Friday, February 27, 2004
Leapfrog – The Need for a Better Approach
In its Issue Brief No. 77 published earlier this month, the Center for Studying Health System Change (HSC) reported that “….few hospitals are close to meeting Leapfrog standards.” Leapfrog (formally The Leapfrog Group) was formed in 1999 by the Business Roundtable, an association of Fortune 500 CEOs, most of whose companies are large-scale purchasers of health care. Leapfrog was created in response to the celebrated finding by the Institute of Medicine that a shockingly large number of patients die each year as a result of medical errors. Its purpose was to improve patient safety, in pursuit of which it has focused on three initiatives – encouraging hospitals to implement computerized physician order entry, physician staffing of intensive care units, and minimum volume thresholds for six high-risk procedures.
The report is available at http://www.hschange.com.
Two conclusions worthy of note are implied in the report. One is that for any “outside group” to try to tell a complex industry like health care how to operate its business is presumptuous and almost certainly fruitless. The second (more disappointing, at least to me) is that the provider system cannot be counted on to take patient safety seriously unless it has a financial incentive to do so.
These conclusions, in turn, would seem to lead to a third one, which is that the most direct way for these large employers to address patient safety issues is to deal with hospitals, physicians and other providers of health care in the same way they presumably deal with all their other suppliers, which is to take their business away from the ones that don’t shape up and give it to the ones that do. (The alternative of “pay for performance,” which pays more to providers with good safety records, has other problems to be discussed in a future posting.)
In order to do that, there are three other issues that will have to be faced:
· Freedom of choice will be compromised for employees who are beneficiaries of employer-sponsored health insurance.
· The provider system must have enough unused capacity to allow purchasers of health care services to shift business from one provider to another.
· Purchasers must have the capability of deciding which providers are doing the best job.
The HSC report ought to convince the members of The Business Roundtable that creating an organization for the purpose of telling the provider system how to operate was a bad idea. Better that they should address the issues that stand in the way of doing what one supposes they are good at, which is picking vendors.
In its Issue Brief No. 77 published earlier this month, the Center for Studying Health System Change (HSC) reported that “….few hospitals are close to meeting Leapfrog standards.” Leapfrog (formally The Leapfrog Group) was formed in 1999 by the Business Roundtable, an association of Fortune 500 CEOs, most of whose companies are large-scale purchasers of health care. Leapfrog was created in response to the celebrated finding by the Institute of Medicine that a shockingly large number of patients die each year as a result of medical errors. Its purpose was to improve patient safety, in pursuit of which it has focused on three initiatives – encouraging hospitals to implement computerized physician order entry, physician staffing of intensive care units, and minimum volume thresholds for six high-risk procedures.
The report is available at http://www.hschange.com.
Two conclusions worthy of note are implied in the report. One is that for any “outside group” to try to tell a complex industry like health care how to operate its business is presumptuous and almost certainly fruitless. The second (more disappointing, at least to me) is that the provider system cannot be counted on to take patient safety seriously unless it has a financial incentive to do so.
These conclusions, in turn, would seem to lead to a third one, which is that the most direct way for these large employers to address patient safety issues is to deal with hospitals, physicians and other providers of health care in the same way they presumably deal with all their other suppliers, which is to take their business away from the ones that don’t shape up and give it to the ones that do. (The alternative of “pay for performance,” which pays more to providers with good safety records, has other problems to be discussed in a future posting.)
In order to do that, there are three other issues that will have to be faced:
· Freedom of choice will be compromised for employees who are beneficiaries of employer-sponsored health insurance.
· The provider system must have enough unused capacity to allow purchasers of health care services to shift business from one provider to another.
· Purchasers must have the capability of deciding which providers are doing the best job.
The HSC report ought to convince the members of The Business Roundtable that creating an organization for the purpose of telling the provider system how to operate was a bad idea. Better that they should address the issues that stand in the way of doing what one supposes they are good at, which is picking vendors.
