The Leapfrog Group

= The Leapfrog Group =

The Leapfrog Group is an initiative driven by organizations that buy health care who are working to initiate breakthrough improvements in the safety, quality and affordability of healthcare for Americans. As a member supported program, The Leapfrog Group aims to mobilize employer purchasing power to alert America’s health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded. Among other initiatives, Leapfrog works with its employer members to encourage transparency and easy access to health care information as well as rewards for hospitals that have a proven record of high quality care.

The mission of the Leapfrog Group is to trigger giant leaps forward in the safety, quality and affordability of health care by supporting informed healthcare decisions by those who use and pay for health care and promoting high-value health care through incentives and rewards. The Leapfrog Group Fact Sheet. Available at: http://www.leapfroggroup.org/media/file/The_Leapfrog_Group_Fact_Sheet_03_2008.pdf ]

History of the Leapfrog Group

In 1998, a group of large employers came together to discuss how they could work together to use the way they purchased health care to have an influence on its quality and affordability. They recognized that there was a dysfunction in the health care market place. Employers were spending billions of dollars on health care for their employees with no way of assessing its quality or comparing health care providers. The Leapfrog Group: How and Why Leapfrog Started. Available at: http://www.leapfroggroup.org/about_us/how_and_why ]

A 1999 report by the Institute of Medicine gave the Leapfrog founders an initial focus – reducing preventable medical mistakes. The report found that up to 98,000 Americans die every year from preventable medical errors made in hospitals alone. The Institute of Medicine. Available at: http://www.ahrq.gov/qual/errback.htm.] In fact, there are more deaths in hospitals each year from preventable medical mistakes than there are from vehicle accidents, breast cancer, and AIDS.

The report recommended that large employers provide more market reinforcement for the quality and safety of health care. The founders realized that they could take ‘leaps’ forward with their employees, retirees and families by rewarding hospitals that implement significant improvements in quality and safety. Funding to set up Leapfrog came from the Business Roundtable (BRT) and The Leapfrog Group was officially launched in November 2000. Leapfrog is supported by the Leapfrog membership.

Leapfrog Safety Practices: Four Leaps in Hospital Quality, Safety and Affordability

Overview of Leaps

A range of hospital quality and safety practices are the focus of Leapfrog’s hospital ratings via the Leapfrog Hospital Quality and Safety Survey, as well as our hospital recognition and reward programs. Endorsed by the National Quality Forum (NQF), the practices are: computer physician order entry; evidence-based hospital referral; intensive care unit (ICU) staffing by physicians experienced in critical care medicine; and the Leapfrog Safe Practices Score.

# Computer Physician Order Entry (CPOE): With CPOE systems, hospital staff enter medication orders via computer linked to prescribing error prevention software. CPOE has been shown to reduce serious prescribing errors in hospitals by more than 50%.
# Evidence-Based Hospital Referral (EBHR): Consumers and health care purchasers should choose hospitals with extensive experience and the best results with certain high-risk surgeries and conditions. By referring patients needing certain complex medical procedures to hospitals offering the best survival odds based on scientifically valid criteria — such as the number of times a hospital performs these procedures each year or other process or outcomes data — research indicates that a patient’s risk of dying could be reduced by 40%.
# ICU Physician Staffing (IPS): Staffing ICUs with doctors who have special training in critical care medicine, called ‘intensivists’, has been shown to reduce the risk of patients dying in the ICU by 40%.
# Leapfrog Safe Practices Score: The National Quality Forum-endorsed 30 Safe Practices cover a range of practices that, if utilized, would reduce the risk of harm in certain processes, systems or environments of care. Included in the 30 practices are the three leaps above. This fourth leap assesses a hospitals’ performance on 13 of the remaining 27 NQF safe practices. The 13 safe practices were chosen because they were 1.) auditable 2.) not being asked in other areas of the survey and 3.) Evidence based.

The Leapfrog Group asks hospitals to report on both “leaps” and “measures”. An example of a “leap” is its requirement to have hospitals staff their ICUs with physicians trained in critical care medicine (IPS Leap). An example of a measure is the portion of the survey that asks hospitals to report on hospital-acquired injuries (HAC).

Criteria for Leaps

Leapfrog uses a structured process to review suggested refinements to existing leaps and to review suggested new leaps. Leaps must adhere to the following criteria:
# Strong scientific evidence based in the peer-reviewed literature that the practice improves safety, quality, or efficiency – e.g., evidence indicates the intervention is likely to save nationally >5,000 lives/year, avoid >20,000 errors/year, or reduce per capita health care spending in the U.S. by 1% or more.
# Face value can be readily appreciated by consumers/purchasers (e.g. knowing that if you are sick enough to be in the ICU, then an ICU specialist will be guiding your care at least 8 hrs/day).

Criteria for Measures

The decision to include new measures is a balance of the three criteria below:
# Measures included in the course of Leapfrog’s assessments, to adhere to the Consumer Purchaser Disclosure Project guidelines and should align whenever possible with national priority areas whenever possible (e.g., CMS’s HAC list, CMS VBP measure sets, IOM and NQF priority areas, etc.).
# In order to facilitate the implementation of rewards that encourage delivery of high value health care, measures need to draw upon readily available data sources.
# Measures that have not been previously publicly reported are preferred.

Because the health industry needs time to meet these standards, Leapfrog purchasers are working with the provider community to arrive at aggressive but feasible target dates for implementation of Leapfrog’s recommended quality practices.

