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14. Hospital Performance in a Statewide Commercial Insurer Episode-Based Incentive Program.

Author

Thompson, Michael P., Cain-Nielsen, Anne H., Yost Karslake, Monica L., Pizzo, Chelsea A., Yaser, Jessica M., Syrjamaki, John D., Nathan, Hari, Norton, Edward C., and Regenbogen, Scott E.

Subjects
*INSURANCE companies, *HOSPITALS, *EVALUATION of medical care, *MANAGED care programs, *EVALUATION of human services programs, *ELECTRONIC data interchange, *RETROSPECTIVE studies, *COST control, *PATIENT readmissions, *MEDICAL care use, *LABOR incentives, *DESCRIPTIVE statistics, *RESEARCH funding, *PAY for performance, *HOSPITAL charges, *LONGITUDINAL method
Abstract

OBJECTIVES: To evaluate hospital performance and behaviors in the first 2 years of a statewide commercial insurance episode-based incentive pay-for-performance (P4P) program. STUDY DESIGN: Retrospective cohort study of price- and risk-standardized episode-of-care spending from the Michigan Value Collaborative claims data registry. METHODS: Changes in hospital-level episode spending between baseline and performance years were estimated during the program years (PYs) 2018 and 2019. The distribution and hospital characteristics associated with P4P points earned were described for both PYs. A difference-indifferences (DID) analysis compared changes in patient-level episode spending associated with program implementation. RESULTS: Hospital-level episode spending for all conditions declined significantly from the baseline year to the performance year in PY 2018 (-$671; 95% CI, -$1113 to -$230) but was not significantly different for PY 2019 ($177; 95% CI, -$412 to $767). Hospitals earned a mean (SD) total of 6.3 (3.1) of 10 points in PY 2018 and 4.5 (2.9) of 10 points in PY 2019, with few significant differences in P4P points across hospital characteristics. The highest-scoring hospitals were more likely to have changes in case mix index and decreases in spending across the entire episode of care compared with the lowest-scoring hospitals. DID analysis revealed no significant changes in patient-level episode spending associated with program implementation. CONCLUSIONS: There was little evidence for overall reductions in spending associated with the program, but the performance of the hospitals that achieved greatest savings and incentives provides insights into the ongoing design of hospital P4P metrics. [ABSTRACT FROM AUTHOR]

Published
2023
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27. Clinical and Economic Outcomes of Enhanced Recovery Dissemination in Michigan Hospitals.

Author

Regenbogen, Scott E., Cain-Nielsen, Anne H., Syrjamaki, John D., and Norton, Edward C.

Abstract

Objective: To evaluate real-world effects of enhanced recovery protocol (ERP) dissemination on clinical and economic outcomes after colectomy. Summary background data: Hospitals aiming to accelerate discharge and reduce spending after surgery are increasingly adopting perioperative ERPs. Despite their efficacy in specialty institutions, most studies have lacked adequate control groups and diverse hospital settings and have considered only in-hospital costs. There remain concerns that accelerated discharge might incur unintended consequences. Methods: Retrospective, population-based cohort including patients in 72 hospitals in the Michigan Surgical Quality Collaborative clinical registry (N = 13,611) and/or Michigan Value Collaborative claims registry (N = 14,800) who underwent elective colectomy, 2012 to 2018. Marginal effects of ERP on clinical outcomes and risk-adjusted, price-standardized 90-day episode payments were evaluated using mixed-effects models to account for secular trends and hospital performance unrelated to ERP. Results: In 24 ERP hospitals, patients Post-ERP had significantly shorter length of stay than those Pre-ERP (5.1 vs 6.5 days, P < 0.001), lower incidence of complications (14.6% vs 16.9%, P < 0.001) and readmissions (10.4% vs 11.3%, P = 0.02), and lower episode payments ($28,550 vs $31,192, P < 0.001) and postacute care ($3,384 vs $3,909, P < 0.001). In mixed-effects adjusted analyses, these effects were significantly attenuated-ERP was associated with a marginal length of stay reduction of 0.4 days (95% confidence interval 0.2-0.6 days, P = 0.001), and no significant difference in complications, readmissions, or overall spending. Conclusions: ERPs are associated with small reduction in postoperative length of hospitalization after colectomy, without unwanted increases in readmission or postacute care spending. The real-world effects across a variety of hospitals may be smaller than observed in early-adopting specialty centers. [ABSTRACT FROM AUTHOR]

