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- Hello everyone, and welcome to The Wrap
brought to you by Michigan Medicine Headlines.
I'm Dan Ellman with the Department of Communication.
Today, we'll be bringing you
one of the most highly ranked episodes of The Wrap.
That's because we'll be discussing
the U.S. News & World Report Best Hospitals Rankings,
which named Michigan Medicine
the 11th best hospital in the nation.
Before we get into that,
be sure to go back and listen
to all previous episodes of the employee podcast.
Now you don't need to rank all 83 shows,
you can if you want.
But all episodes can be found on iTunes, Stitcher,
Google Play, or any other podcast hosting platform.
The most recent shows can also be found on YouTube.
And of course you can check them out on Headlines
as part of the Weekend Review each Friday.
With that let's bring in two members
of the Michigan Medicine Quality department,
Justin Pestrue and Sandeep Vijan.
First can the two of you introduce yourselves
and explain your roles.
- Sure. My name's Justin Pestrue,
I'm the Administrative Director
of the Quality Analytics Team in the Quality Department.
And I, along with Sandeep,
co-manage a nice group of analysts
who analyze data across the spectrum
of the healthcare continuum.
- And I'm Sandeep Vijan.
I am a General Internist here at the university
and I am the Medical Director
of the same group Justin just discussed.
- Outstanding, now, as I mentioned before,
Michigan Medicine was ranked number 11
in the U.S. News & World Report Rankings
for 2020 and 2021,
can you explain what goes into these types of rankings?
- Sure.
So there's four key domains
that go into the U.S. News Rankings.
There's a ranking of structure,
which is things along the lines
of how many patients you see,
what your nurse staffing ratios look like.
What kind of technologies you have
such as intensivists on staff and a few others as well.
There's an outcome domain,
which is functionally two key areas.
One is mortality.
So how well patients in your hospital survive.
And the second is how often they are discharged to home.
So instead of going to an extended care facility
or a rehab facility,
how often we're actually able to get patients
to go directly home from the hospital.
Then there's a couple of other areas.
The biggest next one is reputation.
So this is done by survey.
So, U.S. News commissioned some other people to do surveys
of physicians to basically ask them,
where would you send a patient in some specialty?
So if you have an orthopedics question, you would say,
which hospital would you send your orthopedics patients for?
Mostly for more difficult and advanced care.
And then there's a couple of other smaller areas
that are involved such as there's a small contribution
of patient experience.
So that's a nationally measured scale,
where basically patients tell you
how they feel about the hospital.
And then there's a few other much smaller measures
around whether or not you voluntarily participate
in public reporting of data and outcomes
that are of interest to patients and providers and payers.
So those are the major areas that contribute
to the overall ranking.
- So it's pretty wide ranging field of data
that they look at.
- Yes.
- So now diving deeper into that data,
last year, Michigan Medicine was also ranked number 11,
but were there specific areas that differ
between this year and last year?
- We certainly saw some of our specialties.
One of the things that U.S. News does
is they will take all of those measures we just discussed
and they rank 12 specialties
like orthopedics, like neurosurgery, like cardiology,
and they rank them all individually.
And so one of the things we typically see year over year,
is we see adjustments in those rankings
for each particular specialty, some will move up,
some will move down on the basis
of both kind of some of those quality outcomes
like mortality, but also by some of the survey measures
around process and reputation, that kind of thing.
So that's typically,
I think between this year and last year,
that's what we saw the most changes
just within specific specialties,
not the organization as a whole.
- Gotcha.
Now I know the organization is constantly tracking
this type of data regarding patient safety,
outcomes, mortality, things like that.
Can can the two of you sort of explain
how that data is actually collected at Michigan Medicine?
- Yeah, it's actually an interesting question
because what's done at Michigan Medicine
and what U.S. News does is a little bit different.
So U.S. News has to rely on outside sources of data,
they don't ask in this case, in the adult rankings,
they don't ask hospitals to submit
all this information to them.
So instead what they do is primarily go to Medicare data.
So CMS claims files, and then they create these ratings.
So they basically know from the Medicare data,
what the mortality rate is, for example.
Now the issue with that is Medicare data
always lags by a couple of years.
So as it turns out, these datas
are actually at least two years old in general,
sometimes one year old, but generally two.
And they go back several years before that.
So what we're interested in,
in terms of much more realtime quality improvement
is a little different than what they are reporting,
which is again, a little bit more
of a backwards view on things.
Now that said, we do of course track many of these measures,
but not always using the same data sources.
So that is one of the things that people do worry about
a little bit with these rankings
is how actionable they are in a very short timeframe.
'Cause you're always kind of chasing ghosts from the past
a little bit in a way.
So it's gonna a bit of a challenge at times.
- Yeah.
- And we do have, we do have near realtime,
or at least within a month or so measures
that are pretty nice proxies of all the things
U.S News uses to rank us.
So we are, while it's not the exact same number,
we are monitoring it on a nearly monthly,
even daily, in some instances,
basis of these particular indicators,
making sure our performance is where it needs to be.
- So is that mostly coming from faculty and staff
who are sort of on the ground and in the clinics
or how is that sort of collected?
- Yeah, I would say a lot of it is EMR based.
So a lot of it comes from coding of the patients
as they're discharged from the hospital.
Billing data, billing when submitted to payers,
is often the key piece of this.
And then in the case of patient satisfaction,
Michigan Medicine runs a large scale effort
to collect the opinions of most of our patients
across the spectrum of healthcare.
