Hospital quality issues remain but accountability growing, says watchdog group

Hospital quality, not only a critical determinant of patient outcomes but also costs incurred by employers, remains highly variable, according to the most recent report issued by The Leapfrog Group. That payer-funded hospital quality watchdog also reported record-level participation by hospitals in its latest study.

“Employers are getting much more aggressive in asking hospitals to participate in our surveys,” said Leah F. Binder, president and CEO of the Washington-based organization.

Some 1,501 hospitals nationwide participated in the group’s latest survey, whose data was analyzed by Castlight Health, an enterprise health care management company.

“Never events” policy

One question in Leapfrog’s survey asks hospitals whether they will publicly commit to complying with its “never events” policy. “Never events” are occurrences in hospitals, such as a sponge being inadvertently sealed inside a surgery patient or the amputation of the wrong limb, that are never supposed to happen, but on rare occasions do.

The policy Leapfrog is seeking to have hospitals comply with when such events occur is that they apologize to the patient, report the event to a hospital oversight entity such as The Joint Commission, waive all costs associated with the event, analyze what caused the event, and furnish a copy of the hospital’s never-events policy to patients upon request.

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Leapfrog says its aim isn’t to punish hospitals, but to praise those that have adopted that policy and its other guidelines.

In its latest survey, Leapfrog found that hospital adoption of its recommended never-events policy “remains low.” Specifically, only 79% of surveyed hospitals have done so. The survey also found that:

• One in six reporting hospitals “have higher infection rates than expected” for central line infections, and one in ten perform poorly in preventing catheter-associated urinary tract infections;
• Hospitals “are struggling” to comply with Leapfrog “safe practices” guidelines, although urban hospitals are making greater progress than rural ones; and
• More hospitals with intensive care units are complying with Leapfrog’s ICU physician staffing and hand hygiene standards.

Pushing for transparency

Encouraging hospitals to participate in Leapfrog’s surveys and adhere to its quality standards requires employers and health care companies not only to ask hospitals that don’t participate for the reasons they choose not to, and requesting that they do so, Binder says. They can also ask very specific questions, such as, “Do you have a hand hygiene policy, and if so, do you hold management accountable for enforcing it?” she adds.

All of the major national health care plans are members of Leapfrog, and some incorporate Leapfrog guideline compliance metrics into their incentive-based payment systems for hospitals.

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One area of particular focus for Leapfrog is extra hospital stay costs triggered by adverse ancillary (and generally preventable) medical events, such as blood and surgical site infections. Surgical site infections add an average of $39,000 to the hospital tab for private payers, according to a study published in the Journal of the American Medical Association that Binder has read.

Opaque accounting

But being able to identity which charges are associated with such events is very difficult. “These mistakes are common, and the cost to employers is huge, but the accounting is very opaque,” Binder says. But the kind of transparency Leapfrog is pushing hospitals to provide can help payers distinguish between hospitals where such events are common, and those where they are rare.

Employers can apply pressure to hospitals that don’t participate in Leapfrog surveys or adhere to their standards either directly, or through state or local health care purchasing coalitions, Binder says.

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Employers may have more confidence in a hospital that, even with reported quality issues in certain areas, is willing to be transparent about it, than in institutions that refuse to furnish the kind of data that Leapfrog is encouraging them to provide.

Leapfrog, founded in 2000, serves a dual function:

1. Providing substantive quality data on hospitals for purchasers to inform their hospital selection processes, and

2. Raising hospital quality by establishing performance benchmarks and motivating hospitals to achieve them lest they be shown in Leapfrog survey data to be lagging their peers.

Leapfrog’s hospital ratings and its latest report are available on its website.

Richard Stolz is a freelance writer based in Rockville, Maryland.