MVC Push Reports -

27 Apr 2023

Latest MVC Push Reports and Resources Draw Attention to Low-Value Preoperative Testing

April 27, 2023 | 0 Comments | MVC Push Reports, preoperative testing

This week MVC distributed its first of two preoperative testing push reports of 2023, providing members with an opportunity to benchmark their testing practices. MVC first introduced its preoperative testing push reports in 2021 to help members reduce the use of unnecessary testing for surgical procedures. Preoperative testing for low-risk surgeries, especially for young and healthy patients, often provides no clinical benefits yet is ordered regularly at hospitals across Michigan.

The report distributed this week had many similarities to versions distributed last year, namely that members continued to see their rates across a variety of tests for three elective, low-risk procedures performed in outpatient settings: laparoscopic cholecystectomy, laparoscopic inguinal hernia repair, and lumpectomy. Claims were evaluated for the index event as well as 30 days prior to the procedures for the following common tests: electrocardiogram (ECGs), echocardiogram, cardiac stress test, complete blood count, basic metabolic panel, coagulation studies, urinalysis, chest x-ray, and pulmonary function.

The latest report utilizes claims from Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) plans exclusively, including both the commercial and Medicare Advantage plans. This allows members to see MVC’s most up-to-date data, which includes episodes with index admissions from 7/1/2020 through 6/30/2022. Members only received reports if they had 11 or more cases in at least one of the three conditions and at least 20 cases across all three conditions.

The reports received by members this week included a patient snapshot table that defined rates for preoperative testing and no preoperative testing in patients of varying races as well as those with zero, one, or two or more comorbidities. Generally speaking, patients with no comorbidities were more likely to have no preoperative testing than patients with one or more comorbidities. There were also observed differences in testing by age; patients who had preoperative testing were older on average than patients who had no preoperative testing.

A key finding in the report is the average testing rate for all three procedures combined for the entire collaborative, which continues to showcase the wide variability across hospitals in Michigan. Some in the collaborative have an average testing rate close to 10% and some nearly 100% (Figure 1). Individual hospitals receiving a report will see on this figure where they fall compared to other hospitals in the collaborative, as well as their average rate for the three separate procedures to help deduce which procedure is driving their average rate.

Another trend that continued in this April 2023 report is the consistency of average testing rates for combined procedures over time. A trend graph showed members how their overall rate for any preoperative testing compared in 2020, 2021, and the first half of 2022, with data points for their hospital, the MVC average, and their regional comparison group (Figure 2). There continues to be very little change in testing rates over time when looking at aggregated preoperative testing practices. The prevalence of low-value preoperative testing has remained high on average across the collaborative for three years and likely longer.

A third figure included in this report shows the absolute change in the rate of any preoperative testing for their hospital’s highest volume surgical condition among laparoscopic cholecystectomy, laparoscopic inguinal hernia repair, and lumpectomy (Figure 3). In this figure, positive values represent an increase in annual preoperative testing from 7/1/2020 to 6/30/2022, and negative values represent a decrease. The MVC average for this metric was -2.3%, so there was a small net decrease in the average rate of any testing in that time period. Once again, the variation across the collaborative was notable, with some hospitals seeing greater than 40% swings in either direction – though some sites may see drastic changes to their rates if case counts are smaller.

The remaining figures in the report provide preoperative testing rates for specific types of tests, with caterpillar plots for each condition to help benchmark performance to other hospitals across the state. The types of tests with the highest average testing rates across conditions are blood tests—which include complete blood count, basic metabolic panel, and coagulation tests—and electrocardiography tests. For a majority of hospitals, their testing rates are highest within the lumpectomy patient population regardless of test type, with the exception of urinalysis testing rates that are heavily driven by the cholecystectomy population.

The last time MVC shared preoperative testing reports was in July 2022, and since then MVC contributed to and launched resources to help healthcare providers implement changes. MVC members now have access to a sample preoperative testing decision aid for low-risk surgeries, developed in partnership with the Michigan Surgical Quality Collaborative (MSQC) and the Michigan Program on Value Enhancement (MPrOVE), and MVC (Figure 4). The decision aid also comes with a supplemental suggested preoperative testing chart that identifies which tests are recommended for patients who are classified by the American Society of Anesthesiologists (ASA) as Class III or above and undergoing low-risk surgery (Figure 5). Both resources are intended as guides and can be downloaded in their original file formats so hospitals may edit and adapt them within their institution. These resources were developed with input from one institution’s surgery, anesthesiology, and preoperative clinic teams, and based on clinical recommendations put forth by a number of professional societies.