So we're getting those results back to us
on a daily, weekly, and monthly basis.
- So you mentioned that sort of,
you're trying to get this almost in realtime,
this type of data.
Why is that so important to consistently
have this data coming in?
- Well, it's very difficult to respond to any changes
if you're not aware of what's going on, right?
Actually the easier part of responding to this
is just tracking it, to be honest.
The hard part is figuring out what to do about it.
So digging deep and working with the clinical care teams
on any issues that may be coming up
is actually the bigger of the two challenges.
But, you know, we never ever want to have things go wrong
for patients that are potentially avoidable.
So we're very, very vested in creating a culture
of reporting around concerns and errors,
and getting those done in as rapid as a fashion as possible
so that we can review issues that come up
and correct them as quickly as possible.
There's a commitment to continuous improvement in the system
around safety and quality in particular.
So that's a huge part of what we do.
Yeah, I was gonna say, that's really a part
of what our departments Sandeep and mine,
and our larger team does.
We're trying to keep our eyes on the pulse
of the performance of the organization
so that we're always ready to react
and bring kind of things to people's attention
so that the change can really take place
that needs to take place.
- Yeah. So what sort of changes could take place?
How will you sort of take all the data that comes in
or possibly take some of these rankings?
I know that some of that data is a couple of years old,
but take some of the results of this
and make changes as we look ahead,
and sort of try to put into place different processes
that may improve rankings
or improve performance moving forward.
- Yeah, that's an interesting question.
So I would say the rankings are a motivating factor
in the sense that they have a lot of visibility, of course.
And so nobody ever wants to be ranked poorly in anything,
you know, we're a competitive group of people.
But interestingly, I think that by and large,
they really do capture areas
that we think are quite essential to our performance, right?
Obviously we don't want patients to die
if they, not necessarily or unexpectedly,
I guess is a better way to put it.
So we have internal motivation to wanna do that.
And this is just in my view kind of a validation
of the work that we do every day.
So I think it's a thing to celebrate a bit
in that we have done quite well in general.
But it does help provide a little bit of a compass
and things that we know that other people are interested in.
And so we don't just have a narrow vision
on only the things that we think are important.
But I would say that while it provides
sort of a high level motivation,
we really wanna do get into the weeds a little bit
and dig deep into the data,
so we really understand where our problems may lie.
I can give you one example from patient experience.
So the patient experience measures that we collect
are very detailed.
There's many, many questions that patients answer
after they have an encounter with us,
whether it's an inpatient or an outpatient encounter.
And we do generally pretty well on the overall rankings,
So patients say, yes, we recommend this hospital highly.
We had a really good experience in general.
But we do have areas of weakness, right?
And we know that some of those are structural to our system.
Our hospital's a little bit older.
We have a lot of double beds,
you know, two people in a room.
And so maintaining things like quietness,
and privacy's a little bit more challenging in domain.
So we know we don't do as well on some of those things.
So we're constantly trying to figure out ways
to address some of those problems.
And so our own data, which again, goes a lot deeper
than the U.S. News data might,
gives us a chance to really dig in
and figure out where our problems may lie.
And gives us a chance to respond to it.
- Yeah and also say that, you know, just recently,
because mortality is such an important indicator
of quality for a health system,
we've undertaken an effort to really kind of revamp
how we look at mortality within the organization.
Historically, we had done call mortality
and morbidity reviews that are often up to a month
after the fact, sometimes longer.
In the Quality Department we're launching an initiative
to really get to the point where we're reviewing
every death in the organization
within a day or two of it occurring.
So that there's a lot more awareness,
a lot more fresh memories to bring to these situations
so that we can uncover exactly what may be going on.
- Yeah. And I know that the organization
does a great job too with responding to patient safety
events and things like that,
where basically, if there's any outcome
that isn't a preconceived outcome,
the organization is looking at what happened,
what went into it and what changes can take place, correct?
- That's right, yes, absolutely.
- Well, thank you both so much for giving us
this deeper dive into the data
and giving us insight into what goes into
the U.S. News & World Report Rankings.
If you wanna learn more about how the organization did,
including which specialties earned especially high marks
go to mmheadlines.org, that's mmheadlines.org.
While you're there, check out some other featured stories
from this past week.
For instance, readers learned about the team
behind the Rogel Cancer Center's cancer registry,
which helps compile data that will impact research
and patient care for years to come.
Employees also learned about tools and resources
that will help them improve their financial wellbeing.
And the Comprehensive Eating Disorders program
explained how they are providing a mix of in-person
and virtual care to give their patients
the help they need during COVID-19.
Find those stories and much more at mmheadlines.org.
All right, it's time for the weekly trivia contest.
Last episode, we asked listeners,
which MHealthy campaign is designed
to help employees incorporate gratitude
into their day-to-day and personal lives?
The answer is Be Kind Be Well.
Congratulations to Eileen McMyler
with Patient Relations and Clinical Risk.
Eileen, a member of the Department of Communication
Will be in touch shortly to help you claim your prize.
Now for this week's question,
how many Michigan Medicine specialties were ranked
in the top 10 nationally by U.S. News & World Report.
Once again, how many Michigan Medicine specialties
were ranked in the top 10 nationally
by U.S. News & World Report,
you can find the answer in this week's headline story.
Once you know it, send it to headlines@med.umich.edu
for the chance to win a prize.
That's all the time we have.
Thank you so much, Justin and Sandeep
for joining us today,
and thanks as always to our listeners and viewers
for everything you do for patients, families,
and each other, we'll see you next week.
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