The Michigan Value Collaborative

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

Month: August 2017 (page 1 of 3)

BCBSM Collaborative Helps Improve Joint Replacement Initiatives and Patient Outcomes in Michigan

Rochelle Igrisan

Rochelle Igrisan, MBA, MSN, RN is MARCQI’s Senior Project Manager.

Established in 2012, The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), essentially focuses on hip and knee procedures, such as joint replacements and revisions of those procedures. MARCQI currently works with 60 member hospitals using clinical data to track the progress of these hospitals in improving patient outcomes related to joint surgery. Several of the quality initiatives initiated by MARCQI and utilized at participating hospitals have proven to be valuable and successful at improving patient outcomes while also reducing costs.

Optimize Use of Blood Transfusions Post Joint Replacement

By disseminating data on usage, sharing and promoting the American Red Cross (ARC) Guidelines for blood transfusions, and reviewing best practices regarding the standard for blood transfusions after joint replacement surgery MARCQI recognized the use of transfusions as an area to address among their member hospitals. The ARC guidelines suggest:

  1. Providing blood transfusions post joint replacement (unilateral) if the patient’s hemoglobin level is less than eight; and
  2. Only transfusing one unit of blood at a time and then testing the patient’s hemoglobin levels again to assess further treatment.

Following implementation of these guidelines, MARCQI member hospitals the use of blood transfusions after joint replacement decreased from 9.8% to 2.6%. This best practice has not only helped improve patient care by providing an appropriate and necessary amount of care for the patient, but has also helped reduce costs for hospitals. It has also reduced blood utilization throughout the state of Michigan allowing this precious commodity to be available for other occasions.

Improving Patient Care and Self-Management Post Joint Replacement

A second initiative MARCQI participants worked on has been geared towards decreasing the inappropriate use of skilled nursing facilities after joint replacement surgery. The majority of joint replacement patients have better post-operative outcomes if they are sent home. Thus, hospitals provided patients with guidance on how to better self-manage their condition post joint replacement. Prior to implementation of this quality initiative, about 33 to 50 percent of patients went to a nursing home following joint replacement surgery. However, after working on this initiative, only about 15 percent of patients are sent to nursing homes post joint replacement.

Other initiatives MARCQI is working on are better understanding of pain management post joint replacement, and reducing surgical site infections in post joint replacement candidates. Overall, the different quality initiatives that MARCQI has worked on has helped improve patient outcomes and save hospitals millions of dollars. In 2014-2015, MARCQI member hospitals saw a shared cost savings of $3,453,424. This cost savings goes hand in hand with helping improve patient experience and quality of care related to joint replacement surgery.

To promote hospital and CQI collaboration, MVC and MARCQI work on a Joint Replacement Workgroup together. If you are interested in learning more about MARCQI or the Joint Replacement Workgroup, please contact Deby (, Abeer ( or Rochelle Igrisan from MARCQI (

Michigan Hospital on the Forefront of Reducing Hospital Readmissions

Dino Recchia

Dr. Recchia is Chief of Cardiology at Munson Medical Center

Some goals of the MVC Hospital Engagement team are to help hospitals reduce Heart Failure (HF) readmission rates along with improving patient care and quality in order to have Michigan become a leader in this domain. The Hospital Engagement team has been locating and speaking to hospitals nationwide with the lowest HF-related readmissions. One hospital, Munson Medical Center, falls in the top 1% of hospital readmissions and is located right in Michigan. Munson is on the forefront of using coordination of care to reduce readmissions. The Hospital Engagement team had the opportunity to speak to Dr. Recchia, Sheila Falk, and Anne Bacon about the HF Clinic at Munson Medical Center, which has helped better manage patients and improve readmission outcomes among their sickest patients.

The clinic was the shared vision of Dr. Recchia and Sheila Falk who began planning the program in 2010.  They identified gaps in the care of many heart failure patients which was resulting in high rates of readmissions and sub-optimal quality of life.  They also saw the growing role of LVADs in the management of end stage heart failure which presented difficulties for LVAD patients in northern Michigan who lived many hours away from an LVAD center.  A similar situation existed for patients with pulmonary hypertension.  They approached the Munson Foundation with a plan to establish a multidisciplinary heart failure program to address the needs of this difficult patient population. With seed monies from the Foundation, the Munson Heart Failure Clinic was established in 2011.

Patient Management

The clinic has grown dramatically over the last 5 years now involving a heart failure cardiologist, special heart failure nurse practitioner, 3 dedicated nurses, and 2 support staff.  90% of the referrals to the program come from Dr. Recchia’s partners and involve cases that are too complex to manage in a general cardiology practice.   Once the patient is referred, care is taken over completely by the Heart Failure clinic with no co-managing between cardiologists. Patients referred to the HF Clinic begin care management the day they are discharged. Inpatients are seen and educated by the nurse prior to discharge as the team found that the time between discharge and their first HF Clinic appointment is a very vulnerable time.  The Munson team has also developed a “shared care” approach for patients with LVADs allowing these patients to be co-managed with their implanting LVAD centers downstate greatly reducing the frequency with which patients and their families have to drive long distances for a routine LVAD follow up appointment.  The same approach is used for co-managing patients with pulmonary hypertension seen in those same institutions.  Another unique feature of the HF Clinic at Munson Medical Center is the phone call strategy they employ.  Instead of suggesting patients call the HF Clinic if something is wrong after a change in their treatment regimen is made, the HF Clinic team arranges a “phone call appointment” at a specific date and time to follow-up on the response to the treatment and facilitating further decision making. These patient management methods at the Munson Medical Center HF Clinic help better coordinate care and consequently improves patient experience and outcomes. Patients reap such benefits from being in the program that they often want to stay in the program even after they have improved enough to no longer need this level of care.  Munson has also had great success integrating hospice care in to their program for those patients that have no further care options resulting in over 60% of the deaths in the program occurring in a hospice setting.

Outcomes and Measurement of Success

Readmission rates can be used as a measurement of success of a program geared towards improving patient care and costs. Munson took less than 2 years to measure the positive outcomes the clinic had on patient care and on readmission rates. Munson’s overall hospital readmission rate for heart failure is 18.6% down from 23% before the HF program was established.  The national average for this metric is 22%.  The patients followed by the HF Clinic are the most difficult heart failure cases with a predicted readmission rate based on clinical parameters of over 25% yet this subgroup had an overall readmission rate of only 12% which is a further testament to the success of the program.  Moreover, Munson has used patient testimonials and resource usage to measure the downstream impact of the HF Clinic and shown benefactors the benefit of investing in a HF clinic.

Advice to Hospitals

Munson was able to provide great advice for hospitals seeking to begin a HF Clinic program. First and foremost, there has to be complete buy-in from the cardiologists where the specialty clinic takes over care for the patient so there is no confusion. Hospitals should structure a multi-disciplinary clinic where each member works to the full potential of their credentials. This ensures coordination of care among services and makes patients feel secure in their decision to use the HF Clinic services. This team is critical to ensuring that patients are receiving timely and quality care.

Dr. Recchia and the HF Clinic team are happy to talk to anyone interested in finding out more about the clinic at Munson. Please contact Deb Evans (, Abeer Yassine (, or Dr. Recchia ( for more information.

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