The Michigan Value Collaborative

Helping Michigan hospitals achieve their best possible patient outcomes at the lowest reasonable cost

Month: May 2016

How to integrate episode cost data with quality improvement: A story from McLaren Greater Lansing

Maya Peters is a Research Associate with the Michigan Value Collaborative.

As part of the MVC site visit team journeying across Michigan this year, one question I’ve heard from many hospitals is this: How do we integrate the clinical outcomes data from our other Blue Cross CQIs with the episode cost data provided by MVC?  Luckily, a few weeks ago we visited McLaren Greater Lansing, where we discovered a team working on a project that helps answer that question. 

Andrew Syrek, a Patient Advocate and Quality Data Specialist, and Jorgieann Stoneham, a Clinical Data Abstractor for the Michigan Surgical Quality Collaborative (MSQC), are working on a new pre-habilitation project for their colectomy patients.  This project was informed by episode cost data from MVC along with clinical outcomes data from MSQC.  I immediately thought this would be a great example for the rest of the collaborative, so I asked to speak with Andrew and Jorgieann again after our site visit.

How it began

The collaboration began last year, when Andrew discovered on the MVC registry that McLaren Lansing’s readmissions for colectomy patients were high when compared to the MVC average. He told me that he first noticed this as an improvement opportunity on the “Key Insights” report page.

The next step for Andrew was to connect with Jorgieann, because he knew that she worked with MSQC and might have some insight on these colectomy patients.  At McLaren Lansing, the quality department holds monthly meetings in which everyone touches base and shares what they’ve been working on.  These monthly meetings allowed Andrew reach out to Jorgieann directly, as he already had an idea of what she worked on.  As it turned out, Jorgieann had been looking specifically at McLaren Greater Lansing’s colectomy patients as part of her work with MSQC.

What they did

After Andrew and Jorgieann discovered their shared interest in reducing readmissions for colectomy patients, they began to put together a care improvement plan.  Andrew showed Jorgieann the readmissions data from the MVC registry, which at that point had 2012 and 2013 data. He then went into their electronic medical record, Premier, and pulled more recent reports on colectomy readmissions.  Jorgieann compared the patients that Andrew had pulled to her own data she had abstracted for MSQC, and was able to take a close look at each patient’s case to try and determine what may have led to their readmission.  Through these analyses, they were able to identify a possible driver of readmissions: A lack of education prior to and throughout each patient’s hospital stay.

To address this problem, Jorgieann came up with the idea of providing patients with a pre-habilitation kit.  These kits contain educational materials instructing patients what to do prior to surgery, as well as what to expect after their surgery.  They also receive an incentive spirometer, antibacterial soap, mouthwash and a pedometer to help each patient be as well prepared as possible for surgery.  Jorgieann said that her kits help to “empower patients to take an active role in their care” and gives them realistic goals for after surgery.

The pre-habilitation project officially began on February 1st, 2016, and Jorgieann will be doing 30 day follow-ups with each patient.  There isn’t any data to share yet, but Jorgieann and Andrew are looking forward to tracking each patient’s outcome, as well as tracking McLaren Greater Lansing’s colectomy episode cost on the MVC registry.  I will be reconnecting with them later this year.

Recommendations

Lastly, I asked Andrew and Jorgieann about what this experience had taught them, and what advice they had for others.  Andrew recommended using the MVC registry to see an overview of potential cost savings opportunities at your hospital, and then digging in deeper to these opportunities with the relevant CQI representative at your hospital.  Jorgieann added that it’s helpful to have the cost data along with the clinical outcomes data to show to surgeons; it is stronger and more believable this way.

They also stressed the importance of the monthly quality department meetings at McLaren Lansing.  For Andrew and Jorgieann, these meetings help to foster collaboration through increasing awareness of what others in your organization are working on, as well as helping to create connections across departments and projects.

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Questions or comments?  We’d love to hear from you.  You can comment on this article, or use the form at the bottom of the page.

10 key questions to ask about any new bundled payment program

Jim Dupree

Jim Dupree, MD, MPH, is Co-Director of MVC and Assistant Professor of Urology at University of Michigan.

Bundled payments seem to be everywhere these days.  For episodic care, like surgeries or acute medical conditions, bundled payments attempt to improve quality and decrease costs for the duration of the care window. Bundled payments are meant to align incentives between all of the various providers who care for a patient during the episode.

Bundled payments have been used by the Centers for Medicare & Medicaid Services (CMS) for many years through their voluntary Bundled Payments for Care Improvement initiative.  Most recently, CMS enacted its first mandatory bundled payment program, the Comprehensive Care for Joint Replacement.  Bundled payments are also found in the private insurance market and even outside the insurance market all together.  Some large employers are now contracting directly with hospitals to provide bundles of surgical care for their employees.  And we can expect to see bundled payment programs flourish after passage of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, which incentivizes physicians to participate in alternative payment models like bundled payments. 

But, not all bundled payment programs are the same; each bundle will have different structure and rules.  Here are 10 key questions you should ask about each new program:

  1. What is the target condition, and how is it defined? What are the inclusion and exclusion criteria for patients to qualify for the bundle?
  2. For bundles based on hospitalizations, are pre-admission services included in the bundle?
  3. What is the time window for the bundle? Most bundles attempt to capture care for 30 to 90 days after discharge.
  4. How is patient choice accommodated in the bundle?
  5. What are the bundle’s quality measures? How do those quality measures help ensure that important, needed care is not withheld from patients?
  6. Are all services and types of care within the time window attributed to the bundle? If not, how is it determined which services are and are not attributed to the bundle?
  7. What type of risk adjustment is used in the calculation of episode costs?
  8. Does the target bundled price incorporate regional variation, teaching status, or other structural characteristics of your hospital?
  9. How much variation do you think exists for that services?
  10. What are your current episode costs for that condition, and how do you compare to your peers?

All of this data is available for MVC member hospitals to help them understand their local care episodes. For additional reading, Health Affairs recently released an excellent summary about designing bundled payment initiatives.


Questions or comments?  We’d love to hear from you.  You can comment on this article, or use the form at the bottom of this page.