These resources were added to a new resource website developed in partnership with MPrOVE, MSQC, and MVC. The goal of the site is to help providers safely “waive the workup” by providing the latest research, national recommendations, arguments against common myths, and frequently asked questions.

In addition, the MVC team is holding several workgroups in 2023 dedicated to preoperative testing. The first took place on March 15 and was heavily attended by MSQC and MVC members working to reduce preoperative testing as part of their P4P programs. A full recording of the workgroup is available here. MVC also has a preoperative testing workgroup scheduled for August 1, from 1-2 p.m., featuring guest presenter Nick Berlin, MD, MPH, MS, who has published several papers on patterns and determinants of low-value preoperative testing. A third preoperative testing workgroup is tentatively scheduled for October 26, from 11 a.m. to 12 p.m. Sites are encouraged to attend these events in order to learn best practices and collaborate with peers on common barriers.

For additional analysis or consultation on your hospital’s preoperative testing rates or practices, reach out to the MVC team for assistance at Michigan-Value-Collaborative@med.umich.edu.

12 Jan 2023

hip replacement joint replacement knee replacement MVC Push Reports physician organizations

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Latest PO Joint Replacement Report Adds Outpatient Rehab Rates, Demographics, and More

January 12, 2023 | 0 Comments | hip replacement, joint replacement, knee replacement, MVC Push Reports, physician organizations

MVC proudly partners with 40 physician organizations (PO) spanning the state of Michigan and continues to refine and add to the resources tailored to these members. As part of this work, MVC recently refreshed and shared PO joint replacement reports in December. These PO-level reports were first shared in October 2021 with a focus on the shift away from inpatient surgeries as well as post-acute care utilization for combined joint procedures.

The recently refreshed reports carried forward many of the joint episode metrics included previously, but with additional stratification and detail. For instance, whereas the 2021 version presented figures for all joint surgeries combined, many of the figures in the December 2022 version provided data stratified by hip procedure, knee procedure, and all joint procedures. Similarly, some figures are stratified by the location of the procedure (inpatient vs. outpatient). This new differentiation was intended to help POs more easily understand the underlying drivers of their metrics. For example, the blinded hospital below (Figure 1) could observe that its average 30-day price-standardized total episode payment is driven more by hip surgeries ($17,399) than knee surgeries ($16,643). This site could also observe that its overall total episode payment is below both the collaborative-wide PO average and the average in their region, and at the average for other POs of a similar size.

Additional detail was also added to the patient attribution table, which now identifies the top 10 index facilities (rather than five) where a PO’s attributed patients underwent joint replacement surgery. This table now also includes each index facility’s percent of joint episodes performed in an outpatient setting as well as their average 30-day price-standardized total episode payment for attributed patients. This change was intended to inform quality improvement discussions between POs and partner hospitals or Ambulatory Surgical Centers (ASCs).

Also new to this report were 30-day outpatient rehabilitation rates and a patient population snapshot table to help POs better understand the demographics of patients included in the report. The table included mean age, top two patient Zip codes, the percent of patients living in an “at-risk” or “distressed” Zip code according to the Distressed Communities Index, the proportion of patients belonging to different racial categories, their average length of stay, and their 30-day post-surgery complication rate. Each of these categories was summarized separately by insurance plan.

This report utilized administrative claims from attributed members spanning 1/1/19 – 6/30/21 for Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, BCBSM Medicare Advantage, and Medicare Fee-for-Service. Reports were prepared for all POs that participate in MVC and had at least 20 joint replacement episodes in 2019 and 2020, and at least 11 episodes in the first half of 2021.

In general, report findings indicated that utilization of outpatient surgery settings continued to increase in 2021 on average (Figure 2). However, there was still significant variation between MVC’s 40 PO members in their average rate of joint replacement surgeries taking place in outpatient settings (Figure 3). For joint episodes in 2019 through the first half of 2021, outpatient surgery rates ranged from just over 20% to nearly 80%.

01 Dec 2022

Cardiac Rehab MVC P4P MVC Push Reports P4P preoperative testing

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PY 2024-2025 Selection Reports Sent for MVC Component of BCBSM P4P Program

December 1, 2022 | 0 Comments | Cardiac Rehab, MVC P4P, MVC Push Reports, P4P, preoperative testing

Beginning in 2018, Blue Cross Blue Shield of Michigan (BCBSM) allocated 10% of its Pay-For-Performance (P4P) Program to a metric based on Michigan Value Collaborative (MVC) claims data. In 2022, the BCBSM P4P Quarterly Workgroup approved changes to how hospitals are evaluated in future program cycles. The upcoming two-year cycle including Program Years (PYs) 2024 and 2025 will be the first impacted by these changes, with performance years in 2023 and 2024, respectively (see Figure 1). Hospitals received selection reports for the next cycle this week to aid in their decision-making on metrics within the new program structure.

