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Whats New in 2008: The Leapfrog Hospital Survey

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Title: Whats New in 2008: The Leapfrog Hospital Survey


1
Whats New in 2008 The Leapfrog Hospital Survey
  • April 16, 2008

2
Town Hall Call Overview
  • Introduction
  • Survey Team
  • Leapfrog and the Hospital Surveywhy complete?
  • Goals for 2008 survey
  • Survey Submission Logistics/Timeline/Website
    Resources
  • Whats New for 2008
  • Approach to the Survey
  • Detailed review of survey questions
  • Safe Practices Score
  • Computerized Physician Order Entry (CPOE)
  • Intensive Care Physician Staffing (IPS)
  • Evidence-based Hospital Referral (EBHR)
  • Never Events
  • Transparency Indicator
  • Hospital Acquired Conditions
  • Common Acute Conditions
  • Q A
  • Schedule for Town Hall Special Calls

3
Why Complete Leapfrog Survey?Unique in the Milieu
  • Represents employers/purchasers/consumers
    interests
  • Seeks public accountability/transparency
  • Rewards high performance
  • High impact performance measures not the low
    hanging fruit (e.g., CPOE, IPS, EBHR, HACs)
  • Full range of measuresstructural, process and
    outcome (but focused on outcome)
  • Regional and national in scopeall payer
    information
  • Standardized measures to assure same fruit is
    sampled
  • Harmonized with other major national performance
    measurement programsbut shows more complete
    picture of care delivery
  • Significant hospital input for 2008 survey

4
Survey Review Process
  • Steps in the process to revise the survey have
    included 
  • (August, 2007) Roundtable calls - A
    representative group of hospitals that completed
    the 2007 Leapfrog Hospital Survey participated in
    three roundtable calls to share comments and
    feedback on the 2007 survey.
  • (October, 2007) First review 14 hospitals
    reviewed an early draft of the proposed changes
    to the 2008 Leapfrog Hospital Survey and provided
    feedback to Leapfrog.
  • (November , 2007) - Public review and comment
    period hospitals were invited to share comments
    and feedback on the proposed changes for the 2008
    Leapfrog Hospital Survey. 
  • (January, 2008) - Pilot test of revised survey
    19 hospitals participated in a test of the draft
    2008 Leapfrog Hospital Survey and provided
    feedback to Leapfrog.
  • (February, 2008) - Pilot of CPOE test Eight
    hospitals participated in a test of the CPOE
    evaluation tool and provided feedback to Leapfrog.

5
Behind the Changes in 2008
  • Goals for the new survey
  • Streamline surveyreduce burden
  • Reduce ambiguity in language in Safe Practices
  • Support CMS initiatives (HACs)
  • Align with other performance measurement groups
  • Provide two composites that are important to
    consumers and purchasers
  • Efficiency of care
  • Survival predictor
  • Incorporate Leapfrogs Pay for Performance
    program

6
How did we do?
  • Significantly reduced survey question pagesnow
    66 pages vs 106 pages
  • Language in Safe Practices tightened to reduce
    ambiguity/increase action on safety
  • Added LHRP conditions and efficiency
  • Added 2 hospital acquired conditions identified
    by CMS
  • Reduced LF-developed measures down to only a
    fewhospitals can report their results from other
    data collectionslowering burdenbut providing
    full picture of care

7
Survey Submission Logistics, Timeline, Website
Resources
8
Submission Issues
  • Security Codes and CEO Delegation
  • Survey Affirmations and Maintaining survey
    records of answers
  • Helpdesk services
  • Website resources

9
Survey Security and Integrity
  • Core principle hospital self-certification
  • Executive authority . . .and accountability
  • Survey security and integrity are critical
  • 16-digit security code
  • Authorization to access granted only to
  • CEO . . . can provide code directly to any
    delegate(s)
  • CEO-authorized delegate . . . Help Desk can email
    security codes

10
Regional Rollout Contacts
  • RRO contacts
  • Identified on survey home page
  • Help Desk refers RRO hospitals to contact for
    16-digit code
  • Hospitals should consider getting CEO Delegation
    authorizations for alternative hospital contact
    person fax authorizations to the Help Desk

