What Is the Business Case for Patient Safety? Costs and Potential Costs Savings A Leap Frog Case Study

1
What Is the Business Case for Patient
Safety?Costs and Potential Costs SavingsA Leap
Frog Case Study

• Dolores Mitchell
• Executive Director, Massachusetts Group Insurance
  Commission, Boston, MA

2
The Leapfrog Group

• IOM Report up to 98,000 people die in US
  hospitals yearly from medical errors
• Business leaders decide to join forces as health
  care purchasers to deal with this issue

3
The Leapfrog Group

• To mobilize employer purchasing power to save
  lives and reduce preventable medical mistakes
• Inform and educate employees
• Use incentives for breakthrough improvements in
  safety
• Hold health plans accountable for Leapfrog
  implementation
• Three initial methods to improve patient safety
• Computer physician order entry
• Evidence-based hospital referral
• ICU physician staffing.

4
Group Insurance Commission Joins Leapfrog in 2001

• Public Commendation
• Implementation is hardest part
• Limitations of Best Practices and Protocols

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Challenges to Implementation

• Structural Barriers
• Purchasers contract with health plans, not
  hospitals
• Must use plans as the vehicle to get data
• Put data collection in HMO contracts
• Included financial penalties for failure
• Included financial rewards for moving admissions
  to complying hospitals
• More than 1 million on the table

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Challenges to Implementation

• Economic Barriers
• Timing in life is everything.
• 2001 not the best of times.
• Health plans under attack.
• Hospitals in financial stress.

• Institutional Barriers
• Hospital Associations not supportive.
• Critical of the three leaps
• Some resentment at outsiders interfering in their
  business.

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Log Jam Begins to Lift

• Benefit Consultant acts as a go-between
• Dana Faber reports
• Acting as mediator sets up meeting with selected
  hospital leaders GIC and national Leapfrog
  leaders to thrash out issues
• Sets up negotiating sessions with major hospital
  system
• Compromise reached - reporting deadlines delayed
  in exchange for commitment to report

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Lessons Learned

• Patience combined with quiet persistence works
  best
• There is strength in numbers
• Keep the message simple and focused.
• Dont demonize the other side
• Compromise on the small points
• Speak softly and carry a big stick.

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Patient Safety

• Low profile on the public agenda
• Purchasers concerned about quality not safety
• Hard to get consumer interest
• Patients assume both quality and safety

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The Early Bird Sometimes Finds it Hard to Hold on
to the Worm

• Good press, both national and local
• GIC, State of Maine, Mass Medicaid still not able
  to get hospitals to report
• Even hospitals who had CPOE would not report
• Partial data collected by more aggressive HMOs

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There is Strength in Numbers

• GIC, Medicaid joined by Verizon, GE, Fidelity,
  and the Mass Healthcare Purchaser Group, agree to
  form a joint committee to make Massachusetts a
  roll-out state
• 19 areas throughout America are now rolling out
  the program
• Leapfrog now covers 30 million consumers
• Hospital after hospital begin to report (28
  hospitals, or 40.3 as of September 1, 2002)

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Next Steps

• Cooperate with Leapfrog committee to publicize
  the hospitals that report and comply
• Encourage financial incentives for complying
  program
• Publicize complying hospitals in our annual
  enrollment materials

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Education

• Used our news letter to discuss importance of
  measures
• Used our website - including links to other
  websites
• Review plans by our HMOs to do their own
  education and outreach
• Made ourselves available to the press, as
  speakers at professional meetings to discuss
  safety issues

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Purchasing Principles

• Educate and inform enrollees
• Compare at the provider level
• Reward superior provider online
• volume
• pay for performance
• public recognition

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Leaps and Cost Savings

• Computerized physician order entry (CPOE)
• Prevent 8 of 10 serious drug errors
• Brigham and Womans reported a per event cost of
  4,500 or 2.8 million per year
• ICU daytime staffing with an intensive care
  specialist
• 10 morbidity reduction

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Leaps and Cost Savings

• Evidence based referrals for 7 high risk
  procedures
• 20 morbidity reduction
• COST is 1.4 million plus 500,000 per year
  maintenance or 5 million in savings if you add
  avoidance of ADE and greater efficiency of drug
  use (6.5 of admits have adverse events 28
  avoidance)