Opinion: Employers should demand hospital participation in quality and safety survey

By Robert Smith

The Leapfrog Group recently issued the results of its 2013 Leapfrog Hospital Survey, an in-depth examination of seven key areas of hospital quality and safety: medication errors, maternity care, high-risk surgeries, Intensive Care Unit (ICU) physician staffing, serious adverse events, safety practices and hospital-acquired conditions (HACs) – including infections in ICUs, pressure ulcers, and injuries.

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The report, prepared by Castlight® Health, is based on hospital performance data gathered through the Leapfrog Hospital Survey of 1,437 U.S. hospitals in 2013, the highest hospital participation rate to date in the annual survey.

In reviewing the survey results, which the Colorado Business Group on Health (CBGH) sponsors in Colorado, we noted three key trends of importance to employers and their employees.

Hospital participation

  • Participation in the survey is voluntary. Participation should be required if a hospital expects to earn an employers’ business.
  •  Although a record number of hospitals submitted a survey, it still only amounted to a 37 percent participation rate nationally.
  • This matters because purchasers and consumers should demand transparency from their hospital. Hospitals that do not participate in Leapfrog deny purchasers and consumers important information about their performance.

Survival rates for high-risk procedures

  • Patients deserve the highest standards of care when they are admitted to a hospital. Most people assume that’s what they will receive, regardless of where they are admitted.
  • Leapfrog reported as much as a seven-fold variation in predicted survival rates for high-risk procedures across hospitals nationally.
  • Colorado’s results teach the same lesson. We see better patient outcomes for high-risk procedures at hospitals where these procedures are routinely performed.
  • This matters because varied outcomes suggest that consumers would be wise to research Leapfrog Hospital survey results when considering one of these procedures.

Hospital-acquired conditions

  • Among hospitals that reported on hospital-acquired injuries, infections and pressure ulcers, rates varied tremendously nationwide. One in six Leapfrog-reporting hospitals have higher infection rates than expected for central line infections and one in 10 perform poorly in preventing catheter-associated urinary tract infections.
  • Among 25 urban facilities, no one Colorado hospital fully met the applicable standards for all four of the hospital-acquired conditions that are monitored.
  • This matters because the golden rule of health care is and must be, “First, do no harm.” While we believe that all hospitals aspire to this, the reality is that not all hospitals are doing what’s needed to achieve it.

What this means to employers.

Whether they are self-funded or fully insured, Colorado’s employers are paying for hospital care. The 2013 Hospital Survey Report clearly shows that there is a good deal more they could be getting for their money.

Employers should do two things:

  • Demand transparency: As purchasers, employers should require participation in Leapfrog by any hospital that expects to earn its business. Virtually no employer can sell its goods or services without the expectation of being measured, and neither should hospitals. Companies should demand that contracted hospitals participate in Leapfrog as part of their contract with insurers or third party administrators.
  • Track performance: Expect improvement and demand accountability. Employers should track the performance of their contracted hospitals and expect improvement in any area or service that is less than excellent. No hospital will be best at everything but all hospitals must have robust and effective efforts in place to improve quality and reduce waste.

Leapfrog survey results are an invaluable tool for informed purchasers and users. Employers are paying for top quality care. Hospitals claim to provide it. But Colorado’s hospitals have room to improve if they believe in transparency. Hospitals that choose not to participate should not expect an employer’s business. And employers should not give it to them.

To download a copy of the “Health Matters Quality Report 2013 – Urban Hospitals” go to https://www.cbghealth.org/publications/quality-reports/. The 2013 Leapfrog Hospital Survey results can be viewed at https://leapfroghospitalsurvey.org/view-survey-results/

Robert Smith is project manager for the Colorado Business Group on Health, a nonprofit organization that is changing the way employers buy health care. Reach him at [email protected]

Opinions expressed in Health News Colorado represent the views of the individual authors.

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