What is staying the same?

The program will continue to be scored out of 10 points maximum, and hospitals will continue to be evaluated on their risk-adjusted, price-standardized total episode payment, though this will make up a smaller component of the overall program. In addition, most conditions hospitals could select previously for episode payment scoring will still be available for that component of the program. Those include chronic obstructive pulmonary disease (COPD), colectomy (non-cancer), congestive heart failure (CHF), coronary artery bypass grafting (CABG), joint replacement, and pneumonia. Additionally, a hospital’s metric selections will continue to be scored on improvement compared to the hospital’s own past performance and scored on achievement related to an MVC cohort. Each hospital will continue to be awarded the greater of the two scores, either improvement or achievement, which are calculated using Z-scores. Cohort designation is still based on bed size, critical access status, and case mix index.

What is changing?

The PY 2022-2023 program was scored out of 10 points, but 12 points could be earned (10 points from episode spending plus two bonus points). In PYs 2024-2025, the overall program structure (Figure 2) will change so that the maximum score will be 10 points, made up of a maximum of four points from an episode spending metric, a maximum of four points from a value metric (a new component), and a maximum of two points from engagement activities completed in the program year (the calendar year following the performance year). This means that rather than selecting two conditions as in previous program cycles, hospitals will now select one condition for the episode spending metric and select one value metric. In order to be eligible to select a payment condition or value metric, a hospital must be projected to have at least 20 cases in the full baseline year of 2021. No bonus points will be available for PYs 2024-2025.

Brand new in PYs 2024-2025 will be value metrics, which are evidence-based, actionable measures that show variability across the state. Hospitals will be rewarded for high rates of high-value services or low rates of low-value services. Seven value metrics are available for hospitals to choose from: cardiac rehabilitation after CABG, cardiac rehabilitation after percutaneous coronary intervention (PCI), seven-day follow-up after CHF, 14-day follow-up after COPD, seven-day follow-up after pneumonia, preoperative testing, and risk-adjusted readmission after sepsis. The preoperative testing value metric is composed of a group of three low-risk procedures: cholecystectomy, hernia repair, and lumpectomy. Each procedure will be scored separately, and points for this value metric will be awarded based on the highest points achieved for a hospital’s eligible procedures.

Finally, engagement in MVC activities will be built into the program’s scoring structure, rather than being offered as “bonus” points. Hospitals will be eligible to earn up to two points by attending and participating in MVC activities throughout each program year. These points are intended to increase engagement with other hospitals and the MVC Coordinating Center. Hospitals may select their own combination of activities but must include at least one activity from each of the attendance and participation categories to earn any points.

The P4P selection reports distributed this week include tables for the various episode spending and value metrics that identify projected case counts, the hospital’s average payment or rate of utilization, the cohort and MVC All average payments or rates, and the projected changes necessary for the hospital to earn 1 – 4 points. Accompanying the reports was an interpretation guide to walk recipients through a blinded sample report. It includes guidance on how to interpret the tables with suggestions for how this data could be used to inform a hospital’s P4P selections. The guide can be viewed here.

A complete summary of changes to PYs 2024 and 2025 is available here. These changes will not be retroactively applied to PYs 2022-2023. For complete details about PYs 2024-2025, please refer to the P4P Technical Document. Contact the MVC Coordinating Center with any questions. MVC requests that member hospitals complete and submit their PY 2024-2025 selections by December 23, 2022.

17 Nov 2022

Medicare MVC Push Reports sepsis

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Latest Sepsis Report Compares Medicare Advantage and Medicare FFS Patient Outcomes

November 17, 2022 | 0 Comments | Medicare, MVC Push Reports, sepsis

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%).

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.

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.

13 Oct 2022

COPD COPD Readmissions MVC Push Reports PO Push Reports POs

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MVC Shares New COPD Report with Physician Organizations

October 13, 2022 | 0 Comments | COPD, COPD Readmissions, MVC Push Reports, PO Push Reports, POs

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.

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).

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.

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.

