Emergency care quality imaging benchmarks in a statewide collaborative: Estimated excess and associated spending
Kocher KE, Arora R, Bassin BS, Benjamin LS, Bolton M, Dennis BJ, Ham JJ, Krupp SS, Levasseur KA, Macy ML, O'Neil BJ, Pribble JM, Sherwin RL, Sroufe NS, Uren BJ, and Nypaver MM. Emergency care quality imaging benchmarks in a statewide collaborative: Estimated excess and associated spending. Acad Emerg Med 2019; 26:S11.
Acad Emerg Med
Background: As the US shifts to value-based care, there are opportunities to safely reduce over-testing in emergency departments (EDs). The Michigan Emergency Department Improvement Collaborative (MEDIC), a statewide quality network connecting a diverse set of unaffiliated EDs, provides a unique opportunity to benchmark appropriate use of imaging and estimate the burden of low-value studies. Methods: MEDIC is a physician-led partnership supported by a major third party payer with 15 member hospitals (25,000-125,000 ED visits annually) contributing data to a central registry. Data were obtained from electronic health records and chart review by trained abstractors. Baseline performance data were collected for 4 quality measures: appropriateness of computed tomography (CT) for minor head injury for (1) adults (Canadian Rule) and (2) children (PECARN Rule); (3) chest x-ray (CXR) utilization for children with asthma, bronchiolitis, or croup; and (4) diagnostic yield of CTs for suspected pulmonary embolism (PE). Estimates of excess imaging studies in 2017 were calculated based on Achievable Benchmark of Care (ABC™), a method for determining quality improvement targets across a population of performance. Direct standardization was then used to project estimates for 10,000 annual ED visit increments with 20% pediatrics. Spending estimates were calculated for excess studies based on fair market price quotes from the Healthcare Bluebook using the 15 site locations in Michigan and reported as ranges. Results: From 6/1/16 - 10/31/17, the MEDIC registry contained data on 1,124,227 ED visits, representing ∼22% of all ED visits in Michigan, including 261,157 (23.2%) for children. Visits reflected typical demographics and acuity found in the general ED population. Across the collaborative, we found substantial variation, suggesting the potential to avoid 1,519 head CTs; 3,308 CXRs; and 4,254 PE CTs in 2017 if the ABC™ targets were achieved. Estimated spending on these excess studies ranged from $3.59 - $5.02 million. This represents an excess of 14 head CTs, 122 CXRs, 24 PE CTs, and $34,760 - $48,189 for each additional 10,000 ED visit volume increment per year. Conclusion: There is substantial opportunity for avoiding low value imaging studies in EDs. If ABC™ targets can be safely achieved, the result would be significant health care savings.