11
Survey Helpdesk Available
  • Survey Helpdeskdesigned to respond within 48
    hours of question (unless it requires an expert
    panel member to respond)
  • Dont wait until June 30if you have a problem
    you likely will not make deadline..
  • Survey must be completed before CPOE
    certification. If completing MUST do before last
    week in June otherwise will not be able to get
    Help Desk support
  • Helpdesk link on survey homepage
  • leapfrog.medstat.com

12
2008 Timeline
  • April 1, 2008Leapfrog Launches 2008 Survey
  • June 30, 2008- RRO targeted hospitals report or
    be listed on Leapfrogs Web site as Did Not
    Disclose
  • July 7, 2008 Website lists new results
  • Top Hospitals List--Recognition
    programs/initiatives will be done in 2008
    beginning as early as mid-September

13
Website Resources
  • To assist hospitals in completing the Survey,
    Leapfrog makes the following tools available
  • Frequently Asked Questions
  • Overview of Whats New in 2008?
  • Fact sheets on Each Leap (including bibliography
    information)
  • White Papers on Severity-adjustment for LOS, and
    Survival Predictor
  • Scoring Algorithms
  • End Notes
  • Specifications for measuring and reporting rates
    of Hospital-Acquired Conditions
  • Link to purchase NQF Safe Practices Revised
    Handbook

14
Website Resources for EBHR
  • Medical Coding for High-Risk Procedures and
    ConditionsProcedure code, diagnosis codes and
    other specifications for counting high-risk
    surgery volumes
  • Publicly Reported Outcomes for CABG and PCIFor
    hospitals in CA, MA, NJ, NY and PA publicly
    reported risk-adjusted mortality rates for
    responding to survey questions about PCI (MA, NY
    only) and CABG (all five states).
  • Process Measures -- SpecificationsDetailed
    specifications for Leapfrogs procedure-specific
    process measures of quality -- for CABG, PCI, AAA
    Repair and high-risk deliveries.
  • Resource Utilization Measures Specifications
  • Detailed specifications for Leapfrogs CABG and
    PCI including
  • Coding for counting eligible cases
  • Coding and other criteria for identifying cases
    with risk factors
  • Specifications for reporting geometric mean
    length of stay
  • Criteria for identifying cases followed by
    readmission
  • Excel Tool for Computing Geometric Mean Length of
    Stay

15
Website Resources for Common Acute Conditions
(CAC)
  • Volume Standard Coding Medical Coding for
    Chronic Acute Conditions
  • Procedure/diagnosis codes and other
    specifications for counting AMI and Pneumonia
    volume
  • Process Measures - SpecificationsSpecifications
    for Leapfrogs nationally-endorsed
    procedure-specific process measures of quality --
    for AMI and Pneumonia.
  • Resource Utilization Measures Specifications
  • Detailed specifications for Leapfrogs Common
    Acute Conditions (AMI and Pneumonia) including
  • Coding for counting eligible cases
  • Coding and other criteria for identifying cases
    with risk factors
  • Specifications for reporting geometric mean
    length of stay
  • Criteria for identifying cases followed by
    readmission
  • Excel Tool for Computing Geometric Mean Length of
    Stay

16
Whats New for 2008
17
Survey Changes The Details
  • Computerized Prescriber Order Entry Evaluation
    Tool
  • Streamlined Safe Practices
  • Hospital-Acquired Conditions
  • Common Acute Conditions AMI Pneumonia
  • Efficiency of Care Score
  • Additional Evidence Based Hospital Referral
    Changes
  • Survival Predictor
  • Surgeon Volume Dropped
  • Public Reporting Additions- Mass North. New
    Engl.
  • NICU Volume Change
  • Bariatric Volume Standard Increases
  • Expansion of ICU Physician Staffing (IPS)
  • Leapfrog Hospital Rewards Program Changes
  • Other Hospital Recommendations

18
Computerized Prescriber Order Entry (CPOE)
Evaluation Tool
  • The CPOE Evaluation Tool provides hospitals an
    opportunity to assess the hospitals
    implementation of system alerts for potential
    medication-related adverse events
  • Test involves a hospital loading
    computer-generated patient profiles and
    medication orders into their CPOE system and
    reporting back on the alerts they received
  • Hospitals must complete the test to achieve
    either Fully Meets or Good Progress on the CPOE
    Leap in 2008
  • In the 2008 survey, scored results will not be
    used, only the fact that the hospital tested its
    system. In 2009, scores from the test will be
    used.
  • Hospitals access the tool from the survey website
    once they have completed the CPOE section of the
    online survey (i.e. CPOE Q1YES).
  • Same security code as survey.