15 Sep 2022

MVC Push Reports MVC workgroup sepsis sepsis awareness month

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MVC and Members Promote Sepsis Awareness Month

September 15, 2022 | 0 Comments | MVC Push Reports, MVC workgroup, sepsis, sepsis awareness month

Throughout the month of September, providers and advocacy groups are calling attention to the prevalence and signs of sepsis, the body’s life-threatening response to infection. It is the leading cause of death in U.S. hospitals, taking the life of a patient every two minutes and affecting an estimated 49 million people every year worldwide. Despite this, at least one in every three adults has never heard of sepsis. That is why in 2011 the Sepsis Alliance officially designated September as Sepsis Awareness Month.

To support its member hospitals in improving their outcomes related to sepsis, MVC collaborated with the Michigan Hospital Medicine Safety Consortium (HMS) in 2019 to develop a sepsis episode definition for its registry. MVC then began distributing sepsis push reports in 2020 with regular refreshes each year. Hospitals received their latest sepsis reports in April, which showcased wide variation across the Collaborative for measures such as total episode payments and 90-day readmission rates (see Figure 1). In addition, hospitals received details on their inpatient mortality and discharge to hospice rates compared to their geographic region and the Collaborative as a whole (see Figure 2). More information about this report was detailed in a previous MVC blog post.

MVC also began hosting a sepsis workgroup in June 2019 to help facilitate idea and practice sharing among Collaborative members. MVC has continued to host sepsis workgroups since then, with the most recent workgroup taking place last week on September 8. That workgroup honored Sepsis Awareness Month with a member panel featuring guest speakers from several health systems in Michigan. Attendees learned about current sepsis initiatives underway at hospitals throughout the state as well as insights on the impact of COVID-19, sepsis screening, sepsis bundle compliance, transitions of care, and other related topics. Those unable to attend can view the complete recording of this panel and discussion here.

One area of focus for this year’s Sepsis Awareness Month is a Sepsis Alliance tool to help providers remember the signs and symptoms. Their acronym approach asks providers to remember, “It’s about T-I-M-E,” with the word “time” representing temperature, infection, mental decline, and extremely ill (see Figure 3).

This resource and many others have been created, collated, and packaged by the Sepsis Alliance in their yearly Sepsis Awareness Month Toolkit. Hospitals and providers are encouraged to utilize these resources to help educate their staff and patients. The hope is that through public education we can raise awareness of the signs and symptoms of sepsis so people in our communities know when to seek emergency care. Together, we can help save lives and limbs from sepsis. Learn more at sepsisawarenessmonth.org. To contact the MVC Coordinating Center about your sepsis reports, future workgroup speakers, or other questions, please email michiganvaluecollaborative@gmail.com.

04 Aug 2022

Emergency Department Utilization MEDIC MVC Push Reports post acute care

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

August 4, 2022 | 0 Comments | Emergency Department Utilization, MEDIC, MVC Push Reports, post acute care

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.

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.

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.

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.

28 Jul 2022

MVC Push Reports preoperative testing

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Latest MVC Preop Testing Report Features New Figures and Data

July 28, 2022 | 0 Comments | MVC Push Reports, preoperative testing

This week MVC distributed its second preoperative testing push report of 2022, providing members with another opportunity to benchmark their testing practices. MVC first introduced its preoperative testing push reports in 2021 to help members reduce the use of unnecessary testing for surgical procedures. Preoperative testing, especially for low-risk surgeries, often provides no clinical benefits to patients but is ordered regularly at hospitals across Michigan.

The report distributed this week had many similarities to the version distributed earlier this year in April, namely that members continued to see their rates across a variety of tests for three elective, low-risk procedures performed in outpatient settings: laparoscopic cholecystectomy, laparoscopic inguinal hernia repair, and lumpectomy. Claims were evaluated for the index event as well as 30 days prior to the procedures for the following common tests: electrocardiogram (ECGs), echocardiogram, cardiac stress test, complete blood count, basic metabolic panel, coagulation studies, urinalysis, chest x-ray, and pulmonary function.

The latest report has a few key differences from the spring version, the most significant of which is that it utilizes claims from Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) plans exclusively. This allows members to see MVC’s most up-to-date data; the report includes index admissions from 1/1/2019 through 12/31/2021. In addition, since the report contains BCBSM/BCN data only, there is no case count suppression, whereas members would only see their data in the spring version if they had at least 11 cases in each year of data for the three combined conditions.

