Let's look at the cost before we Leapfrog

By Kathleen O'Connor
Special to The Seattle Times

Like the Stealth Bomber, The Leapfrog Group has been gliding under the health-care radar screen busily preparing for an assault to improve patient safety and quality care in hospitals. While well intended, this new marketplace directive promises as much havoc as any government mandate.

Leapfrog is putting the screws to hospitals to have better medication-management programs and new standards for high-risk patient referrals and intensive-care staffing. But the process is essentially another unfunded mandate leaving each hospital to develop its own internal computerized system, which will only add another layer of computerized functions and cost on top of an already frazzled information infrastructure.

But, the fatal flaw -- which is what I think is really driving this hardball approach -- is that the business community has simply given up on the health-care industry in general and hospitals in particular to voluntarily produce good, accurate, reliable and understandable information on quality and cost.

I hate to say it, but the health-care industry has brought this upon itself in many ways. Just ask any patient who has been to a hospital recently. They can't understand their bills. Their records are not shared between departments. A friend and retired business executive fumed for 45 minutes recently: "I can't make sense of the paperwork."

So Leapfrog is surveying local hospitals and will post the results on its Web site for all to see and decide about each hospital's performance. I think years of frustration have led to this dictate, but you and I are the ones caught in the crossfire of these unrelenting health-care game-and-blame wars.

The Leapfrog Group (www.leapfroggroup.org), whose members include Boeing and the Washington State Health Care Authority, intends to "mobilize employer purchasing power to initiate breakthrough improvements in the safety and overall value of health-care to American consumers... "

Hospitals that don't meet their standards stand to lose business with these large, self-insured employers who spend over $45 billion each year on health care for some 24 million people. Not an idle ramification here.

Estimates of lost income, disability and lost household production as well as outright health-care costs (which are over half of these costs) are estimated to range from $17 billion to $29 billion per year.

One adverse drug reaction in a hospital can average $2,000 -- for an annual total cost of $2 billion per year.

Leapfrog wants each hospital to create a computerized physician order-entry system for prescriptions, to catch potential drug reactions and interactions and reduce confusion about medication orders.

One hospital in Boston that implemented the program reduced its medication errors by 55 percent and serious errors declined by 88 percent. On the downside, it cost the hospital $1.9 million to implement and $500,000 a year in maintenance. So, if all 7,000 some odd hospitals in America adopted this, the cost would be about $14 billion for their combined separate efforts.

Hospitals are also being asked how frequently they perform certain surgeries, such as angioplasty or artery bypass surgery. Why? Because studies show patients with high-risk conditions have better outcomes in hospitals that do those procedures most frequently. Estimates indicate this would save 4,000 lives each year.

Finally, Leapfrog will also monitor intensive-care units (ICU) staffing to see if hospitals with ICUs have fulltime "intensivists" on staff and what their working hours are. Studies indicate that hospitals with "intensivists" have a mortality rate of 7 percent compared to 21 percent in hospitals without them.

But what about hospitals with 10 ICU beds? Do they close those ICUs because they can't afford a fulltime intensivist? Who makes those decisions? Hospitals? Patients? Employers? Insurers?

These patient-safety issues are extremely important questions, but they require wider dialogue, not just independent decisions based on survey results.

Because we do not have a system of health care, we keep getting these separate initiatives, whether government- or business-driven, which only increases all our costs. I do not disagree with what Leapfrog is trying to do. I do disagree with how they are doing it. This initiative is yet another reflection of how fractured our health-care system is. We need collaboration, not dictates, when it comes to quality patient care. Is anyone listening out there?

Don't forget, the last marketplace-driven initiative brought us managed care.

Kathleen O'Connor is a health-care industry analyst and publisher of The O'ConnorReport (oconnorhealth-analyst.com).

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Let's look at the cost before we Leapfrog

By Kathleen O'Connor Special to The Seattle Times

By Kathleen O'Connor
Special to The Seattle Times