Published
2021
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33. Surgical Post-acute Care Spending Driven by Choice of Post-Acute Care Setting Rather than Intensity of Services

Author

Chen, Lena M., Norton, Edward C., Banerjee, Mousumi, Regenbogen, Scott, Cain-Nielsen, Anne, and Birkmeyer, John D.

Subjects
Aged, 80 and over, endocrine system diseases, education, food and beverages, Fee-for-Service Plans, Medicare, Home Care Services, Rehabilitation Centers, humanities, Article, Hospitals, United States, health services administration, Surgical Procedures, Operative, Humans, Health Expenditures, Subacute Care, Aged, Skilled Nursing Facilities
Abstract

The rising popularity of episode-based payment models for surgery underscores the need to better understand the drivers of variability in spending on postacute care. Examining postacute care spending for fee-for-service Medicare beneficiaries after three common surgical procedures in the period 2009-12, we found that it varied widely between hospitals in the lowest versus highest spending quintiles for postacute care, with differences of 129 percent for total hip replacement, 103 percent for coronary artery bypass grafting (CABG), and 82 percent for colectomy. Wide variation persisted after we adjusted for the intensity of postacute care. However, the variation diminished considerably after we adjusted instead for postacute care setting (home health care, outpatient rehabilitation, skilled nursing facility, or inpatient rehabilitation facility): It decreased to 16 percent for hip replacement, 4 percent for CABG, and 21 percent for colectomy. Health systems seeking to improve surgical episode efficiency should collaborate with patients to choose the highest-value postacute care setting.

Published
2017

38. The Michigan Trauma Quality Improvement Program

Author

Hemmila, Mark Richard, primary, Jakubus, Jill L., additional, Cain-Nielsen, Anne H., additional, Kepros, John P., additional, Vander Kolk, Wayne E., additional, Wahl, Wendy L., additional, and Mikhail, Judy N., additional

Published
2017
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40. Calculation and Feedback of Risk-Adjusted Antibiotic Days as a Process Measure in a Statewide Trauma Collaborative

Author

Sangji, Naveen F., Dougherty, Jacob M., Tignanelli, Christopher J., Maqsood, Hannan A., Cain-Nielsen, Anne H., Oliphant, Bryant W., and Hemmila, Mark R.

Abstract

Background Optimization of antibiotic stewardship requires determining appropriate antibiotic treatment and duration of use. Our current method of identifying infectious complications alone does not attempt to measure the resources actually utilized to treat infections in patients. We sought to develop a method accounting for treatment of infections and length of antibiotic administration to allow benchmarking of trauma hospitals with regard to days of antibiotic use.Methods Using trauma quality collaborative data from 35 American College of Surgeons (ACS)-verified level I and level II trauma centers between November 1, 2020, and January 31, 2023, a two-part model was created to account for (1) the odds of any antibiotic use, using logistic regression; and (2) the duration of usage, using negative binomial distribution. We adjusted for injury severity, presence/type of infection (eg, ventilator-acquired pneumonia), infectious complications, and comorbid conditions. We performed observed-to-expected adjustments to calculate each center’s risk-adjusted antibiotic days, bootstrapped Observed/Expected (O/E) ratios to create confidence intervals, and flagged potential high or low outliers as hospitals whose confidence intervals lay above or below the overall mean.Results The mean antibiotic treatment days was 1.98°days with a total of 88,403 treatment days. A wide variation existed in risk-adjusted antibiotic treatment days (.76°days to 2.69°days). Several hospitals were identified as low (9 centers) or high (6 centers) outliers.Conclusion There exists a wide variation in the duration of risk-adjusted antibiotic use amongst trauma centers. Further study is needed to address the underlying cause of variation and for improved antibiotic stewardship.

Published
2024
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