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Hospitals Receive PY22 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

Hospitals Receive PY22 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

This week the Michigan Value Collaborative (MVC) Coordinating Center distributed the Mid-Year Scorecards for Program Year (PY) 2022 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. These were the first scorecards for the new two-year program cycle for PYs 2022 and 2023.

PY2022 evaluates the index admissions from 2021 as the performance year against admissions in 2019 as the baseline year. MVC is using an improved z-score methodology to calculate both improvement and achievement scores. Hospitals will continue to receive the better of the two scores for each of their two selected conditions. For a description of how the program has changed from the last two-year cycle see the Change Document.

Additionally, this cycle offers hospitals bonus points for completing and submitting a survey for each selected condition by November 1, 2022. These surveys will be used by the MVC Coordinating Center to improve the program for future years and elicit improved best practice sharing between members. The full methodology for the new program can be found in the PY2022-2023 Technical Document.

Figure 1 below illustrates the distribution of total hospital points out of 10. The average points scored for the Mid-Year Scorecards was 5.9/10 before including the survey bonus points. This is 0.9 points higher than the average points scored at the conclusion of PY21 excluding all bonus points.

Figure 1.

Figure 2 below illustrates the breakdown of average points by condition out of five. Consistent with previous years, joint replacement was the highest scoring condition with an average of 4.5 points earned. The success of the joint replacement condition can be attributed to the shift from post-acute care in skilled nursing facilities (SNF) to home health and the move towards outpatient surgeries. Pneumonia was the lowest scoring condition with hospitals earning less than one point on average. The MVC average payment for a 30-day pneumonia episode increased by $792 from the baseline in 2019 to the performance year in 2021. The largest contributors to this increase were the base payment and readmission payments.

Figure 2.

The Mid-Year P4P scores are subject to change as new data is added. The final scorecards will be distributed after all 2021 claims have been added to the data in quarter one of 2023. Hospitals can track their score through the new P4P PY2022-2023 reports on the MVC registry. These new reports provide all relevant scoring information for both improvement and achievement points in one place except for the survey bonus points. They can be filtered by selected conditions to make the tracking of P4P points easier. For a walkthrough of your hospital’s Mid-Year P4P Scorecard or P4P registry reports, please contact the MVC Coordinating Center.

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MVC Distributes New Push Report Dedicated to P4P Conditions

MVC Distributes New Push Report Dedicated to P4P Conditions

MVC launched a new push report this week dedicated to the MVC P4P conditions. Its purpose is to support hospitals in identifying areas of opportunity within past and present conditions of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. The conditions currently included in P4P and in this report are chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), colectomy (non-cancer), coronary artery bypass graft (CABG), joint replacement (hip and knee), pneumonia, and spine surgery. Acute myocardial infarction (AMI) is also included in this report as a historical P4P condition. Hospitals received a page for each condition if they met a case count threshold of 11 episodes in 2019 and 2020.

This report was limited to episodes included in the P4P program with index admissions in 2019 and 2020, and thus included the following payers: BCBSM Preferred Provider Organization (PPO), BCBSM Medicare Advantage, Blue Care Network (BCN) Health Maintenance Organization (HMO), BCN Medicare Advantage, and Medicare Fee-For-Service (FFS). To align with the P4P program, MVC excluded patients with a discharge disposition of inpatient death or transfer to hospice, episodes that started with an inpatient transfer, and episodes with a COVID-19 diagnosis on a facility claim in the inpatient setting. To fully exclude COVID-19 patients, pneumonia episodes in March 2020 were also excluded.

The reports provided data on hospital trends in episode payments, readmission rates, post-acute care utilization, and emergency department utilization for P4P patients. Data from the push report can be used in conjunction with the registry reports to inform areas of opportunity in the P4P conditions. The push reports also provided a snapshot of each hospital’s P4P patient population (see Figure 1), including race, mean age, and the average number of comorbidities.

Figure 1. Patient Population Snapshot for Blinded Hospital

For Critical Access Hospitals (CAHs), the report also included index length of stay. For acute care hospitals, the report included a “reasons for readmissions” table that identified the top five reasons a P4P patient was readmitted. However, this table was removed from the report’s joint replacement page due to low readmission rates among joint replacement surgeries. In its place, acute care hospitals received their ratio of outpatient to inpatient surgeries.

As with other push reports, hospitals were compared to other members in the collaborative for select measures. For acute care hospitals, each hospital’s report includes a comparison point for all MVC episodes (“MVC All”) as well as for episodes at hospitals in the same geographic region (“Your Region”). These reference points do not include episodes that occurred at hospitals with a CAH designation. Similarly, the reports distributed to CAHs included comparison points for MVC episodes at all CAHs in the collaborative (“CAH Average”).