19
CPOE Evaluation Impact on Overall CPOE Score
  • 2008 survey cycle successful completion of test
    is the only requirement for credit in CPOE
    overall score
  • 2008 survey scoring algorithm
  • Fully implementedCPOE implemented, 75 IP
    orders, and appropriate test completed
  • Good progress (3/4)CPOE implemented, orders, and appropriate test completed
  • Good early stage effort (1/2)CPOE implemented
    ORSelecting/implementing, written strategy,
    budgeted, champion
  • Will to report publiclyCompleted CPOE section
    of survey
  • 2009 Leapfrog will release results of test,
    scoring criteria TBD

Adult inpatient test for adult/general hospital
(pediatric test optional) pediatric test for
childrens hospital
20
CPOE Evaluation Scored Results, Sample
21
CPOE Evaluation Scored Results, Sample (contd)
22
Feedback on CPOE Evaluation Tool



  • No
    questionthis is a valuable experienceit is very
    important work and it should be applauded.
  • David Stockwell, Patient Safety Officer
  • Childrens National Medical Center

23
Streamlined Safe Practices
  • Through numerous hospital roundtable calls, we
    heard substantial feedback from hospitals on the
    length and the ambiguity of the 2007 Safe
    Practices section
  • The 2008 Safe Practices chosen for hospitals to
    report on are those that have the strongest
    supporting evidence and are not measured in other
    sections of the survey
  • The 2008 Safe Practices section focuses on 13 of
    the 27 non-Leapfrog-created Safe Practices
  • The Safe Practices have kept the 4A framework,
    but have been re-worded to make the questions
    more tightly defined and actionable
  • Hospitals that wish to continue to report on all
    27 Safe Practices may do so through TMIT.
    Leapfrog will recognize hospitals that do so as
    part of the surveys Transparency Indicator
    section.

24
Safe Practices 2008
  • Basic design of survey ( 4 As) remains the same
  • Awareness
  • Accountability
  • Ability
  • Action
  • Changes to the content
  • Revisions to existing measures
  • Individual practice weighting remains the same as
    2007, but overall is now 707
  • Fewer questionsmore crisply defined actions

25
13 Safe Practices
26
Hospital-Acquired Conditions
  • New section added on two hospital-acquired
    conditions for which CMS has indicated they will
    no longer reimburse hospitals
  • This survey cycle measures hospital-acquired
    pressure ulcers and hospital-acquired injuries
    (burns, falls, etc.)
  • Results will be reported as a rate per inpatient
    days
  • Pressure ulcers aligned with IHI 5 million lives
    campaign
  • These two conditions can be identified by
    hospitals using the same codes that CMS is using
    for its payment reduction
  • Hospitals will need to rely on CMS-required
    Present-On-Admission coding to identify which
    conditions occurred during the hospital stay.
  • Hospitals have until October 31, 2008, to report
    on six months of data to the survey after that,
    results will indicate Did not measure or report
    this information

27
Common Acute Conditions
  • New section focused on two common acute
    conditions -- Acute Myocardial Infarction (AMI)
    and Pneumoniaboth were measured in LHRP
  • Quality measures for these conditions are based
    on CMS/Joint Commission Process Measures of
    Quality
  • Scoring thresholds for the quality of care
    process measures are set based on historical
    Joint Commission data
  • Resource Utilization is measured using severity
    adjusted LOS inflated by readmission
  • Resource Utilization combined with safety and
    quality measures produce an Efficiency of Care
    score for these two conditions

28
Resource Utilization Measures
  • Measure Severity-adjusted average length of stay
    inflated by readmission rate
  • Length of stay associated with resource
    utilization
  • Readmission used as inflator to avoid perverse
    incentive
  • (inappropriately releasing patients too early)
  • Measurement is specific to a condition--added to
    compliment quality measures for four procedures
    /conditions CABG, PCI, AMI, and Pneumonia
  • For each procedure/condition, hospitals are asked
    to report
  • the average length of stay (logarithmically
    transformedGEOMEAN),
  • the number of cases followed by any readmission
    to that hospital within 14 days for any cause,
  • a count of cases with certain risk factors
    present

