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Insurer, University of Michigan Target Surgery Quality, Share Weight-Loss Data

Posted on: Saturday, 16 July 2005, 00:00 CDT

Jul. 16--A new program to improve the quality of weight-loss surgeries in Michigan could set a standard for the practice of medicine nationwide and lower costs.

In their latest quality-improvement program, Blue Cross Blue Shield of Michigan and the University of Michigan are recruiting hospitals and surgeons for the program to collect data on weight-loss, or bariatric, surgeries with the goal of identifying the best practices and sharing them with each other.

The Blue Cross and U-M program challenges conventional wisdom by suggesting that comprehensive data sharing is more likely to improve results across the board than rewarding just those hospitals that achieve the best results.

If the program is successful it could help reduce the number of people who die from medical errors each year while helping to hold down medical costs for employers and individuals.

Many health insurers now pay for better quality.

The most common of those programs is called pay for performance. It involves paying higher reimbursements to doctors or hospitals that achieve above-average results.

But a handful of programs funded by Blue Cross Blue Shield of Michigan and led by U-M doctors -- including the new bariatric quality improvement program -- could set a new standard for improving quality statewide by paying hospitals for participation rather than performance.

The latest program will pay Michigan hospitals with large bariatric surgery programs to collect data about those surgeries and contribute them to a statewide database so that the collective results can be analyzed and then shared with participating doctors and hospitals to determine the best practices for weight-loss surgery.

"The goal is to raise the tide, not to single out the good apples from the bad apples," said Dr. John Birkmeyer, professor of surgery and director of the Michigan Surgical Collaborative for Outcomes Research and Evaluation at U-M.

But Katherine Capps, president of Health2 Resources in Washington, D.C., said the program sounds like a cautious step being taken to really peg down true quality measurements. But to be most useful, the program should include as a future step plans to report data to the public.

If public reporting were a part of the program, Birkmeyer said, it would hamper participation and make it more difficult to collect and learn from comprehensive data.

Blue Cross Blue Shield and U-M already have documented success in an 8-year-old pay-for-participation program to improve angioplasty. An angioplasty is a medical procedure in which a balloon is used to open narrowed or blocked blood vessels.

Blue Cross Blue Shield credits that program, which incorporated data from 17 Michigan hospitals, with saving at least $8 million a year in medical costs, reducing heart attacks by 19 percent, reducing unplanned coronary artery bypass surgery by 22 percent, reducing kidney failure requiring dialysis by 57 percent and reducing in-hospital deaths by 27 percent.

On the heels of the angioplasty program, Blue Cross Blue Shield and U-M launched a similar program in May to improve the outcome of other cardiac surgeries. Now, they are recruiting hospitals and surgeons to participate in a program to improve the quality of bariatric surgeries throughout Michigan.

They plan to launch programs in breast cancer as well as general and vascular surgery later this year.

"This is really the first wholesale effort aimed at improving the quality of weight-loss surgery anywhere in the country," Birkmeyer said. "I think this is going to serve as a national model."

Nationwide, there are a couple of programs collecting bariatric quality data, but participation is voluntary and there is no system for auditing the data, Birkmeyer said. The Michigan program conducts data audits.

Blue Cross and Birkmeyer expect about 20 of the state's busiest bariatric surgery hospitals to participate in the program. David Share, Blue Cross clinical director for health care quality and evaluative studies, said he expects formal data collection to begin in 2006.

The program is expected to include results from about 6,000 of the 8,000 weight-loss surgeries performed in Michigan each year. Annually, 30 to 80 Michigan bariatric surgery patients die, Birkmeyer said. He expects the program to reduce deaths. Blue Cross expects the program to cost about $800,000 annually.

With a couple of hundred cases, Share said, there are insufficient data to know what the best practices are.

"If your hospital does 200 procedures and you have one to three deaths, how do you know what the cause is?" Share asked. "When you have 8,000 or 9,000 procedures in the state and begin to see dozens of deaths, you can see, ' Ah ... it's the people with diabetes or kidney disease who are dying.' You can start to draw conclusions."

Pay-for-performance plans collect data on just a few processes doctors believe to be key indicators, Share said. They could ignore critical factors.

For example, the Medicare program this year began a pay-for-performance program that will reward hospitals for increasing the number of diabetic patients whose blood sugar is under control.

The potential pitfall with pay-for-performance, Share said, is that the measure might not take into account the numbers of high-risk patients a hospital or doctor treats. So a hospital that refers complicated cases to an academic center might be rewarded simply because it doesn't take the tough cases, Share said.

And a study in the Journal of the American College of Cardiology said that doctors whose results are publicly graded are likely to shy away from angioplasties on high-risk patients who could affect their ratings.

That's part of the reason Share and Birkmeyer believe in pay-for-participation.

"I think that Michigan is breaking ground and others are intrigued," Share said. "We do believe the future will really be strongest if we are not only deploying these tools but deploying them in ways in which we actually create new systems."

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Source: Detroit Free Press

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