The Michigan Value Collaborative

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

Tag: cost reduction (page 1 of 2)

November 2017 Semi-Annual Meeting Key Takeaways and Resources

Shiyuan Yin

Shiyuan Yin is the Research Associate at MVC

This past Semi-Annual was my first MVC collaborative-wide meeting. I appreciated the opportunity to meet members of the Collaborative in-person and would like to share some takeaways from the presentations and breakout sessions.

The November 2017 meeting focused on the emergency department (ED) as a location to improve health care value, including strategies for reducing preventable ED utilization and unnecessary hospital admissions. In addition, the new MVC Obstetrics Initiative led by Dr. Dan Morgan aiming to address variation in obstetric care was launched. Below is a brief summary of each speaker’s presentation and breakout session discussion.

  1. Obstetrics Initiative Dr. Dan Morgan introduced the new MVC Obstetrics Initiative (OBI) and emphasized the tension in the existing obstetric practice. Not only is cesarean delivery often associated with increased rates of complications and higher cost than vaginal delivery, the triple aim of “patient experience, reduced costs, and population health” is also rarely met.

With a focus on the health of maternal and neonatal outcomes, OBI will:

  1. Develop labor & delivery practices that value, and support intended vaginal birth for low-risk patients
  2. Promote best practices for labor & delivery
  3. Improve the culture of care, awareness, & education

Leveraging the data available in MVC, OBI will:

  1. Determine hospitals’ cesarean delivery rates for “low” and “non-low” risk groups with proper risk adjustment.
  2. Recruit obstetric champions and enable peer-to-peer Michigan hospital comparisons regarding rates of vaginal and cesarean delivery as well as maternal and neonatal outcomes.
  3. Identify and support dissemination of strategies shown to promote vaginal births and reduce cesarean delivery rates for low-risk births.

The afternoon breakout session discussed how to use the MVC online tool at michiganvalue.org to review hospital’s obstetric reports. If you have any questions regarding the MVC OB initiative or would like to join this effort, please contact mvcobiproject@med.umich.edu.

  1. The Michigan Emergency Department Improvement Collaborative’s (MEDIC) PATH Initiative: Co-Directors for MEDIC, Drs. Keith Kocher and Michelle Macy, provided an overview of its Program on Alternatives to Hospitalization (PATH) quality initiative designed to provide decision support in the ED for diagnosis and treatment as well as coordinate admission decisions. During the breakout session, representatives from Beaumont and Michigan Medicine shared their experiences implementing the PATH initiative. Through the PATH program, Michigan Medicine revised its admission decision-making process for atrial fibrillation patients. As part of Beaumont Royal Oak’s engagement in PATH, the hospital implemented a Gold Card program for patient follow up and a pediatric observation program to ensure bed spaces for emergent cases. Favorable outcomes in both patient satisfaction and cost reduction have been noticed at both hospitals. For more information about MEDIC and its PATH program, please visit: http://medicqi.org/.
  2. Michigan Medicine’s Complex Care Management Program: Donna Fox, RN, and Heather Rye, LMSW, shared how they develop plans for patients with multiple comorbidities and integrate the ED clinicians in follow-up visits with patients and primary care physicians. The breakout session focused on specific strategies for building relationships with patients in the context of varying health systems. The value of cold calls to providers and inviting them to hospitals for monthly meetings to review patient cases was suggested as a mechanism to initiate coordinated care. More information on Michigan Medicine’s Complex Care Management Program may be found on its website: http://www.med.umich.edu/aco/index.html.
  3. Population-based approach to high ED utilization: Lauran Hardin, MSN, RN-BC, CL, is the Senior Director for Cross Continuum Transformation and the Camden Coalition. Prior to serving in this role, Lauran was Director of a Complex Care Center at Mercy Health St. Mary’s in Grand Rapids that created a cross continuum program coordinating patient care with providers across the county. An extensive root cause analysis of patient medical records allowed for targeted interventions and streamlined communication through the Complex Care Map. In the breakout session, the group discussed how the same interventions were effective on high ED utilizers regardless of payer type. For hospitals looking to implement a similar program, it was suggested to use a patient-specific story to physicians, or residents and fellows.  When building the business case for a complex care program it was recommended to review length of stay and admission data layering based on greatest risk and to include the health system’s own employees in the analysis.  Hospitals interested in integrating complex care into clinician education may visit: https://www.camdenhealth.org/programs/student-hotspotting/ for additional resources. More information on the complex care program and support, please visit: https://www.camdenhealth.org/ or https://www.nationalcomplex.care/.

All presentation materials are available on the MVC Registry under the “Resources” page. If you have any further questions or need further information about any of the speakers or content, please contact the MVC Coordinating Center at shiyuan@med.umich.edu.

We are excited to support the Collaborative’s work on the 2018 Value Coalition Campaigns and look forward to seeing you at our next meeting on April 20th, 2018 at the Radisson Hotel Lansing at the Capitol.

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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