The Michigan Value Collaborative

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

Tag: post-acute care (page 1 of 2)

5 ways MVC can help you develop a post-acute care strategy

Kristyn Vermeesch

Kristyn Vermeesch is the Project Manager for MVC.

As highlighted in previous blog posts, the transition to value-based purchasing has brought greater attention to post-discharge care, and how to improve its value for patients.  This is not an easy riddle to solve. A previous blog post, “Optimizing Post-Acute Care Spending: Care Setting or Intensity?”, showed improvements could be made regarding the type of post-acute care chosen for patients. An example of how to translate these findings into action is the post-acute strategy checklist developed by the Deloitte Center for Health Solutions. The checklist was developed based on recommendations from a broad interviewee list including health systems, health plans, professional organizations and post-acute care companies.  Whether by using the Deloitte checklist or another alternative, the Michigan Value Collaborative (MVC) can help hospitals develop their own personal roadmap for post-acute care success.

  1. Identification of post-acute partners: One of the biggest challenges faced by hospitals is understanding where and what additional care patients are receiving after discharge. This is especially true when patients receive post-acute care from an unaffiliated provider.

How can MVC help?  On the MVC registry, member hospitals are able to identify the skilled nursing facilities (SNFs) utilized by their patients and for what conditions.  Spoiler alert: the Coordinating Center is creating a similar report to help hospitals gain more information about their home health care partners.  For more information on how to access the SNF report, check out our YouTube videos.

  1. Building post-acute care partnerships: Understanding where patients receive care is important, but it is also critical to know which post-acute providers are delivering high-quality care. This includes scrutinizing clinical measures such as average length of stay, readmission rates, infection rates, and ED visit rates. This knowledge will help to solidify strong partnerships and help with patient referrals.

How can MVC help?  The SNF report on the MVC registry displays the total length of stay and price-standardized, risk-adjusted cost associated with each SNF utilized by your hospital.  Each SNF’s adjusted costs are a derivative of the length of stay and services provided – not payer contractual rates, which can help to assess the quality of care provided by each partner SNF.  The report also includes any readmission payment associated with the patient visit, and in the next few months, the registry will be expanding to provide greater analytic support for post-acute decision-making. More details to come at the April semi-annual meeting!

In addition to the SNF report, members may assess their performance in other downstream post-acute care components such as readmissions, ED visits, and inpatient and outpatient rehabilitation to help improve patient care.  The MVC data can not only inform hospitals on what providers perform greater high-quality care, but it may also be used to develop quality improvement initiatives both within the hospital as well as with its strategic partners. The Coordinating Center is another resource to help hospitals understand the data as well as provide customized analytics. 

  1. Decide where to begin improving performance: Identifying an opportunity is only half the equation.  The next step is deciding where to focus quality improvement efforts.   

How can MVC help?  The MVC registry allows hospitals to compare themselves to hospitals throughout the state and soon to their MVC cohort (facilities with comparable patient case mix and structural similarities).  Hospitals can evaluate which care component(s) have the greatest impact on post-acute spend and whether they have higher utilization rates of more expensive services, such as SNFs or inpatient rehab. 

  1. Develop achievable goals: Goals for hospitals and post-acute partners should be realistic and not compromise patient care.

How can MVC help?  Performance data from post-acute partners, as well as benchmarking data from other Michigan hospitals, can be used to develop achievable goals that can be tracked over time to assess progress.

  1. Implement evidence-based practices: Identifying successful initiatives and best-practices from other institutions can help hospitals implement positive change; however, identifying those opportunities can present a challenge.

How can MVC help?  In addition to data analytics, MVC provides a platform for cross-institutional learning and sharing of best practices.  MVC’s peer-to-peer virtual workgroups allow hospitals throughout the state to discuss challenges and innovative quality improvement initiatives, including strategies to reduce readmissions and inappropriate SNF utilization.  The workgroup discussions are captured in “Toolkits”, which identify root causes and best practices to address the challenges faced by many Michigan hospitals.  The Toolkits are freely available to all MVC hospitals. In addition to the workgroups, the MVC blog features articles on statewide and national initiatives as well as highlighting key research findings that may be useful to hospitals. Finally, the MVC semiannual meetings allow hospitals to learn more about how other members are addressing similar challenges, provides an opportunity to ask questions and network.

Want to learn more?  Register for our April semi-annual meeting or contact the Coordinating Center using the form at the bottom of this page.


Optimizing Post-Acute Care Spending: Care Setting or Intensity?

Scott Regenbogen

Dr. Regenbogen is a Co-Director of MVC and an Assistant Professor of Surgery at the University of Michigan.

MVC hospitals confronting the CMS Episode Payment Models, BCBSM Hospital P4P metrics, and other episode-based measures ask themselves (and us): “Where can we find opportunities to reduce episode spending?” A publication in last month’s Health Affairs authored by several members of the MVC Leadership, may help. This study suggests that hospitals can most effectively address post-discharge ancillary care costs by examining how frequently they choose to send their patients to inpatient rehabilitation care facilities after discharge.

In the past, we have found the greatest point of leverage in overall episode spending involves post-acute care services. An often cited paper from our previous MVC Director and current Associate for Strategy, David Miller, found that post-acute care was responsible for the greatest share of variation in episode payments after inpatient surgery, ranging from 31% for coronary bypass (CABG) to 85% for hip replacement (THR). However, it is less obvious how a hospital would set about addressing their patients’ post-acute care spending if they found themselves to be high utilizers.

This new study — authored by MVC Associate Director Lena Chen, Economist Edward Norton, and Co-Director Scott Regenbogen — asks a simple question: do high post-acute care expenditures result from (i) the decision to use any post-acute care; (ii) the choice of what kind of post-acute care to use; or (iii) the quantity of services used once enrolled in post-acute care.

To answer these questions, the study identified hospitals nationwide in the highest and lowest quintiles of post-acute care spending for fee-for-service Medicare beneficiaries undergoing colectomy, CABG, and THR. It then performed both price standardization and risk-adjustment, as we do in MVC data, to allow uniform comparisons of the spending that would be expected if all hospitals treated clinically similar patients under similar regional price and wage constraints. Next, it evaluated the degree to which remaining differences in utilization and spending could be explained by the choice of setting (home without services, home with visiting nursing or in-home rehabilitation, inpatient skilled nursing, inpatient rehabilitation etc.) versus the intensity of care (the quantity of services billed within the chosen modality of care). This analysis used the Oaxaca-Blinder decompensation method to identify the separate contributions of factors within and between the care settings.

The choice to use any inpatient rehabilitation explained the largest share of all variation in adjusted post-acute care spending, ranging from 26% for colectomy to 52% for CABG. The intensity of use of inpatient rehabilitation, in contrast, explained 3% or less of differences. Choice of skilled nursing was responsible for 16-25% of variation, and choice of home health accounted for another 8-13%. The only site and condition for which the intensity of care made a meaningful contribution was in skilled nursing facilities after colectomy, where the quantity of billed services contributed to 20% of variation.

These findings suggest that hospitals seeking to reduce their post-acute care costs after major inpatient surgery should first examine the proportion of their patients that enter the most expensive types of care after discharge. In general, they need worry less about the quantity of services that get used once the patients arrive there.

The research was supported by the National Institute of Aging (Grant No. P01AG019783-0751). Dr. Chen was also supported by the Agency for Healthcare Research and Quality (Grant No. K08HS020671).

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

Older posts