The Michigan Value Collaborative

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

Tag: Readmissions (page 1 of 9)

Using Clinical Pillars to enhance value in a Joint Replacement Bundled Payment Program

Deby Evans

Deb Evans is the MVC Site Engagement Manager

An article published in the Journal of Arthroplasty in June 2017 discussed 5 clinical pillars that one hospital in New York identified for enhancing value in their joint replacement practices through the bundled payment program.

  1. Optimizing patient selection and comorbidities: The hospital identified common comorbidities within their Total Joint Arthroplasty (TJA) patient population. The most frequent were found to be musculoskeletal comorbidities, hypertension, hyperlipidemia, tobacco use and diabetes. Each of these comorbidities is associated with an increased risk for readmission. By incorporating the use of a readmission risk assessment tool (RRAT) into the Perioperative Orthopedic Surgical Home (POSH) initiative, the hospital identifies patients that are at high risk for readmission and delays surgery in favor of working to optimize the patient’s modifiable risk factors. By getting the patient in optimal condition for surgery, the risk of an unplanned readmission can be reduced, saving the hospital the associated costs.
  2. Optimizing care coordination, patient education, shared decision-making and patient expectations: Multiple studies have shown that splintered care pathways, unnecessary services and a lack of patient-centered care negatively impact clinical outcomes. Characteristics of programs that displayed improved patient outcomes were synchronized management among the patient’s care team and managing the expectations of the patient and family. The goal for this hospital was to institute a streamlined pathway for the duration of the episode of care that focused on collaborative decision making and standardized pathway criteria.
  3. Multimodal analgesia: An increased length of stay not only affects cost but also increases the risk of readmission. One of the factors known to influence length of stay is pain management. This facility reviewed their pain management protocol and made changes with the intention of decreasing opioid use while maintaining pain relief as well as facilitating early ambulation and rehabilitation and decreasing falls. These principles help to reduce length of stay by expediting discharge and decreasing the use of post-acute care facilities.
  4. Risk-stratified Venous Thromboembolic disease (VTED) prophylaxis: Use of an aggressive mode of VTED prophylaxis may be effective in preventing venous thrombosis, but has also shown to increase the risk of major complications. The institution performed a study to analyze their adapted risk-stratification algorithm with positive results. The use of this algorithm to identify which VTED prophylaxis trajectory was most appropriate helped the hospital optimize care and reduce costs.
  5. Minimize Post-acute care facility and resource utilization: Increased costs have been shown to be related to the use of post-acute care facilities and the associated resource utilization. In an effort to help control post-acute care costs, this institution worked on identifying selected post-acute care partners. Once identified the hospital and the partnering skilled nursing facility increased communication and collaboration through meetings and performance and resource utilization monitoring. By establishing these partnerships post-acute care length of stay was reduced with associated cost savings.

Through focusing on these five clinical pillars, this New York hospital was able to identify areas of improvement and subsequently implement initiatives targeted towards care and cost improvement. If your hospital is interested in identifying five clinical pillars of focus, the MVC Coordinating Center can help  identify common readmission diagnoses, along with post- acute care SNF utilization and length of stay information.

Moreover, the MVC Coordinating Center, in conjunction with MARCQI and MOPEN, is also holding workgroups on November 30th and December 7th to discuss pre- and post- surgical pain management. If you are interested in joining either of the workgroups, please register here.

Please contact Abeer Yassine at abeery@med.umich.edu or Deb Evans at debevans@med.umich.edu  for more information and if you have any questions.

Why I’m excited for the November 3rd Semi-annual collaborative meeting

Jim Dupree

Jim Dupree, M.D., M.P.H. is the Director of MVC

The next MVC collaborative-wide meeting is coming up soon, November 3rd at Schoolcraft College http://www.schoolcraft.edu/vistatech/maps-parking

I wanted to take a minute to explain why I’m particularly excited for this fall’s meeting. In the six months since our last collaborative-wide meeting, the coordinating center has been hard at work across several fronts:

  • We have expanded our peer-to-peer workgroups program to offer more hospitals a platform for learning from and teaching each other about best practices for improving care. This has included new workgroups about optimizing skilled nursing facility/extended care facility use for patients with congestive heart failure. We have also expanded these workgroups to cover topics such as palliative care and how to establish a heart failure clinic. For more information about joining these workgroups, please contact Abeer Yassine at abeery@med.umich.edu
  • We have added two new services lines: Atrial Fibrillation and Nephrolithiasis. Atrial Fibrillation represents a common reason for inpatient admission and the service line data expands our ability to provide actionable data about medial admissions. Nephrolithiasis is a high-volume surgery, and we now have a window into emergency department (ED) visits and/or hospital admissions that occur after this outpatient procedure.
  • In response to your comments, we have made several improvements to the registry website and its underlying data. For example, we have improved the accuracy of the National Provider Identification (NPI) number available on Blue Cross Blue Shield of Michigan (BCBSM) claims. In addition, we added patient age, gender and comorbidities (COPD, diabetes and ESRD) filters to the BCBSM claims. Finally, in response to your suggestions, we have added an index place of service indicator that allows users to identify episodes beginning in the hospital inpatient, outpatient, or ED settings.

On November 3rd, we will discuss the next opportunities for value improvement in Michigan.  These include:

  1. A focus on the emergency department as a location for improving healthcare value. We will learn from Donna Fox from Michigan Medicine about their program that leverages social and medical supports to reduce ED visits and readmissions. We will also learn from Lauran Hardin about a population-based intervention to reduce ED utilization and cost for high-need patients.
  2. A special presentation from Dr. Keith Kocher Program Director for the Michigan Emergency Department Improvement Collaborative (MEDIC). MVC members have asked previously for increased collaboration with other BCBSM collaborative quality initiatives, and Dr. Kocher will introduce the PATH initiative to prevent avoidable hospitalizations after ED visit.
  3. The launch of an important new initiative aimed at improving safe births in Michigan. Many hospitals are working to reduce the use of C-section for low-risk births, and we now have new tools to assist in those efforts. Dr. Dan Morgan will discuss this initiative at the collaborative-wide meeting and seek your feedback.

The November 3rd meeting will offer the Collaborative a chance to decide how we, collectively, want to improve the value of health care in Michigan.  We look forward to seeing you at Schoolcraft College (http://www.schoolcraft.edu/vistatech/maps-parking) on November 3rd . Please be sure to register by clicking here.  And as always, contact us at shiyuan@med.umich.edu with any suggestions or questions.

 

 

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