The Leapfrog Group: New Software System May Aid in the Goal of Efficiency for Health Care

In an age of constant rising health care costs, a growing number of uninsured citizens, and frequent medical errors, the need to address and change the health care system is constantly debated and challenged on a regular basis. In an effort to help improve health care and make it more accessible to Americans everywhere, the Leapfrog Group was created.

The Leapfrog Group is a voluntary program composed of hospitals, vendors, employers and health plans working towards a common goal in providing safe, affordable and quality health care to Americans. It is a member supported program aimed at mobilizing 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 (http://www.leapfroggroup.org/media/file/LF_Fact Sheet_01_26_06.pdf).

The goal of Leapfrog includes the following:

• Reduce preventable medical mistakes and improve the quality and affordability of health care.
• Encourage public reporting of health care quality and outcomes so that consumers and purchasing organizations can make more informed health care choices.
• Reward doctors and hospitals for improving the quality, safety and affordability of health care.
• Help consumers reap the benefits of making smart health care decisions

(www.leapfroggroup.org/).

The members of Leapfrog have to agree to purchase health care in the following manner for their enrollees:

1) Educating and informing enrollees about the safety, quality and affordability of health care and the importance of comparing the care health care providers give. Initial emphasis on the Leapfrog safety and quality practices.

2) Recognizing and rewarding health care providers for major advances in the safety, quality and affordability of their care.

3) Holding health plans accountable for implementing the Leapfrog purchasing principles.

4) Building the support of benefits consultants and brokers to use and advocate for the Leapfrog purchasing principles with all of their clients (http://www.leapfroggroup.org/media/file/lf_factsheet_01_26_06.pdf).

Leapfrog personally believes that this can be accomplished through a Leapfrog Hospital Rewards Program. This is innovative, of-the-shelf pay-for-performance program that drives improvements in hospital quality and efficiency in five clinical areas while demonstrating dollar savings as hospital performance improves (http://leapfroggroup.org/media/file/lf_factsheet_01_26_06.pdf). Through this program, hospitals are rewarded according to whether or not they have shown excellence by improving hospital quality and efficiency.

It is the desire of the group to encourage members to take giant leaps 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 (www.leapfroggroup.org/media/file/lf_factsheet_01_26_06.pdf)

This effort is rooted in four ideas:

1) American health care remains far below obtainable levels of basic safety, quality, and overall customer value.

2) The health industry would improve more rapidly if purchasers better recognized and rewarded superior safety and overall value.

3) Voluntary adherence to purchasing principles by a critical mass of America's largest employers would provide a large jump-start and encourage other purchasers to join.

4) These principles should not only champion superior overall value but should initially focus on a handful of specific innovations offering "great leaps" to maximize media and consumer support and adoption by other purchasers (http://www.leapfroggroup.org/media/file/lf_factsheet_01_26_06.pdf).

Leapfrog is important because its initial focus is in reducing the number of preventable medical mistakes. A report published in 1999 in the Institute of Medicine reported that up to 98,000 Americans die every year from preventable medical errors made in hospitals alone (http://www.leapfroggroup.org/about_us/how_and_why). Leapfrog promotes the need for improvements in the safety of health care by allowing consumers to gain access to pertinent information regarding hospital survey results, patient safety surveys links to helpful websites.

I do agree with Leapfrog in that patient safety has to improve. The need to improve the affordability and quality of health care is a grave issue in the United States. There are a large number of people who are lacking health care coverage due to cost. Hospital error is another issue that is a concern to Americans. People are dying in the hospital because of neglect on the part of doctors, nurses or other hospital personnel.

I will admit that I do not quite understand Leapfrog completely, so it may be difficult to fully explain the program in detail. However, on what I know about Leapfrog from reading the website, there are also some things that I do not agree with. For example, hospitals have the opportunity to participate in any of the five clinical areas on which the Leapfrog Hospital Rewards Program focuses:

1) coronary artery bypass graft (CABG);

2) percutaneous coronary intervention (PCI);

3) acute myocardial infarction (AMI);

4) community acquired pneumonia (CAP); and

5) deliveries/newborn care

(https://leapfrog.medstat.com/hrp/references/factsheet.doc).

My question is, why not choose other areas? What makes these areas so important? According to Leapfrog, the clinical areas were chosen based on:

1) the opportunity they represent for improvements in quality and cost;

2) their total cost in the hospitalized commercial population; and,

3) the availability of national measures of hospital quality already being collected (https://leapfrog.medstat.com/hrp/references/factsheet.doc).

My argument is this, hospitals are composed of other areas and departments that are in dire need of improvement. Maybe economically or financially they are not significant areas, but they are still important. The other areas that I am speaking of includes human resources, professional services, information services, administrative services, rehabilitation services, facilities services, other areas of nursing services, and food services (just to name a few).

I do not have that many years in the medical field as an employee, so I am confident that my argument may not be sound. But I do have many years in the industry as a consumer receiving patient care. As an outsider looking in I can see the need for improvements in some of the areas that I have mentioned above. Certainly some hospitals may have improvements in the areas, but I am certain that there are a few more that can use a little help. So, why not expand the requirements and include other areas? Is it possible to look at the health care industry as something other than a profit in the sense of money? Can we look at it instead as a place of humanitarian profit where employees can go and simply be happy because they are giving care to another individual because they enjoy the feel good feeling?

It appears to me that the Leapfrog Group is looking at the health care industry from the view of financial gain instead of patient care gain because of the clinical areas listed. Financially this is good because it will help to improve affordability of health care for people and this is what we want as a nation. These clinical areas represent 33% of commercial hospital admissions and 20% of commercial payers' spending on inpatient services [source: Medstat MarketScan] (https://leapfrog.medstat.com/hrp/references/faq.doc). In this sense it is important for the selected areas to improve in quality and cost reduction so that health care can become more affordable.

I agree with Leapfrog in not awarding bonus payments or a shift in market share for not showing a high performance or quality improvements. This should be an incentive in itself for the desire to improve the performance of hospitals. I also agree with the fact that the results of hospital surveys and rankings are made public by Leapfrog. The issue that I have with this method deals with the number of hospitals that are not listed. So this raised a question with me as to whether or not all hospitals are participating in Leapfrog or not. The answer to this question is no, so how can consumers be certain that this program, or any program similar to this is truly effective if it is voluntary and not mandatory? Are all hospitals meeting the standards set by Leapfrog and are all hospitals participating? How can a consumer be certain?