29
Resource Utilization Reporting
  • The clinical information (risk factors) and
    LOS/Readmission statistics needed to report these
    data can be accessed from the hospitals
    administrative data system no chart abstraction
    is necessary
  • Hospital will use an automated worksheet to
    calculate GEOMEAN for LOS (see next slide)
  • LF will report the efficiency of care scores as a
    composite of the two scores and a drilldown of
    quality and resource utilization scores

30
GEOMEAN Calculator
31
Evidence Based Hospital Referral (EBHR) Changes
  • Additional statewide and regional public
    risk-adjusted mortality outcomes recognized
  • Massachusetts for CABG and PCI
  • Northern New England Cardiovascular Disease Study
    Group (NH, ME, and VT) for CABG, PCI, and AVR
  • NICU census changed to annual count of very-low
    birthweight babies 50 required to fully meet
    standard
  • Based on research by Ciaran Phibbs, Ph.D., and
    others
  • All hospitals in the 50group were over 15
    average daily censusreverse not truethus,
    raising the bar!
  • Reporting time periods specified for those not
    participating in a specific reporting program
  • Resource utilization measures added to CABG and
    PCI

32
EBHR Survival Predictor Added
  • No additional questions from last year
  • Survival predictorbased on volume and
    non-adjusted in-hospital deaths--a composite
    measure that predicts future hospital performance
    on mortality
  • Takes into account number of cases via weightsso
    that reliability related to small numbers is
    assured
  • No predictor for bariatric surgery in this survey
    cycle
  • DevelopersDrs. Justin Dimick and John Birkmeyer,
    U.Mich Medical School, Doug Staiger from
    Dartmouth
  • Reported as independent score on consumer pages
  • White paper available on LF website
    http//www.leapfroggroup.org/news/leapfrog_news/47
    29468

33
EBHR Surgeon Volume
  • Given addition of the survival predictor
    surgeon volume was droppedexcept for bariatric
    surgeries (no survival predictor available yet)

34
Expansion of IPS
  • IPS Leap expanded to include neuro ICUs (first
    specialty ICU included in the standard)
  • Patients in a neuro ICU must be managed or
    co-managed by neuro-intensivists or critical
    care intensivists
  • Neuro-intensivists are classified as
    neurologists and neurological surgeons who are
    board-certified in their primary specialty and
    who have completed a UCNS-certified fellowship
    training program in neurocritical care, or a
    physician who is board certified in
    neuro-critical care.
  • Use of neuro-intensivists only applies to neuro
    ICUs

35
Leapfrogs Hospital Rewards Program Changes
  • A revised Leapfrog Hospital Rewards Program
    (LHRP) will be based solely on Leapfrog survey
    data
  • Key data elements of Leapfrog Hospital Insights
    (LHI) were included in the 2008 survey (LHI
    database eliminated)
  • Any hospital submitting a completed 2008 Leapfrog
    survey now meets all the reporting requirements
    for participation in licensed LHRP programs
  • A current survey must be submitted by June 30,
    2008 to be included in July 2008 LHRP results. An
    updated 2008 survey must be re-submitted in
    November/December 2008 to be included in January
    2009 LHRP results.

36
Other Hospital Recommendations
  • Hospitals requested a revamp of the organization
    of ancillary documents for each section of the
    surveythis will take place in the 2009 survey
  • Revamp of the websitehospitals often had
    difficulty finding documentshave changed
    document names to better reflect section of the
    survey
  • Page references to the specific Safe Practices
    section which the survey question relates to are
    included in the paper copy of the survey

37
Questions?
38
Dates of Town Hall Specialty Calls
  • Severity adjustment for LOS (resource utilization
    measure) -- April 25, 2 PM EDT
  • CPOE Tool -- May 2, 11 AM EDT
  • Survival Predictor -- May 7, 2 PM EDT
  • Check News Events on Leapfrogs website for
    call details and materials
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