Value Based Reimbursement (VBR)
Blue Cross Blue Shield of Michigan has developed a Value-Based Reimbursement model which encourages hospitals to work with physicians to provide cost-efficient care at both hospital and population levels. For more information, see their website.
2024
Eligibility:
- Participating specialist must be contracted with BCBSM’s PPO prior to the VBR effective date of 3/1/2024
- Have at least 2-years of data in MPOG
- Performance calculated at hospital level – providers practicing at more than one hospital are assigned to the hospital where they performed the most cases
Increase in fee schedule:
- 3% – aggregate hospital performance met for 2 / 3 measures
- 5% – aggregate hospital performance met for 3 / 3 measures
| Measure | Measurement Period | Target Performance |
|---|---|---|
| GLU 03: Percentage of cases with perioperative glucose > 200 mg/dL with administration of insulin or glucose recheck within 90 minutes of original glucose measurement. Measure Specification | 12/1/2022 – 9/30/2023 | ≥78% |
| PAIN 02: Percentage of patients ≥ 18 years old who undergo a surgical or therapeutic procedure and receive a non-opioid adjunct preoperatively and/or intraoperatively. Measure Specification | 12/1/2022 – 9/30/2023 | ≥85% |
| SUS 01: Percentage of cases with mean fresh gas flow equal to, or less than 3L/min, during administration of halogenated hydrocarbons and/or nitrous oxide. Measure Specification | 12/1/2022 – 9/30/2023 | ≥85% |
Smoking Cessation VBR Measures (in addition to standard VBR)
Eligibility:
- Standard VBR rules apply (see above)
Increase in fee schedule:
- Additional 2% increase
| Measure | Measurement Period | Target Performance |
|---|---|---|
| SMOK 01: Percentage of patients, ≥18 years of age, with smoking status documented within 30 days prior to any procedure requiring anesthesia. Measure Specification | 12/1/2022 – 9/30/2023 | ≥70% (12-month average) |
| Proportion of current smokers that have smoking treatment offered SMOK 02: Percentage of patients, ≥18 years of age, who are documented as current tobacco smokers and also receive an approved smoking cessation intervention from an anesthesia provider. Measure Specification | 12/1/2022 – 9/30/2023 | ≥10% (best month) |
2023
Eligibility:
- Member of a Physician Organization for at least 1-year
- Have at least 2-years of data in MPOG
Increase in fee schedule:
- 3% – aggregate hospital performance met for 2 / 3 measures
- 5% – aggregate hospital performance met for 3 / 3 measures
| Measure | Measurement Period | Target Performance |
|---|---|---|
| GLU 03: Percentage of cases with perioperative glucose > 200 mg/dL with administration of insulin or glucose recheck within 90 minutes of original glucose measurement. Measure Specification | 12/01/21 – 11/30/22 | ≥65% |
| PAIN 02: Percentage of patients ≥ 18 years old who undergo a surgical or therapeutic procedure and receive a non-opioid adjunct preoperatively and/or intraoperatively. Measure Specification | 12/01/21 – 11/30/22 | ≥70% |
| SUS 01: Percentage of cases with mean fresh gas flow equal to, or less than 3L/min, during administration of halogenated hydrocarbons and/or nitrous oxide. Measure Specification | 12/01/21 – 11/30/22 | ≥80% |
New Smoking Cessation VBR Measures (in addition to standard VBR)
Eligibility:
- Must meet 2 out of 2 measures
Increase in fee schedule:
- Additional 2% increase
| Measure | Measurement Period | Target Performance |
|---|---|---|
| Smoking Status Documented within 30 days prior to surgery | 12/01/21 – 11/30/22 | ≥70% |
| Proportion of current smokers that have smoking treatment offered | 12/01/21 – 11/30/22 | ≥10% |
2022
Eligibility:
- Member of a Physician Organization for at least 1-year
- Have at least 2-years of data in MPOG
Increase in fee schedule:
- 3% – aggregate hospital performance met for 2 / 3 measures
- 5% – aggregate hospital performance met for 3 / 3 measures
| Measure | Measurement Period | Target Performance |
|---|---|---|
| GLU 03: Percentage of cases with perioperative glucose > 200 mg/dL with administration of insulin or glucose recheck within 90 minutes of original glucose measurement. Measure Specification | 12/01/20 – 11/30/21 | ≥70% |
| BP 03:Percentage of cases where intraoperative hypotension (MAP < 65 mmHg) was sustained for less than 15 minutes. Measure Specification | 12/01/20 – 11/30/21 | ≥85% |
| SUS 01: Percentage of cases with mean fresh gas flow equal to, or less than 3L/min, during administration of halogenated hydrocarbons and/or nitrous oxide. Measure Specification | 12/01/20 – 11/30/21 | ≥85% |
2021
Eligibility:
- Member of a Physician Organization for at least 1-year
- Have at least 2-years of data in MPOG
Increase in fee schedule:
- 3% – aggregate hospital performance met for 2 / 3 measures
- 5% – aggregate hospital performance met for 3 / 3 measures
| Measure | Measurement Period | Target Performance |
|---|---|---|
| PUL 02: Percentage of cases with median tidal volumes less than or equal to 8 ml/kg. Measure Specification | 1/1/2020 – 11/30/2020 | ≥85% |
| TEMP 03: Percentage of patients, regardless of age, who undergo surgical or therapeutic procedures under general or neuraxial anesthesia of 60 minutes duration or longer for whom no body temperature was greater than or equal to 36 degrees Celsius (or 96.8 degrees Fahrenheit) recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time. Measure Specification | 1/1/2020 – 11/30/2020 | ≤5% |
| PONV 01: Percentage of patients, aged 18 years and older, who undergo a procedure under an inhalational general anesthetic, AND who have three or more risk factors for post-operative nausea and vomiting (PONV), who receive combination therapy consisting of at least two prophylactic pharmacologic antiemetic agents of different classes preoperatively or intraoperatively. Measure Specification | 1/1/2020 – 11/30/2020 | ≥85% |
