The Leapfrog Group CEO wants public reporting of nine so-called "never events" to remain public. The AHA, she says, wants to suppress it. But that's not all. Binder wants "more data—a lot more data."
Leah Binder has a very tricky job.
As president and CEO of the Leapfrog Group, she has to be nice to hospitals because she needs more of them to voluntarily report quality data to Leapfrog, even though they may suffer the ignominy of getting a poor safety grade, or appear shabby for not having implemented electronic systems for physician orders.
If she isn't nice to them, they might get turned off, or drop out of Leapfrog's program, and the employer groups and others she represents—who want public reports on lots of measures to show them where to spend their healthcare dollars won't be happy.
But she also has to be critical of the hospital industry, be tough, and hold her ground. And that side came out this week in her Forbes blog, which was topped with the provocative headline: "Bone-Chilling Mistakes Hospitals Make and Why They Don't Want You to Know."
In it, Binder criticized the hospital industry, specifically its lobby, the American Hospital Association, for its efforts to stall public reporting of quality measures and delay penalties for hospital mistakes, a trend in the opposite direction of the one I thought we're supposed to be headed.
The AHA specifically wants the Centers for Medicare & Medicaid Services to remove public reporting on Hospital Compare of nine so-called hospital-acquired conditions, sometimes called "never events," such as forgetting to remove a metal retractor after surgery.
Binder referred to an incident in which surgeons forgot to remove one such surgical tool "the size of a crowbar" from a patient's abdomen. I can, from my newspaper days, recall a similar incident I wrote about involving a 14" by 2" metal retractor left inside a surgical patient.
The hospital industry wants to "suppress" information like this, Binder says. So far, CMS has said it is not taking these measures off its website, although a report this spring indicated they might.
Here's an excerpt from Binder's blog:
We used these nine measures in our Hospital Safety Scores —letter grades assigned to more than 2,500 general hospitals warning consumers of their propensity for deadly mistakes. We found that some hospitals have many more of these never events than others. And the public deserves to know which hospitals protect patients best.
"But the American Hospital Association (AHA) and its lobbyists disagree. They did not want hospital data on these never events, as well as some other terrible measures, publicly reported. They acknowledge these events happen, but they say the government wasn't measuring them in a way that's perfectly fair to hospitals."
Binder notes that the AHA makes many of these arguments in its 58-page comment letter to CMS' proposed rules for paying hospitals for care of Medicare patients to take effect Oct. 1.
In one of the AHA passages I read, the industry group wants CMS to reconsider implementing a provision specified in the Patient Protection and Affordable Care Act that requires imposition of a 1% Medicare penalty or pay cut for hospitals with hospital-acquired condition rates that are the highest 25% bracket, starting Oct. 1, 2014.
"The selected measures (in the HAC rule) were selected using a flawed process and have significant methodological problems," the AHA wrote. And, it said, "the proposed scoring methodology would not meaningfully differentiate hospital performance," and would "disproportionately harm teaching hospitals and large hospitals [400 beds and over] that tend to care for sicker patients."
Binder seems to suggest that the hospital group is being disingenuous. In one letter to CMS, the AHA argues for delaying finalizing measures requiring public reporting and penalties for hospital-acquired surgical site, methicillin-resistant staphylococcus aureus, and C. difficile infections, "until performance on these measures has improved."
But in another letter to the Senate Finance Committee June 26, Binder says, the hospital lobby seemed to say something much different about the measures CMS wants to display for public view.
"Meanwhile, before the ink was dry on its letter to CMS complaining about the imperfection of measures and requesting delays, AHA was quick to submit testimony to the Senate about its commitment to public reporting — as long as it's on its own terms.AHA's testimony asks for fewer measures to be publicly reported, and although the lack of progress nationally on patient safety is well established, the testimony reports glowing achievements by some of its member hospitals in improving on several important measures of performance. Ironically, the important measures it touts to Congress are among the same ones it tells CMS aren't good enough for public reporting."
In a phone conversation this week, I asked Binder what she really wants to happen now.
"I want hospitals to keep publicly reporting," she replies. "And I want more data. A lot more data." Like on medication errors. That, she says, "is the elephant in the living room."
"Medication errors are the number one most common error in hospitals. Estimates are it happens one time every day for every inpatient. That's a lot of errors and a lot of harm."
But these aren't reported on CMS's Hospital Compare, and there isn't even a good measure to define how they should be counted.
But how? Where do you begin? Do you report medication errors that don't make it into the patient? What about mistakes that get to the patient but which don't cause harm? Or mistakes that cause harm, but not serious harm and which are quickly reversed? Intravenous drugs or oral ones, or topical ones?
What's a good measure of medication error rate inside of a hospital?
"That's the challenge of creating a measure," Binder says. "How do you define it, what mistakes do you include, or exclude? Measure development is a science for a reason and [there are] lots of issues.
"It's tough. But it's not impossible.
"But I just want something. Anything is better than nothing. I just want to know how many times a hospital harmed a patient with a medication error."
CMS is committed to transparency, Binder believes. "But I want them to demonstrate that," she says. "I'm concerned, and worried, that we could have some reversal of the gains that purchasers and consumers have made in improving transparency over the past decade."
That, I think, is the real elephant in the room.