Reducing patients’ risk may lead hospitals to bow to pressure
Looking for a way to reduce errors
A new plan from Washington, DC-based The Leapfrog Group could force hospitals to adopt new measures to reduce medical errors or risk financial losses, and risk managers may find themselves leading the charge at their own institutions. The ultimate goal may be reducing risk to patients, but providers are likely to comply because of the pressure exerted by The Leapfrog Group.
The Leapfrog Group gained attention right after the release of the Institute of Medicine (IOM) report on medical errors. A consortium of major employers in the United States, the Leapfrog Group said then that it would exert strong pressure on health care providers to reduce medical errors by threatening to make health care purchasing decisions on error rates and efforts to reduce them. The threat was looming for months, but the group released what it termed a "forceful, market-based effort to improve patient safety across the nation." The group also released new research indicating that the approach could save up to 58,300 lives and prevent up to 522,000 medication errors each year.
The Leapfrog Group is a consortium of Fortune 500 companies and other large private and public health care purchasers. The Leapfrog Group’s approximately 60 members provide health benefits to more than 20 million Americans; Leapfrog members and their employees spend more than $40 billion on health care annually. Under Leapfrog, employers have agreed to base their purchase of health care on principles encouraging more stringent patient safety measures. If a health care provider doesn’t follow the Leapfrog guidelines, the member companies won’t send any patients.
The group’s plan includes three main requirements for providers: computerized physician order entry, evidence-based hospital referral, and intensive care unit (ICU) staffing by physicians trained in critical care medicine.
None of the ideas are new to risk managers, but the health care community may finally have to listen and start implementing them, says R. Stephen Trosty, JD, MA, director of risk management at Mutual Insurance Corp. of America in East Lansing, MI.
"Hospitals and other providers probably will have to pay attention," he says. "A lot of what they’re saying are things that risk managers have recognized for a while makes perfectly good sense in reducing the potential for errors. This may create a new pressure that makes those ideas move forward.
The power of purchasing
Citing the 1999 report by the IOM found that up to 98,000 Americans die every year from preventable medical errors made in hospitals, Suzanne Delbanco, PhD, executive director of The Leapfrog Group, says the member employers are trying to use their purchasing power to improve the country’s health care system.
"Members of The Leapfrog Group have set out to reduce preventable medical errors by changing the way they purchase health care," Delbanco says. "By encouraging health care providers to adopt three proven safety measures, thousands of Americans can be protected from disability and death."
The plan is designed to force health care providers to take the necessary action to reduce medical errors immediately, says Lewis Campbell, chairman and CEO of Textron Inc. and chairman of The Leapfrog Group’s Business Roundtable Health and Retirement Task Force. Campbell says the group expects health care providers to respond more quickly to the threat of financial losses than to any other motivation.
"The number of tragic deaths brought about by preventable medical errors is too striking for those of us in the business community to ignore," Campbell says. "Coming together with other employers through The Leapfrog Group, we feel confident in our ability to make a difference by harnessing and leveraging our health care purchasing power. It’s a straightforward business approach to tackling a complex problem, one that we must undertake to ensure our employees, retirees, and their families receive the highest quality and safest care available."
Trosty says the impact of the Leapfrog guidelines may come down to how much the member companies come through on their threats. If the employers refuse to send patients to any facility not complying with the guidelines, the impact could be substantial, he says.
"If The Leapfrog Group gets enough major businesses and employers to truly require and mandate this, that may result in sufficient buying power to get hospitals and other institutions to abide by these things," he says. "It depends on what kind of solidarity there is on the part of the businesses."
Other groups are moving in the same direction, Trosty says, and any success by The Leapfrog Group may lead the others to put more muscle behind the guidelines. Other business coalitions and regulatory groups, such as the Joint Commission on Accreditation of Healthcare Organizations, already are looking for ways to reduce medical errors, so The Leapfrog Group’s action could be a bandwagon they will want to jump aboard.
"Ultimately, some of these things might be considered standards of practice, either because The Leapfrog Group has been successful in establishing that idea or because other groups lend their support," Trosty says. "I wouldn’t be surprised if the Joint Commission gets on board and requires these things. I think they may become more than just suggestions from the business community."
Employers say they will use buying power
The Leapfrog Group’s plan was accompanied by research conducted by John Birkmeyer, MD, of Dartmouth Medical School in Hanover, NH. The research indicates that the group’s three suggested improvements could save up to 58,300 lives per year, and prevent 522,000 medication errors, if implemented by all nonrural hospitals in the United States.
Computer physician order entry has been shown to reduce serious prescribing errors in hospitals by more than 50%, according to the group’s research. Evidence-based hospital referral requires that patients needing certain complex medical procedures be referred 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. The group’s research indicates that a patient’s risk of dying could be reduced by more than 30%. The group also claims that staffing ICUs with physicians who have credentials in critical care medicine has been shown to reduce the risk of patients dying in the ICU by more than 10%.
Trosty says the three initiatives are solid ideas that have been proposed by risk managers for some time now. Whether each of them can be implemented quickly and effectively is another question, he says.
"Each thing that you do for reducing the potential for medical error is a positive thing," he says. "But I don’t think there is any one thing that can be the answer to medical error reduction. A cost-benefit analysis might be necessary in some cases. With the intensive care units, for instance, specialists make sense intuitively but that doesn’t mean you can’t provide quality care without them."
There are still a number of questions to be answered regarding how to implement some of the ideas, Trosty says. Could it suffice to have a specialist supervisor on the ICU rather than all specialist physicians? For evidence-based referrals, how far do you carry that idea? For what procedures? What happens to a hospital that can’t afford to comply with the guidelines? Do you shut down the hospital?
The costs of implementing the guidelines must be considered carefully, he notes. Hospitals may have no choice but to comply if The Leapfrog Group’s pressure proves formidable; yet there may be no way to recoup the costs of complying.
"This could put hospitals between a rock and a hard place," he says. "They may understand this is the way to go, but as reimbursement levels continue to decrease, will there be additional reimbursement recognizing the additional cost of providing this level of care? If hospitals agree to do this or are forced to do this, but compensation is not enough, hospitals can only afford to do this for so long before they go out of business."
To put some teeth into the initiatives, The Leapfrog Group member companies have all agreed to adhere to these four purchasing principles in buying health care for their enrollees:
• educating and informing enrollees about patient safety and the importance of comparing health care provider performance, with initial emphasis on the Leapfrog safety measures;
• recognizing and rewarding health care providers for major advances in protecting patients from preventable medical errors;
• holding health plans accountable for implementing the Leapfrog purchasing principles;
• building the support of benefits consultants and brokers to utilize and advocate for the Leapfrog purchasing principles with all of their clients.
Current members of the Leapfrog Group include such 900-lb gorillas as AT&T, BF Goodrich/Rose-mount Aerospace, The Boeing Co., Coors Brewing Co., DaimlerChrysler Corp., Delta Airlines, The Dow Chemical Co., Eastman Kodak Co., Eli Lilly and Co., Ford Motor Co., General Electric Co., General Motors Corp., General Mills, Georgia-Pacific Corp., Honeywell, IBM, Schering-Plough Corp., SmithKline Beecham, United Parcel Service of America, and Xerox Corp.
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