The Michigan Value Collaborative

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

Category: Current events (page 1 of 12)

Pain Management Efforts: Addressing the Opioid Epidemic

Abeer Yassine

Abeer Yassine, is the MVC Hospital Engagement Associate

Drug overdoses are a leading cause of accidental death in the U.S., with as many as 20,000 of these deaths in 2015 related to prescription pain relievers.1 Various studies have also drawn relationships between opioid usage and higher hospital costs (ex: 30-day readmissions). 2,3 Since the opioid epidemic does not come only at a cost to patient lives, but also to hospital systems across the country, pain management interventions have become widespread as a primary focus for hospitals. With hopes of helping address the Opioid Epidemic, there have been several promising interventions across the U.S. that are focused on different facets of pain management.

Straith Hospital, Southfield, Michigan

The original Straith Hospital focused on plastic and reconstructive surgery but over the past twenty-five years has branched out into other realms of heath care. In a recently published Crain’s Detroit article, Straith Hospital was highlighted for their new Interventional Pain Center in Southfield, Michigan.4 This new Interventional Pain Center is focused on comprehensive procedural interventions using multi-modal approaches to help limit and reduce the use of opioids in Michigan. Examples of procedural interventions include physical therapy and steroid injections. Straith decided to take this approach to pain management rather than medication management based on the needs of the population that they treat. To learn more about the variety of services at Straith’s Interventional Pain Center and the procedures they hope to offer click here.

Eliminating Medications Through Patient Ownership of End Results (EMPOWER) Study

For a variety of reasons opioids are often the drug of choice for treating patients with chronic non-cancer related pain. However, with limited knowledge on the effectiveness of these medications and scarce availability of alternative pain relief treatment options, a study is being conducted to elicit information about an online tool to help chronic pain patients. The EMPOWER study is a federally funded study focused on pain management through an online program for non-cancer patients. This $2.5 million study will examine the impact of an online tool, Goalistics Chronic Pain Management Program, over the course of five years. Goalistics offers daily activity trackers, planning, and relaxation tools and exercises to help individuals better manage their pain without the use of medication.

This online program was created by psychologists and offers patients easy-to-use tools to manage their chronic pain and has been shown to be effective in pain management in small samples. With investigators from University of Cincinnati College of Medicine and Washington State University College of Nursing, the EMPOWER study will expand the sample size to further examine the impact of online, holistic pain-management. For more information on the EMPOWER study, click here and here.

1 American Society of Addiction Medicine (2016). Opioid Addiction 2016 Facts & Figures. Google Scholar

2 Rogal, S., Mankaney, G., Udawatta, V., Good, C.B., Chinman, M., Zickmund, S., Bielefeldt, K., Jonassaint, N., Jazwinski, A., Shaikh, O., Hughes, C., Humar, A., DiMartini, A. and Fine, M.J. (2016), Association between opioid use and readmission following liver transplantation. Clinical Transplantation, 30: 1222–1229.  Google Scholar

3 Waljee J.F., Cron, D.C., Steiger, R.M., Zhong, L., Englesbe, M.J., and Brummett, C.M. (2017), Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery. Annals of Surgery, 265: 715-721.Google Scholar

4 Green, Jay (2017). Straith Hospital expands into interventional pain center program. Crain’s Detroit Business

Unpacking Medicare’s MACRA Resource Use measure

Paige VonAchen

Paige is a MVC Research Intern and MD/PhD candidate at the University of Michigan Medical School

The Medicare Access and CHIP Reauthorization ACT (MACRA) Merit-based Incentive Payment System (MIPS) will begin payment adjustments beginning 2019, resulting in approximately $199 million in payment adjustments and $500 million in additional bonuses across physicians nationally each year. The program scores physicians based on their performance in four areas: quality, improvement activities, advancing care information and resource use. While the Resource Use category comprises 0% of the overall weighting in 2019 (based on performance year 2017), the weighting will rise to 10% in 2020 (based on performance year 2018), and then to 30% beginning 2021. Therefore, understanding how the new measure is determined and adapting accordingly will be critical to providers’ success under the new payment system.

So, what does Resource Use really mean? And how is it calculated?

First, let’s establish who is not being scored…clinicians participating in the Advanced Alternative Payment Models (AAPM) and clinicians that are non-patient-facing (e.g., pathologists and radiologists) will also not be scored (instead, the weights of the other categories will increase).

For those that are being scored, it’s important to know the three measures that comprise the Resource Use category:

  • Total per capita costs: this measure represents the total yearly costs (for Parts A and B) for all patients assigned to a physician, divided by the total number of patients assigned to that physician. Patients are attributed to the physician or physician group that delivers the plurality of “primary care services” (under Part B) to the beneficiary as compared to any other practice, and includes admissions due to COPD, CHF, CAD, and Diabetes Mellitus.
  • Medicare Spend per Beneficiary (MSPB): this is a measure of combined Part A and B spend incurred around a hospitalization beginning 3 days prior to admission through 30 days post-discharge. MSPB is attributed to the provider submitting the majority of Part B claims during the index hospitalization. The total cost of care for such an episode is attributed to the physician or physician group that spends the most time with the patient during the initial admission.
  • Condition- and Episode-Based Measures: this measure looks at episodes of care triggered by a specific diagnosis of procedure. Many episodes are surgical (e.g., hip or knee replacement); however, there are medical as well (e.g., CHF, and COPD exacerbation). Any physician that provides over 30% of inpatient E&M codes during the index event (inpatient stay) will have the Part A & B costs of that episode attributed to them. This is currently reported in today’s Quality and Resource Use Report (QRUR); however, now it impacts reimbursement. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/2016-QRUR.html

Needless to say, the Resource Use category of MACRA is complex and the implications for individual physicians depend on their type of practice and compilation of patients. Understanding and monitoring the payment and utilization of your own services will help you identify the most efficient services and allow you to adapt to MACRA’s new payment system.

Read more about MACRA at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Resource-Use-Performance-Category-slide-deck.pdf

 

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