October 9, 2017
Let’s get the bad news over with first. The number of people who die from hospital mistakes could be as high as 400,000 per year.
On today’s episode of Healthcare Simplified, Tyler Willse interviews Leah Binder, President and CEO of the Leapfrog Group. Binder specializes in helping employers use their leverage to get safer and higher quality care for their employees.
Leapfrog, a nonprofit based in Washington, was founded in 2000 after a group of very large employers were shocked to read a 1999 report that over 100,000 people were dying every year in hospitals from preventable medical errors.
“When they looked at their own covered lives, they were stunned to realize that they were potentially losing an employee every other day,” Binder said.
GM, one of Leapfrog’s founders, pointed out that purchasing a car is completely transparent. If types of American cars get compared to each other and rated on different aspects like safety and quality—shouldn’t hospitals do that, too?
So they decided to make it happen. "Leapfrog founders said, ‘We’re going to ask hospitals could you please report to us on quality and safety metrics that we cannot get anywhere else because they’re not made public because so much in health care is not transparent,’” said Binder.
Now, Leapfrog publishes an annual survey based on hospitals’ mortality rates and infection rates. Since 2012, Leapfrog has also given a letter grade to every hospital in the country—A, B, C, D, and F—on how safe they are for their patients.
“But, fundamentally, what these employers have wanted to do with Leapfrog is to use it to drive how they strategically orient their purchasing—how they think of themselves as purchasers and how they use their dollars as wisely as possible to get the best quality and most efficient care for their employees,” she said. “That’s what we’re about.”
How to Grade a Hospital
“We look at errors, accidents, injuries in hospitals in particular,” Binder said. “I wish I could say those are rare and unusual. They are not. They’re actually extremely common.”
That 1999 study that said over 100,000 people die from hospital errors? It’s probably way higher. Some research says 400,000. Other research says 200,000.
“We actually can’t even track it very well because the way that health care is structured. Its lack of transparency makes it extremely difficult to actually count all these bodies,” Binder said.
If the lower number is the correct one, just think that half the size of the city of Miami are dying every year from a preventable error in a hospital.
That’s just the ones who die. “There’s so many more that are injured or harmed or disabled from these errors.”
In industries other than healthcare, a rate of error that’s .001% is high. But one in four people admitted to a hospital will suffer some form of harm.
“This is a 25% rate, which is just astronomical,” Binder said.
Safety is the first place you look because nothing else matters.
So what if you have the best surgeon in the world, if you end up disabled or killed because of errors in the delivery of care?
After safety comes quality in general.
“There are lots of ways to measure quality and there’s never going to be one way that meets the needs of every purchaser or every consumer. But what we focus on first with quality is outcomes,” Binder said.
Things like mortality rates, rates of medically unnecessary procedures, structural measures—all risk-adjusted.
Leapfrog asks the question: Do hospitals have in place the management practices and the technology and principles that will sustain a higher rate of safety and quality?
Does the CEO’s compensation depend on rates of safety problems? “That’s a known factor that does have an impact,” Binder said.
Or what kind of technology they have and whether it’s functional. Or consumer perceptions—what the patients think.
“Every consumer has to look at a whole variety of measures themselves for whatever reason they are seeking care,” Binder said. Luckily those are out there now.
How to Correct Quality Lapses
If you’re an employer who’s listening—after you get over your shock that hospitals could be killing your employees—what do you do about it?
1) Check out Leapfrog’s free tools.
Like the hospital safety grade website.
“It’s easy for employers to understand and to incorporate it into pretty much any kind of purchasing program. Most of the plans are well aware of the letter grade,” Binder said.
“We hope they will all start using it.”
Or the calculator to estimate how much extra money they’re spending because of hospital errors.
2) Reach out to hospitals.
Seriously, call the hospital and say you’re an employer with concerns.
“If hospitals hear from you, they will try to improve,” Binder said. “What hospitals need to do to go from a very poor letter grade to an A is really fundamental things.”
Make sure everyone washes their hands. Make sure things are clean. Make sure everyone follows the rules of infection control.
“I mean, they’re just standard protocol. Every hospital knows what they should be doing,” Binder said.
“They require management to be paying attention and quite real leadership, but they don’t require a lot of money—just putting a priority on safety.”
3) Understand the data.
The data Leapfrog uses is self-reported by hospitals but verified by Leapfrog, up, down, and sideways, including a random onsite verification for reporting hospitals.
“The data is, in fact, scrupulously verified and attested to by their CEO. So you can feel pretty comfortable about the data on there,” Binder said.
How Much Influence Employers Have
Like, a lot.
If you are a small employer with 200 employees or fewer, and you get together with some community employers and you call the CEO about Leapfrog results, what do you think will happen?
“Not only will the CEO take the call, but they roll out the red carpet,” Binder says. She has worked with many communities and seen how amazed employers are by hospital responsiveness.
“Hospitals do really care, and they are very pleased that employers care about what they’re doing,” Binder said.
Even if you ask the hospital to explain why they have a high rate of C-sections, they still want to be noticed.
“They actually want the opportunity to tell their story and what they’re doing to improve,” Binder said. “Because they are doing things and they want to be recognized for it.”
Another way to leverage influence on hospitals as a small employer is to join a business group on health. “That gives you a really strong voice in your community as purchasers and allows you to network with others to come up with and to share best practices for really improving how you purchase health care,” Binder said.
For example, the Maine Health Management Coalition said that if an employee or dependent uses a hospital that meets their quality standards, they will waive the required $250 co-pay. They’ve seen a dramatic increase in the quality of care delivered in main hospitals in terms of safety because of it.
“We’re seeing a lot more innovations nowadays from employers,” Binder said. She referenced Wal-Mart incentivizing employees to consult a center of excellence for a second opinion before undergoing a procedure.
“The fundamental issue, though, is for employers to make sure that public reporting is where they want to be, that their employees can access information, that they make it clear, that the information is unbiased, that they get it to them,” Binder said.
Find Leapfrog Group resources at their website or Hospital Safety Grade. Contact Leah Binder at firstname.lastname@example.org.
If healthcare transparency is as important to you as it should be, consider being a part of the first National Health Summit on healthcare ratings being held in Arlington, Virginia, on December 6-7, 2017.
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