicaid Services (CMS). The QE DUA permits MVC to display Medicare Fee-For-Service (FFS) claims data with fewer data suppression limitations than its research DUA within its online registry. As a result, authorized users of the MVC registry may gain access to identifiable Medicare beneficiary data.

These changes are the result of years of work by the MVC team to earn its QE status through the Qualified Entity Certification Program (QECP), which is also known as the Medicare Data Sharing for Performance Measurement Program. The QE application includes multiple phases before an entity is permitted to show patient-level data. The MVC Coordinating Center has been working through the final phase (see Figure 1) of the application, which involves developing and documenting measures for public reporting.

Figure 1.

The QE Medicare data will be contained in a separate tab on the MVC registry. Authorized users will have access to both the existing Medicare FFS reports as well as the QE reports. The QE data will be available for the most recent 18 months of index admissions only and will not have any case count suppression, allowing users to see the more granular data that is censored in the Medicare FFS reports.

The QE reports also have additional patient population filters to view the data by patient comorbidities, patient age, and more granular date options. These reports also feature trend graphs that can be viewed monthly, quarterly, or annually. In addition to uncensored data, the QE data will allow for patient-level drill-down as is currently available in the Blue Cross Blue Shield of Michigan data. The drill-down includes detailed information on the patient’s comorbidities, price standardized episode payments, and claim level walk-through. Although patient drill-down is available, the provider identifiers have been removed in conjunction with the QECP regulations. Additionally, the skilled nursing facility report is not available in the QE reports to avoid identifying providers.

For those with access, the QE reports should be used when evaluating the most recent years of data. The Medicare FFS reports can still be useful for historical trends and the Coordinating Center may be able to provide custom reports to fill in information that isn’t available through the registry. The patient-level drill-down can be used in conjunction with a hospital’s clinical information to understand what led to high-cost patients. The QE data should make Medicare data more useful to hospital members. However, QE data is only to be used for quality improvement rather than for marketing purposes. Additionally, authorized users are prohibited from disclosing or redistributing data provided in these reports outside of their institution.

Next week MVC member hospitals will receive a new QE DUA to be reviewed and signed by an authorized representative from their institution. This signed DUA is a prerequisite for receiving access to the new QE pages once they are available. MVC’s current CMS research DUA will remain in effect on non-QE registry pages and will continue to utilize data suppression for fewer than 11 episodes to protect patient identities. The MVC registry will also implement multifactor authentication (MFA) upon login for all registry users regardless of QE access in order to comply with the new DUA's security and data privacy requirements.

In the coming weeks, MVC members and registry users are encouraged to be attentive to any communications containing additional details or requests. In the meantime, please contact the MVC Coordinating Center with any immediate questions at michiganvaluecollaborative@gmail.com.