# Presentation: 520020

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

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

**Notes:**
Len Nichols’ slides for the presentation “Trends in the Uninsured: Impact and Implications of the Current Economic Environment.” 

Len Nichols is the Vice President of the Center for Studying Health System Change.

## 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

## 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.

## Group Insurance Commission Joins Leapfrog in 2001

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

## 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

## 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.

## 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

## Lessons Learned

- Patience combined with [quiet] persistence works best
- There is strength in numbers
- Keep the message simple – and focused.
- Don’t demonize the other side
- Compromise on the small points
- “Speak softly and carry a big stick”.

## 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

## 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

## 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)

## 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

## 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

## Purchasing Principles

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

## “Leaps” and Cost Savings

- Computerized physician order entry (CPOE)
- Prevent 8 of 10 serious drug errors
- Brigham and Woman’s 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

## “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)