The reports received by members this week included several new figures. Similar to other MVC push reports, members will now see a patient snapshot table that provides additional information about the report’s patient population. For this, MVC chose to include patient characteristics such as age, zip code, and comorbidities. Generally speaking, there were more comorbidities among patients who underwent preoperative testing compared to patients with one or no comorbidities (see Figure 1). However, the majority of patients who complete a preoperative test do not have multiple comorbidities. There were also observed differences in testing rates by age. In general, patients who had preoperative testing were older on average than patients who had no preoperative testing.

Another new figure showcased the overall preoperative testing rates by year. This trend graph showed members how their overall rate for any preoperative testing compared in 2019, 2020, and 2021, and it included data points for the MVC average and regional comparison groups (see Figure 2). The key finding for this figure was that there has been very little change in testing rates over time when looking at overall preoperative testing practices. This means that, in general, the prevalence of low-value preoperative testing has remained consistently high overall across the collaborative for three years and likely longer.

The latest report also included a new figure for absolute change in any preoperative testing from 2019 to 2021. For each hospital, this appears as a caterpillar plot of absolute change percentages for their highest-volume procedure among the three low-risk surgeries in the report. Members can see the percentage change—positive or negative—in their testing rate for that surgical condition, as well as how their absolute change compares to the rest of the collaborative. For example, hospitals that perform more cholecystectomies than hernia repairs or lumpectomies saw a wide range of both increases and decreases in preoperative testing rates from 2019 to 2021 (see Figure 3).

The blinded hospital in this example observed very little change in its testing rate for cholecystectomy (-1.6%), and the MVC average was similar (-2.2%). This showcases that although the collaborative is not seeing much change to overall rates for any testing over time, individual members might see greater variability over time for specific tests or procedures, especially in instances of low case counts.

Members will be able to take those deeper dives into their rates for specific tests in the figures that make up the remaining pages of the report. Viewing one’s preoperative testing rates for each specific test can help members understand if any specific tests are driving their overall testing rate. One area of opportunity, for example, could be to reduce one's rate of cardiac testing, specifically ECGs; the rate of ECGs is very variable across the collaborative (see Figure 4) and could lead to a cascade of care.

09 Jun 2022

Chronic Disease Management MVC Push Reports

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MVC’s Latest CDM Push Report Reframes Focus to Follow-Up Care

June 9, 2022 | 0 Comments | Chronic Disease Management, MVC Push Reports

The Michigan Value Collaborative (MVC) distributed its chronic disease management (CDM) push report recently, which has been refreshed and reframed from its previous iterations. Originally termed the CDM congestive heart failure (CHF) report and the CDM chronic obstructive pulmonary disease (COPD) report, the new “CDM follow-up report” focuses more specifically on follow-up care after hospitalization for the two conditions.

The newest version aims to provide additional granularity into follow-up care at member hospitals by showcasing variability across different windows of time, across payers, and by type. MVC defines follow-up as episodes where a patient had an outpatient follow-up visit (in person or by telehealth) within 30 days or before a readmission, inpatient procedure, emergency department visit, skilled nursing facility admission, or visit for inpatient rehabilitation.

The report features a new patient population snapshot table that highlights demographic data. These tables (see Figure 1) provide each hospital with demographics for their CHF/COPD patient populations, including race, mean age, the average number of comorbidities, and the proportion of patients who are dual-eligible.

MVC hospitals will see comparisons to their peers on 7-day, 14-day, and 30-day outpatient follow-up rates, as well as 30-day risk-adjusted total episode payments and 30-day outpatient follow-up rates stratified by payer. Members will also see their individual hospital’s breakdown of follow-up types at 30 days, and trends over six months for 3-, 7- and 14-day rates.

Each figure presented reflects index admissions from 1/1/18 – 12/31/20 for Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, Blue Care Network (BCN) Commercial, BCBSM PPO Medicare Advantage, BCN Medicare Advantage, Medicare Fee-For-Service, and Medicaid. Hospitals received report pages for each condition if they met the threshold of at least 11 episodes in each year of data for that condition.

There was wide variation in follow-up rates across the collaborative, with member follow-up rates ranging from less than 40% after 30 days to approximately 80% (see Figure 2). In addition, 30-day follow-up rates were lowest within the Medicaid patient population with an MVC average of 58% (see Figure 3); the collaborative-wide averages for 30-day follow-up among BCBSM/BCN and Medicare patients were 76% and 73%, respectively. It was also the case that most patients (92% on average) received follow-up care in person as opposed to a remote or hybrid option (see Figure 4).

