Editor's note: Sharmila Shankarkumar recently sat down with Leah Binder, President & Chief Executive Officer of the Leapfrog Group to learn more about her organization's efforts to improve healthcare quality and safety.
Sharmila Shankarkumar (SS): What was your personal journey to becoming the CEO of Leapfrog?
Leah Binder (LB): It was an unlikely journey. I had actually never been interested in health care as a career. I was afraid of the sight of blood! But when my dad fell sick I saw how important hospitals are in the lives of patients and their families. After college, I started my career with the National League of Nursing, working for Pam Maraldo, an exceptional and inspiring leader. It turned out to be a great decision. I learned a lot about health policy and we're still working on some of the same issues today that I was working on in the 90s – quality, transparency and patient empowerment.
I spent four years doing health policy work for New York City Mayor Rudolph Giuliani and then relocated to Maine to work for a rural hospital system. They participated with Leapfrog and had seen real improvement in patient safety. So after 8 years at the hospital, when I saw a position listed for CEO of Leapfrog, I remember thinking – this is my dream job!
SS: How would you describe the mission and purpose of Leapfrog?
LB: A purchaser-driven movement to dramatically improve the safety and quality of healthcare in the US. We use the power of transparency to give people choices in the marketplace.
SS: What data does Leapfrog provide on safety and quality?
LB: We collect and publicly report information from about 2,000 hospitals on the safety and quality of care they provide through the annual Leapfrog Hospital Survey. In addition, whether hospitals voluntarily report to our survey or not, we give all general hospitals a grade on their safety (A-F). To calculate a grade, we work with experts and combine our survey data—if we have it – along with CMS data to come up with an overall composite grade. Our grades, which are updated every six months, have been enormously successful in moving the ball forward on patient safety.
We've also become a leading source for data that’s important to consumers and purchasers but not readily available in claims data. For example, our survey includes questions about maternity care since it's the #1 service provided by hospitals and C-sections are the #1 surgery. Purchasers would like the ability to inform families on where C sections are occurring without medical necessity. We collect data on a standard C-section rate so the right comparisons can be made.
SS: What do you think drives a hospital’s decision to participate or not?
LB: The reason that’s often given to us is that it’s too burdensome. But the real reasons for non-participation are often that the hospital is concerned about their performance and they don’t want to publicly report it. Hospitals don’t have a culture of transparency. Even a hospital with a big name might not want to risk letting Leapfrog look under the hood.
The interesting thing is, once they start participating, they find it quite valuable. It helps create momentum for change, and helps them stick with it.
But fundamentally, the most important reason hospitals report to Leapfrog is because employers and other purchasers ask them to. They get letters from purchasers in their area, and business coalitions on health, requesting their data be provided through Leapfrog. In turn, purchasers can use the data and make it available at no cost to the public. Leapfrog was built by, for, and about purchasers having some way of using their leverage to get the information they need, which is why we encourage all purchasers to ask hospitals for Leapfrog participation. You may not always have exactly the data you will want and need from CMS—depending on Washington’s latest politics—so purchasers need Leapfrog to make sure they always have the power of a transparent market.
SS: More recently you started publishing Safety Grades using CMS data. This means you’re able to report on this for a 100% of hospitals whether they choose to participate or not. Tell us about this decision.
LB: In 2010 there was a lot of discussion in the press around whether we had made progress on patient safety. It was the 10th anniversary of the report from the Institute of Medicine, which suggested that over 100,000 patients are dying every year from preventable medical errors. Leapfrog had to ask ourselves, are we on the right track? We were committed to the principle that transparency would lead to improvements. But not all hospitals were transparent, and too many declined to report to our survey. If they declined to report, they got a pass. How were we to fix this?
Our eureka moment came when one of our Board members talked about the letter grades used by restaurant inspectors in LA and New York City. Restaurants are required to post the letter grade on their front door, and it has fundamentally changed restaurant response to hygiene. Why not do something like that for hospital safety? So using data publicly available from CMS, we would publish letter grades for each hospital whether they chose to participate in our survey or not. There was a tremendous amount of opposition to this from some hospitals. But we refused to back down. We continue to issue these grades and update them every 6 months for over five years and it has been very successful.
SS: What are you most proud of that Leapfrog has accomplished?
LB: Leapfrog has put patient safety front and center on the priority list for almost every hospital in the US. Our letter grades are fully transparent – the information explaining how we got to the letter grade is publicly available. This means the Board of Directors, staff and patients can see the metrics. The Board might ask the question – how come we got a C? When those questions start getting asked in the Boardroom, everything changes. We’ve heard anecdotally that many executive incentive compensation plans use our letter grades as performance metrics.
SS: What do you believe are the biggest challenges to improving safety and quality of healthcare in the US? How might we overcome these challenges?
LB: The biggest challenge is that we still have way too many people dying from errors and accidents in hospitals and too many harmed by avoidable errors and accidents in healthcare in general. A recent study in BMJ suggested the number is around 200,000 avoidable deaths every year, making safety problems the third leading cause of death in the U.S.
There is a remarkable lack of precision in this country to recognize when these events are happening. It’s very difficult to pinpoint the problem in claims data but researchers who have done so, like Atul Gawande, find dramatic increases in costs related to these problems.
An important step to overcoming this challenge is incorporating safety into value-based purchasing initiatives. This is important since safety can nullify the value equation. An error in post-operative care, or an infection, can nullify the value of a positive surgical outcome. When this happens the financial and human costs are enormous and far outweigh the absolute cost of the surgery. So the infection and error rate of a facility should be a critical factor in a value-based contract, and that’s where Leapfrog in particular can help.
Health care is a team sport. It's not enough to pick the right surgeon. Most of the care you receive comes from nurses and teams of people, during the surgery and afterward. You have to make sure the whole team works well and puts a priority on your safety.
SS: How might employers and health plans use Leapfrog data?
LB: Make the Leapfrog Survey data and letter grades available to health plan members through decision support tools. Put pressure on transparency vendors, health plans and TPAs to make sure they disclose Leapfrog quality data and the letter grades. For instance, all plan members should know the standardized C-section rate of hospitals in the network and how those rates compare nationally—that’s data only available through Leapfrog. Be forewarned that plan administrators may be reluctant to publish information that contradicts their own provider or center of excellence designations. Incorporate Leapfrog data into payment strategies including direct contracting and pressure insurance carriers and TPAs to make safety a priority when negotiating arrangements with providers. Leapfrog also developed a value based purchasing tool that helps plans and purchasers calibrate payment to quality and safety metrics, all of which are in turn tied to cost-effectiveness.
The number one thing any purchaser can do is ask hospitals in their region or network to participate in Leapfrog. Better yet, insist on it as a term of contract. Because transparency is the least any employer should expect for the enormous investment they make in employee health.