Improving Wisely

Using Data to Improve Quality in Venous Care

What is Improving Wisely?

In 2018, the AVLS developed a partnership with the Robert Wood Johnson Foundation and Johns Hopkins University. Learn more at https://www.improvingwisely.org/.

Improving Wisely harnesses big data to analyze practice patterns and practice variations by standard deviation.

Improving Wisely provides:

  • Confidential, individual reports for each provider based on their Medicare claims data
  • Benchmarking and peer learning opportunities

Why Improving Wisely?

One-third of healthcare expenditures are wasteful and do not improve health, creating a national imperative.

Improving Wisely PHase II utilization benchmarking study published: 2017 vs. 2019 vein claim trends examined

In 2018, with funding support from the Foundation for Venous & Lymphatic Disease, the AVLS embarked on a research partnership with the Improving WiselyCollaborative at Johns Hopkins University to examine national Medicare vein claims and to implement a peer-benchmarking quality improvement effort. The core tenet of the Improving Wisely methodology is that variability in practice patterns and utilization may be highlighted through peer benchmarking, and that simple physician awareness regarding personal utilization compared to peers can result in changes in utilization practices, and on a macro level, help to curb excess health care spending.

In early 2019, over 2,400 providers received confidential data reports of their 2017 Medicare EVTA claims that were mailed to them by the AVLS. These reports showed each NPI’s overall EVTA mean claims and compared that NPI’s thermal claims to a national average. The overall results of that Phase I study were reported in 2019 in the Journal of Vascular Surgery - Venous and Lymphatic Disorders and may accessed here.

Phase II of the project unfolded in 2020 and 2021 and examined 2019 claims to assess if utilization had changed after physicians had received their 2017 claims data report. In short, was the provision of individualized peer-benchmarking data on the performance of endovenous thermal ablation (EVTA) associated with changes in physicians’ practice patterns or costs?  

The new paper notes that “in this quality improvement study of 1,558 physicians who performed at least 11 EVTAs for a total of 188,976 Medicare patients and were given a performance report of their EVTA use compared with their peers, a significant reduction in the number of EVTAs per patient was found after receipt of the reports, resulting in savings of $6.3 million to Medicare per year.”  

In this quality improvement study, peer benchmarking was associated with a change in practice patterns of EVTA-performing physicians and with substantial Medicare savings.

“The Improving Wisely project is a significant investment the Society and the Foundation have made in recent years to implement a peer learning methodology, and ultimately to fortify our guidelines efforts and help to define quality care for the domain. I deeply appreciate the effort our AVLS volunteers have invested in working with the Hopkins team on both phases,” noted AVLS President Mark H. Meissner, MD, FAVLS. “I realize that simply using claims may not capture what is and is not quality vein care and that each patient needs to be seen as a unique clinical encounter. However, this project is a welcome step forward for us as vein care experts to define an EVTA mean and helps to inform our guidelines efforts for the future,” added Dr. Meissner.  

The recent Phase II study may be accessed below on JAMA Network Open.

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