Michigan Value Collaborative calls attention to overuse of preoperative testing at Michigan hospitals
Data show a majority of hospitals order unnecessary preoperative tests such as blood work, chest x-rays and other procedures.
Prior to surgery, most Michigan patients will undergo a series of tests, such as blood draws, urinalysis, chest x-rays or electrocardiograms (ECGs/EKGs). Many of these tests are unnecessary for healthy patients undergoing low-risk procedures such as groin hernia repair.
Routine preoperative testing is widely considered a low-value service, and yet a majority of hospitals continue to order these tests. A team of physicians, researchers, data analysts and engagement specialists from the Michigan Value Collaborative (MVC) are eager to drive improvement in this area and will host a special workgroup on the topic during its June Preoperative Testing Awareness Week.
The workgroup will take place on June 23, from 2-3 p.m., featuring a special presentation from Michael Danic, D.O., an anesthesiologist with Ascension Genesys, titled, “Safe, Evidence-Based Reductions in Preoperative Testing: Why is it so hard to change?”
MVC invites clinicians, health care staff, and those interested in surgical or lab-based practices to attend and participate in the workgroup. The event will occur as part of a larger week-long campaign to increase awareness about unnecessary preoperative testing and encourage medical teams to reduce the rates at their hospitals.
“For a patient, it is key they get the right amount of preoperative assessment,” said Michael Englesbe, M.D., professor of surgery at Michigan Medicine, director of the Blue Cross Blue Shield of Michigan funded Collaborative Quality Initiatives, director of the Michigan Surgical Quality Collaborative (MSQC), and co-director of the Michigan Opioid Prescribing and Engagement Network (Michigan OPEN). “Too little testing and important risks may be missed, too much and patients may be exposed to critical risks of unnecessary testing and delays in care.”
MVC’s Coordinating Center team supports improvement in this area in several ways. One is providing opportunities for MVC’s members to collaborate. The MVC team supports its member base of more than 100 hospitals and 40 physician organizations through events like stakeholder meetings and workgroups, where clinicians and quality improvement staff can discuss solutions to common challenges.
The other key strategy is through data analysis and reporting. MVC analysts utilize administrative claims data to calculate testing rates in the preoperative period, and then share these results with members as reports or as unblinded data at collaborative-wide meetings. More recently, MVC partnered with MSQC to distribute these reports more widely, which enables both clinical and quality personnel to identify patterns, explore new strategies, and work together to reduce preoperative testing at each hospital.
These reports are an invaluable resource in benchmarking the extent of the issue statewide, said Hari Nathan, M.D., Ph.D., MVC’s director and the chief of hepato-pancreato-biliary surgery at Michigan Medicine. “MVC data can be used by hospitals and providers to understand how their rates of preoperative testing compare to those of other hospitals in Michigan. By focusing on a homogeneous cohort of healthy patients undergoing common, low-risk surgical procedures, MVC benchmarks can help all hospitals understand where they have an opportunity to improve, regardless of facility size, resources, or patient population.”
MVC analysts Bonnie Cheng and Monica Yost help lead MVC’s efforts in preop testing and cite large variability between hospitals.
“Across the collaborative, we are seeing wide variation in preoperative testing for low-risk elective surgeries like hernia repairs and lumpectomies,” said Cheng. “Testing rates among young, healthy patients range from 10% to 97% across MVC hospitals. Even within hospitals, we see that there is quite a bit of variation, with certain surgeries driving the overall preoperative testing rate. One great opportunity for improvement could lie within reducing the rate of cardiac testing; the rate of ECGs is quite variable across the collaborative and could lead to a cascade of care.”
Yost added that since focusing on preop testing, MVC has designed and disseminated three preop-specific push reports to help hospitals benchmark their performance, with each report adding new information based on the needs of members.
“I’m proud that we were able to use claims data to work outside of our typical episode structure to identify potential preoperative testing for low-risk surgeries,” Yost said. “We were able to show that there is a huge amount of variation in preoperative testing rates across hospitals, so much so that even high-performing hospitals have room to safely reduce testing rates.”
The MVC team hopes that its reports and workgroup events help providers to understand their role in unnecessary preoperative testing, and take steps that will decrease cost, maximize quality, and improve the patient experience.
Those interested in attending the workgroup can register in advance here.