The CDM follow-up report was distributed in partnership with the Integrated Michigan Patient-Centered Alliance in Care Transitions (I-MPACT) Collaborative Quality Initiative (CQI). I-MPACT is a unique patient-centered, data-driven collaborative that engages hospitals and provider organizations throughout Michigan in developing and implementing innovative approaches for improving care transitions. They work to improve the transition of patients between care settings with the goal of bettering outcomes and reducing readmissions.

In addition to partnering with I-MPACT to expand the report’s reach, MVC also partnered with a CQI to provide members with supplemental materials that may be relevant to their work with CHF/COPD patients. The Healthy Behavior Optimization for Michigan (HBOM) CQI provided tobacco cessation materials that were shared alongside the MVC report, including a Quit Smoking Resource Guide and Quit Smoking Medication Guide. 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 in MVC’s May CQI spotlight blog.

In addition to continuing to offer its CDM push report, the MVC Coordinating Center offers a bimonthly CDM workgroup. The next workgroup will take place on Tuesday, July 12 from 1-2 p.m., and will feature a presentation about the Sparrow Pain Management Center’s Care Management Program. Please register today to join the MVC Coordinating Center for this presentation and discussion.

26 May 2022

hysterectomy MVC Push Reports physician organizations PO Push Reports

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MVC Launches Hysterectomy Report Tailored to PO Members

May 26, 2022 | 0 Comments | hysterectomy, MVC Push Reports, physician organizations, PO Push Reports

Earlier this week, the MVC Coordinating Center shared a new hysterectomy report with physician organizations (POs). This is the third report MVC has created specifically for its PO membership; MVC launched a joint replacement report in 2021 and a colectomy report earlier this year.

Hysterectomies were identified as a focus area in partnership with POs, who expressed an interest in more reports on surgical conditions. In addition to being surgical, hysterectomy aligns with PO activity for a Blue Cross Blue Shield of Michigan (BCBSM) Physician Group Incentive Program (PGIP) women’s health initiative. To align with the metrics used by this BCBSM PGIP initiative, this report was limited to women aged 18 to 64. The report incorporated claims from 1/1/19 – 6/30/21 for BCBSM PPO Commercial and BCBSM Medicare Advantage. Information on common comorbidities was included, as well as a patient population snapshot table showcasing race-based demographics in the hysterectomy patient population.

Several comparison groups were used to stratify data throughout the report. Those comparison groups included:

All MVC POs
INDEPENDENT PO: As defined in the BCBSM PGIP 2021 physician list, POs with less than 50% are considered independent.
PO SIZE: These groups were based on the number of attributed members at each PO. Member reports include a PO size comparison group in which they belong so they can compare their performance to POs of a similar size.

Hysterectomy can be performed laparoscopically, abdominally, or vaginally. Since these modes of hysterectomy can impact clinical outcomes, many of the metrics in the latest MVC report were stratified this way. Across all MVC POs, hysterectomies were most commonly performed laparoscopically and least commonly performed abdominally.

This report included measures on total 30-day episode payments, length of stay, and medical and surgical complication rates. The average price-standardized risk-adjusted total episode payment was $8,562, and the average index length of stay was 2.1 days (see sample figures from a blinded report in Figure 1).

Medical complications included venous thromboembolism, coronary vascular events, cardiac events (angina, myocardial infarction, cardiac arrest, and heart failure), gastrointestinal events (obstruction and abdominal pain), kidney failure, pulmonary events (pneumonia and respiratory failure), and transfusion reaction. Surgical complications included intraoperative injuries, hemorrhage, shock, surgical site infection (including sepsis), and complications related to wound healing (fistula, hernia, foreign body left during procedure). Medical and surgical complications were identified with ICD-10 diagnosis codes. The overall complication rate across all MVC POs was 28.5%. Surgical complications occurred more frequently than medical complications with rates of 23% and 9%, respectively (see Figure 2).

Preoperative testing rates were also incorporated since some of these types of tests are commonly ordered prior to hysterectomies but may not be clinically indicated. Claims for the index event as well as 30 days prior to the procedure were evaluated for electrocardiograms, x-rays, urinalysis, blood tests, and basic metabolic panels. These tests were identified using CPT codes, which do not distinguish between testing for preoperative purposes and testing for other reasons. Tests that were performed in the emergency department or inpatient setting were not included. Across all MVC POs, the most common types of preoperative tests performed were blood testing (which includes complete blood count, basic metabolic panel, and coagulation tests) and basic metabolic panels. The least common types of preoperative tests that were utilized were X-rays and urinalysis testing (Figure 3).

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