Leapfrog: Hospital Quality Still Lagging

While hospital quality in selected categories showed some improvement from the previous year, it still is not where it should be—with waste also remaining a major problem, according to the results of the latest 2009 hospital survey released on Tuesday by the Leapfrog Group, a nonprofit organization representing major private and public purchasers of healthcare benefits.

"This tells us that 10 years after [Leapfrog] got started, we're still seeing nowhere near the progress we ought to be seeing"—despite the fact the "we are the most expensive health system in the world by far," said Leapfrog CEO Leah Binder, who presented the findings at the World Health Care Congress Tuesday.

For 2009, 1,244 hospitals in 45 states completed the voluntary Leapfrog Hospital Survey. Individual hospital results can be viewed and compared at www.leagfroggroup.org/cp.

One of the somewhat more promising measures was related to hospitals meeting Leapfrog's quality standard related to pneumonia treatment. In 2009, 57% of surveyed hospitals met the standard—up from 34% in 2008. But even though the pneumonia rate is good, "it's not where we as a country should be," Binder said. "Good could be even better."

For other categories, 53.5% met Leapfrog's quality standard for heart bypass surgery—compared to only 43% in 2008. Similarly, this year, 44% of hospitals met Leapfrog's quality standard for heart angioplasty, compared to only 35% last year. For heart attack, 33% met the standard in 2009, compared with 26% a year earlier.

"Waste" also emerges as a problem in the Leapfrog Survey, despite arguments in the healthcare reform debate to make more efforts to "bend the cost curve." In 2009, a 56% difference existed, for instance, between the highest and lowest performing hospitals in terms of resource use for heart bypass surgery.

For heart angioplasty, there was a 79% difference between the highest and lowest performers. To gauge waste, Leapfrog's resource use measure is based on risk adjusted mean length of stay compared to readmission rates. Length of stay is a strong determinant of cost.

The variations in waste among hospitals performing the same type of surgery highlight the opportunities that exist for significantly cutting the costs of care, Binder said.

As the country moves forward with insurance reform, Binder said that employers and other large purchasers of care should become "more assertive in demanding hospitals reduce this waste and improve their Leapfrog performance."

Also, in 2009, less than half of hospitals in the survey met Leapfrog's outcome, volume, and process standards for six other high risk procedures and conditions. Research has suggested that following nationally endorsed and evidence based guidelines for these procedures and conditions is known to save lives, Leapfrog suggested.

These procedures, with the percentage of reporting hospitals that fully meet Leapfrog's standard in 2009, are:

• Aortic valve replacement-11.8%
• Abdominal aortic aneurism repair-36.1%
• Pancreatic resection-33.5%
• Esophageal resection-31.5%
• Weight loss (bariatric) surgery-36.6%
• High risk deliveries-29.9%

Research indicates that a patient's risk of dying can be reduced by approximately two to four times—depending on the high risk procedure—if care is obtained from a hospital that meets Leapfrog standards, Binder said. In particular, more than 3,000 deaths could be avoided each year if Leapfrog standards were implemented in hospitals that electively performed these procedures, she said.

Leapfrog's purchaser members use survey results to inform their employees and purchasing strategies. She said "it's going to be very important as we move forward with healthcare insurance reform" that purchasers challenge hospitals if standards are not being met.