The Leapfrog Hospital Survey

The Leapfrog Hospital Survey is the national standard for rating the quality and safety of hospitals in the U.S. Unlike other hospital ratings, the Leapfrog Survey goes beyond the performance of individual clinicians in caring for patients and examines overall hospital outcomes, processes and structures – measures that help determine if quality and safety are truly built into a hospital’s system of care. The Leapfrog Group: Leapfrog Hospital Survey. Available at: http://www.leapfroggroup.org/for_hospitals/leapfrog_hospital_survey_copy ]

The Leapfrog Hospital Survey results:
*Enable people to compare hospitals regionally and nationally;
*Are freely available to the public at [www.leapfroggroup.org] and are also used by regional business coalitions in 37 major US markets to make purchasing decisions;
*Show a hospital’s progress on 16 of the 30 of the National Quality Forum’s Safe Practices for Better Healthcare, which are rigorously researched;
*Include over 1,300 hospitals that serve over half the US population;
*Are updated monthly and are the most current available; and,
*Are compiled by an independent non-profit organization whose mission is to trigger giant leaps forward in the safety, quality and affordability of health care.

Hospital participation in the Survey advances transparency in the health care system, providing individuals and employers access to information they need to make informed decisions about where to seek care. The Survey encourages the widespread adoption of scientifically proven safety and quality standards, thus leading to overall improvement in U.S. health care outcomes, safety and efficiency.

The Survey encourages hospitals to adopt the following standards/practices:

* Safe prescribing. Do physicians enter patient prescriptions and other orders into computers equipped with error prevention software in order to prevent common and often deadly medication errors?::* 2.5% of reporting hospitals had a safe prescribing computer system in 2002; 10.9% of reporting hospitals had them in 2007.
*ICU staffing. Are intensive care units staffed by ICU specialists (intensivists)?::* 10.2% of reporting hospitals employed intensivists in 2002; 29.3% employed them in 2007.
*High-risk treatments. How well does a hospital perform certain high-risk procedures and care for certain high-risk neonatal conditions?
*Safety practices. How well does a hospital employ 13 of the National Quality Forum Safe Practices (e.g. preventing hospital-associated infections, creating and sustaining a culture of safety, improving information transfer) that reduce preventable medical mistakes?
*Never events. Never events are occurrences that should never happen, and according to the National Quality Forum includes such events as surgery on the wrong body part or death due to contaminated drugs. We ask hospitals to commit to our never events policy which requires them to: 1.) Apologize to the patient and/or family; 2.) Report the event to an agency such as the Joint Commission; 3.) Perform an analysis into the root cause; and 4.) Waive costs directly related to the event.::* In 2007 (the first year they were asked), 52% of hospitals said they adhere to the Leapfrog policy on never events. Later that year, CMS announced it will stop paying for eight types of never events starting October 1, 2008.

If all hospitals implemented the first three standards, more than 65,000 lives would be saved, over 900,000 serious medication errors prevented Birkmeyer JD, Dimick J. The Leapfrog Group’s Patient Safety Practices, 2003: The Po-tential Benefits of Universal Adoption. The Leapfrog Group, February, 2004. ] and the health care system would save up to $41.5 billion each year Conrad DA, Gardner M. Updated Economic Implications of the Leapfrog Group Patient Safety Standards Final Report to the Leapfrog Group May 2, 2005 Available at: http://www.leapfroggroup.org/media/file/Conrad_Updated_Economic_Implications_2_.pdf ] .

Among new aspects of the 2008 Leapfrog Hospital Survey:
* Odds of surviving certain surgeries at a hospital;
* The prevalence of two hospital acquired conditions: bed sores and injuries occurring during the stay (e.g., falls, burns) – conditions for which the Centers for Medicare & Medicaid Services has said it will no longer pay;
* Risk-adjusted measures that rate how well hospitals use resources for heart bypass, heart angioplasty, heart attack and pneumonia;
* A new tool that evaluates the effectiveness of a hospital’s prescribing computer system in alerting doctors to common, serious prescribing errors.

Other Leapfrog Initiatives

Leapfrog Hospital Rewards Program (LHRP)^TM:

In 2005, The Leapfrog Group finalized the first generation of its rewards program for hospitals. The first generation Leapfrog Hospital Rewards Program measures hospital performance on five conditions (coronary artery bypass graft, angioplasty, heart attack, community-acquired pneumonia, and deliveries/newborn care) for quality and efficiency using data submitted by hospitals via the Leapfrog Hospital Survey and their data vendors. Hospitals that demonstrate excellence or show improvement along both the quality and efficiency dimensions receive financial rewards and public recognition from employers and/or health plans that license the program from The Leapfrog Group.

Leapfrog is currently collaborating with a group of experts to develop a second generation hospital rewards program that is based on Leapfrog’s experience with the first generation program and lessons learned through other pay-for-performance projects. The second generation hospital rewards program will be based solely on data collected through the Leapfrog Hospital Survey. The Leapfrog Group has designed the 2008 Survey to lessen the burden of reporting for hospitals and to incorporate the latest research on measures that have the greatest impact on saving costs and improving quality.

In 2006, Horizon Blue Cross Blue Shield of New Jersey became the first health plan to implement the Leapfrog Hospital Rewards Program. Aetna launched pilot testing of the program in 2008.

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