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MVC Launches Hysterectomy Report Tailored to PO Members

MVC Launches Hysterectomy Report Tailored to PO Members

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).

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).

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).

Figure 3.

To ensure the continued provision of the highest quality information, MVC engages regularly with PO members to drive the formation and improvement of PO-specific reports. If you are interested in sharing feedback about these new PO reports, have any specific PO analytic requests, are undergoing new PO improvement initiatives, and/or would like more information about MVC, please reach out to the Coordinating Center at michiganvaluecollaborative@gmail.com.

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New Report on Colectomy Distributed to Member POs

New Report on Colectomy Distributed to Member POs

The Michigan Value Collaborative introduced its first colectomy physician organization (PO) report this week. A colectomy is the surgical removal of a section of the large intestine (colon) or bowel and is performed to treat diseases of the bowel (i.e., Crohn’s disease, ulcerative colitis, and colon cancer).

The report incorporated administrative claims of attributed members from 1/1/19 – 12/31/20 for Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial and BCBSM Medicare Advantage, and 1/1/19 – 9/30/20 for Medicare Fee-for-Service. Reports were created for all POs that currently participate in MVC and had at least 11 colectomies per year in both 2019 and 2020.

There were significant differences in the anticipated clinical course and the likelihood of complications between elective (planned) and emergent colectomy. Therefore, MVC provided a stratified summary of planned versus emergent colectomies (Figure 1), and some metrics in the report were stratified by planned and emergent status to highlight when there was an emergency department revenue code on the episode. For example, there were notable differences in post-acute care utilization between planned and emergent colectomies (Figures 2 & 3).

Figure 1. PO A Colectomy Report Table

Figure 2. PO A Risk-Adjusted Payments: Planned Colectomies

Figure 3. PO A Risk-Adjusted Payments: Emergent Colectomies

In an effort to provide valuable data to MVC POs, the Coordinating Center continually meets with key stakeholders, BCBSM, and PO members to drive MVC PO report development. The contents of this report were developed based on that feedback. For example, this report allowed POs to individually compare their organization to new comparison groups.

The comparison groups in the new colectomy report include:

  • All MVC POs
  • EMPLOYED VS. INDEPENDENT POs: As defined in the BCBSM Physician Group Incentive Program (PGIP) 2021 physician list, POs with greater than 50% of their aligned providers employed by a health system are considered employed, and those with less than 50% are considered independent.
  • PO SIZE: These groups were based on the number of attributed members at each PO (Figure 4). Member POs would see the PO size comparison group in which they belong so they can compare their performance to other POs of a similar size.

Figure 4. PO Size Grouping

Other components included in the report were a list of the top 10 facilities where a PO’s attributed patients had a colectomy performed, the five most common comorbidities among attributed colectomy patients, median length of stay, 30-day risk-adjusted total episode payment, 30-day readmission rate, and the utilization rate for post-acute care services (emergency department, skilled nursing facility, and home health). General findings included that diabetes was the most common comorbidity across all colectomies (planned and emergent) performed at POs and was frequently one of the top two comorbidities for individual POs. In addition, home health services had the greatest variation in post-acute care utilization (see Figure 5).

Figure 5. PO A Home Health Utilization Rate

By understanding the needs of MVC PO members regarding present and future patient care improvement activities, MVC will be better able to improve future PO reports. If you are interested in sharing feedback about these new PO reports, have any specific PO analytic requests, are undergoing new PO improvement initiatives, and/or would like more information about MVC, please reach out to the Coordinating Center at michiganvaluecollaborative@gmail.com.

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MVC Releases New Physician Organization Joint Report

MVC Releases New Physician Organization Joint Report

Taking care of patients is the most important responsibility of the healthcare industry. To achieve optimal care, providers require robust and valuable resources that support their efforts. At MVC’s inception in 2013, the primary focus was the development of hospital-based metrics to improve patient outcomes, reduce healthcare costs, and encourage hospitals to collaborate in best practice sharing. MVC has since expanded its focus outside the hospital walls, recruiting all 40 physician organizations (POs) to participate as MVC members and collaborate to improve the health of Michigan through sustainable, high-value healthcare.

In April of 2021, MVC released its first PO population-level report containing data on health care utilization, allowing POs to benchmark themselves against all MVC PO members. To ensure the continued provision of the highest quality information, MVC engages regularly with PO members to solicit feedback on MVC outputs and to understand their priorities. For example, feedback from MVC’s first PO-specific report resulted in the MVC Coordinating Center updating its patient attribution process to align with that of its Blue Cross Blue Shield of Michigan (BCBSM) partners and their Physician Group Incentive Program (PGIP). As a result, MVC members are attributed to their respective POs with Blue Cross attribution methodology. The MVC Coordinating Center continues to leverage input from these stakeholders to drive the formation of PO-specific reports (see Figure 1).

Figure 1.

A new PO report released this week focuses on episode-based metrics related to joint replacement surgery. This report utilizes updated methodologies and is comprised of administrative claims from attributed members spanning 1/1/19 – 12/31/20 for BCBSM PPO Commercial and BCBSM Medicare Advantage. Reports were prepared for all POs that participate in MVC and had at least 11 joint replacement surgeries per year in 2019 and 2020, respectively. The selection of metrics contained in this report is a result of feedback from PO members and BCBSM.

The new PO Joint Replacement Report includes:

  • Top five facilities where attributed patients had a joint replacement surgery
  • Percent of joint replacement surgeries performed in an inpatient setting by six-month interval
  • Percent of joint replacement surgeries performed in the inpatient setting
  • Utilization rate after a joint replacement surgery in the inpatient/outpatient setting for the following:
    • Home health care
    • Skilled nursing facility (SNF)
    • Emergency department (ED)

The MVC Coordinating Center is stratifying metrics by employed vs. independent PO using BCBSM’s Summer 2021 PGIP physician list. Therefore, POs with greater than 50% of their aligned providers employed by a health system are considered employed, and those with fewer than 50% are considered independent.

The report indicates a downward trend over time in the percent of surgeries performed in the inpatient setting (see Figure 2). This is a positive finding given the push for joint replacements to occur in the outpatient setting; however, it is unclear whether COVID-19 was a factor in this decrease given that the reporting period includes 2020.

Figure 2.

In addition, POs generally have low rates of skilled nursing facility (SNF) utilization (see Figure 3) and relatively higher rates of home health (see Figure 4) utilization. This finding is also encouraging since SNFs are expensive.

Figure 3.

Figure 4.

The metrics with the greatest variation among the different POs are home health rates as well as the overall percentage of joint replacement surgeries performed in the inpatient setting (see Figure 5).

Figure 5.

By understanding the needs of MVC PO members regarding present and future patient care improvement activities, MVC will be better able to improve its future PO reports. If you are interested in sharing feedback about these new PO reports, have any specific PO analytic requests, are undergoing new PO improvement initiatives, and/or would like more information about the Michigan Value Collaborative, please reach out to the Coordinating Center at michiganvaluecollaborative@gmail.com.