This report takes the place of the cardiac service line reports, which included data on CHF, AMI, and CABG. The new P4P conditions push report uses many of the same measures and figures from the cardiac service line reports, but for the complete list of P4P conditions.

For more information on the MVC Component of the P4P Program, see the MVC P4P Technical Document. Please share your feedback on the newest P4P conditions push report with the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

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Virtual Site Visits Underway with MVC Members

Virtual Site Visits Underway with MVC Members

The COVID-19 pandemic affected hospital operations in a myriad of ways, with many Michigan Value Collaborative (MVC) members experiencing circumstances that could impact their score on the MVC Component of the BCBSM Pay-for-Performance (P4P) program. In order to mitigate some of the effect of COVID-19, the MVC Coordinating Center introduced two extra bonus points to be earned for Program Year 2021 only. One bonus point can be achieved by attending both MVC semi-annual events; the first was held in May and the second will be held in October. The second bonus point can be earned by undertaking a virtual site visit with the MVC Coordinating Center.

To date, the Coordinating Center has completed 26 site visits, and a further 25 “visits” are scheduled with a variety of hospitals around the state. During these 90-minute virtual visits, MVC provides an overview of the collaborative, our data, and engagement activities. Hospitals receive a quality improvement slide (Figure 1) in advance that they complete and return prior to their scheduled date. These responses drive the main discussion of the site visit.

Figure 1.

Much has been learned about various quality improvement projects being implemented and what hospitals are focusing on for 2021 and 2022. MVC plans to use the information from these slides to connect hospital members with peers interested in implementing similar projects.

In addition, the Coordinating Center is interested in learning: who is utilizing the registry and any individualized reports, the types of MVC data that are most useful, and any challenges hospitals have with using the data. This feedback will help MVC make improvements to the registry and individualized reports to make them more actionable for members.

Finally, the hospital relationship with physician organizations (POs) is discussed. One of MVC’s goals is to help facilitate collaboration between POs that have patients attributed to each hospital, especially in the patient outcomes and quality of care arenas.

If you have not yet scheduled a site visit, please do so here. Slots are available between now and October. If you have any questions or would like further information on a site visit, please contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

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MVC Component of the BCBSM P4P Program: PY20 in Review

MVC Component of the BCBSM P4P Program: PY20 in Review

In early January, the Michigan Value Collaborative (MVC) distributed 2020 Program Year (PY) scores to hospitals for the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay for Performance (P4P) program. This marked the completion of the first year of a two-year cycle for which hospitals have selected two service lines (out of seven) to be scored on their episode spending using MVC data. These service lines include chronic obstructive pulmonary disease (COPD), colectomy, congestive heart failure (CHF), coronary artery bypass graft (CABG), joint replacement, pneumonia, and spine surgery. Figure 1 shows the frequency of hospital service line selections for the two-year program cycle.

Figure 1.

The program evaluates hospital’s risk-adjusted, price standardized, average 30-day episode payments for their two selected conditions through two methods. One way that hospitals earn points in the program is by reducing their payments from the baseline period (index admissions in 2017) to the performance period (index admissions in 2019). These are termed ‘improvement points’. Alternatively, hospitals are able to earn points by being less expensive than the other hospitals in their cohort. These are referred to as ‘achievement points’. The MVC cohorts are groups of hospitals determined to be peers using bed size, case mix index, and teaching status.

While participants are scored on both improvement and achievement, members receive the higher of the two scores for each service line. Hospitals are also eligible to earn a bonus point for each service line provided all hospitals in their respective cohort who selected the same condition reduce spending by five percent. A maximum of ten points can be awarded for participating members. Figure 2 shows the distribution of total points earned by hospitals for Program Year 2020.

Figure 2.

On average, hospitals earned six points, an increase of around one point from the 2019 program year average. Twenty-four hospitals received bonus points within the COPD, colectomy, joint replacement, and pneumonia service lines. Consistent with previous years, joint replacement had the average points, with pneumonia coming in a close second (see Figure 3).

Figure 3.

If you have any questions regarding the MVC Component of the BCBSM P4P program, please refer to the P4P Technical Document for Program Years 2020 and 2021 and the MVC P4P FAQ PY 2020-2021 . If you would like to set up a meeting to review your hospital’s performance, please contact the Coordinating Center at MichiganValueCollaborative@gmail.com.