The Michigan Value Collaborative (MVC) introduced its first ever pneumonia push report this week when the Coordinating Center shared individualized reports with 89 hospitals across Michigan. This report was created in response to member interest and incorporated 30-day claims-based episodes with index admissions from 1/1/18 – 12/31/20 for the following payers: Medicare FFS, Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, Blue Care Network (BCN) Commercial, BCBSM MA, BCN MA, and Medicaid. Reports were created for all MVC member hospitals that had at least 11 pneumonia episodes per year in 2018, 2019, and 2020.
One goal for this report was to provide data that would be useful for a broad range of MVC’s increasingly diverse membership. Critical Access Hospitals (CAHs), for example, are some of MVC’s newest members and differ in several meaningful ways from other hospitals in the collaborative. Therefore, MVC distributed two different versions of the pneumonia report in order to refine comparison groups and provide a more tailored view of the data. As a result, 81 general acute care hospitals received a pneumonia report comparing their performance to 1) all other eligible general acute care hospitals in the collaborative and 2) acute care hospitals in their geographic region. The second version of the report was shared with eight eligible CAHs, which compared their performance to other MVC CAHs. By providing hospitals with tailored comparison groups when appropriate, MVC hopes to strengthen the usability of its claims-based data to inform quality improvement initiatives.
After much consideration, the MVC team decided to remove any pneumonia episodes containing a confirmed diagnosis of COVID-19 (U07.1) in the first three diagnosis positions of an inpatient facility claim from this report. Members can now replicate this approach on the MVC registry for episodes from April 2020 or later using the new COVID-19 filter, which allows users to include or exclude episodes that contained an inpatient facility claim with a confirmed COVID-19 diagnosis. For the purposes of this push report, the Coordinating Center further excluded all pneumonia episodes from March 2020 in order to remove COVID-19 hospitalizations that occurred in Michigan before an official COVID-19 diagnosis code was available and were coded as pneumonia.
Measures included in the pneumonia report were trends in average price-standardized risk-adjusted total episode payments, average index length of stay, index in-hospital mortality rates, trends in 30-day readmission rates, rates of 30-day post-acute care utilization, and rates of seven-day outpatient follow-up. Overall, the Coordinating Center found that the in-hospital mortality rate for both groups of hospitals was about 2%. One noticeable difference between the two report groups was that CAHs had a shorter average length of stay for index pneumonia hospitalizations (4.6 days, see Figure 1) than general acute care hospitals (5.8 days, see Figure 2).
Figure 1. Average Index Length of Stay at CAHs
Figure 2. Average Index Length of Stay at Acute Care Hospitals
Post-acute care utilization rates were stratified by emergency department (ED), home health, rehabilitation, and skilled nursing facility (SNF). In general, the most frequently utilized category of post-acute care for pneumonia episodes was home health at a rate of 20% for acute care hospitals (see Figure 3) and 24% for CAHs (see Figure 4). Furthermore, there was wide variability in seven-day outpatient follow-up rates for both types of hospitals, but the average for acute care hospitals was higher at 39.7% (see Figure 5) compared to 24.4% (see Figure 6) for CAHs.
Figure 3. 30-Day Post-Acute Care Utilization Rates at Acute Care Hospitals
Figure 4. 30-Day Post-Acute Care Utilization Rates at Critical Access Hospitals
Figure 5. Seven-Day Outpatient Follow-Up Rates at Acute Care Hospitals
Figure 6. Seven-Day Outpatient Follow-Up Rates at Critical Access Hospitals
By understanding the unique needs of its members, MVC can improve future reports for use in quality improvement activities. If your hospital is interested in sharing feedback about the new pneumonia report or has a specific follow-up request, please reach out to the Coordinating Center at michiganvaluecollaborative@gmail.com.