To Make Surgery Safer and Less Expensive, Follow Michigan’s Lead
Dozens of hospitals across Michigan have teamed up to improve surgical care, saving lives and dollars. Now, the leaders propose ways to take the model national.
Half the dollars spent on health care in America have something to do with surgical procedures — including preventable post-op problems.
So any chance to make surgery safer, and avoid complications, could have a major effect on both the nation’s health and bottom line.
In a new paper in JAMA Surgery, a team from the University of Michigan lays out the case for a model that could do just that, one that surgeons and nurses in 72 hospitals across Michigan have quietly built over the past decade.
Fueled by funding from the state’s largest insurer, Blue Cross Blue Shield of Michigan, and driven by a pool of detailed data on tens of thousands of operations of all kinds, it’s called the Value Partnerships model.
The VP model hinges on the efforts of teams at each hospital to collect, pool and share a wide range data on every procedure that occurs in their operating rooms. A central office team analyzes it all and feeds aggregate and individual results back to participants.
Together, the network focuses on improving care within its surgical specialty — working as a Collaborative Quality Initiative. The movement started with general surgery and has grown to involve teams across procedure-based disciplines such as obstetrics, bariatrics, orthopedics and interventional cardiology. Each has resulted in meaningful improvements in care.
It’s worked so well that four other states — Illinois, Pennsylvania, South Carolina and Tennessee — have borrowed it to build their own models, with insurer money and a physician-driven approach.
But for the model to spread further and faster, the authors of the new article call for federal help. A partnership between the Centers for Medicare & Medicaid Services and private insurers could give the VP approach a needed boost and help providers in more areas improve care and cut costs.
Proposing a public-private partnership
Darrell A. Campbell Jr., M.D., the U-M surgeon and emeritus professor who co-authored the new piece and has helped lead the Michigan effort, says the VP approach could provide the kind of evidence-based, public-private innovation model that CMS has said it’s looking for.
Although the Michigan VP effort aims to improve the care of all surgical patients, no matter how they’re insured, Campbell notes that Medicare covers 30 percent of the operations and 20 percent of the Michigan patients.
“This effort, designed by the people on the front lines of surgical care, has succeeded because it’s collaborative, nonpunitive, data-driven and supported by a payer that has supported the vision of using shared data to improve care in ways that make sense to the care team,” says Campbell.
“We believe it could be a model for the nation, but it will take partnership on a federal level to incentivize more payers and providers to start new efforts in their areas.”
For instance, he and co-author Greta Krapohl, R.N., Ph.D., say CMS could pay physicians more under the MACRA (Medicare Access and CHIP Reauthorization Act) payment model if they take part in a VP-like effort in their area. And it could offer tax credits or other incentives to private insurers if they fund a VP effort in their state.
Campbell, Krapohl and their co-author, U-M surgeon Michael Englesbe, M.D., cite a wide range of results achieved in Michigan so far and published in the medical literature. All come from the various Collaborative Quality Initiatives under the VP model, including the Michigan Surgical Quality Collaborative the co-authors lead.
These results include:
A 20 percent reduction in general surgery complications over five years, reducing costs to hospitals and insurers by $20 million, a far larger decline than in comparison states
A substantial drop in short-term death rates among Michigan residents undergoing bariatric surgery, a faster drop than in other states
Major reductions in surgery-related infections after colon surgery, after the VP effort identified and shared six strategies to reduce risk; in addition, new data in preparation for publication show progress against surgical site infections in a broader range of operations
The use of the VP networks of doctors, nurses and hospitals as a platform for discovering new opportunities to improve care — such as a surgical opioid prescribing reduction effort that just published its first recommendations
The VP approach started with general surgeons in 2005 and now covers a variety of procedure-based specialties. Some nonsurgical disciplines have also adopted the approach, including emergency medicine and hospital-based general medicine.
At the root of the approach is a network of participating hospitals that gather and analyze a wide range of data from every health care encounter, creating benchmark outcomes with similar hospitals in the region.
Coaching the lower-performing outliers can improve care, and analysis of high performers can identify best practices that can be shared with others, or even be rolled out as part of “bundles” of tactics that all should use.
Next stop: national?
Recently, the Michigan VP team welcomed people from 12 other states to a conference to learn more about the VP approach. It also launched a nationally focused initiative with funding from the U-M Medical School’s Department of Learning Health Sciences. Called the Center of Excellence for Collaborative Quality Improvement, it intends to spread the concept and serve as a nexus for information and tools to help others adopt the approach.
“We need to think of ways to encourage the spread of this model and to integrate it into the quality and value focus that is emerging in health care,” says Campbell. “This also means increasing awareness of what the Michigan model has achieved by harnessing the best ideas of those who provide care, building trust among participants and spreading the approaches that yield the best results.”
The authors of the paper are members of the U-M Institute for Healthcare Policy and Innovation. Most of the Value Partnerships Collaborative Quality Initiatives funded by Blue Cross Blue Shield of Michigan are based at IHPI.