Leapfrog de­fends method­ol­ogy

Modern Healthcare - - OPINIONS / LETTERS -

The Amer­i­can Hos­pi­tal As­so­ci­a­tion wrote to Mod­ern Health­care last week, “Leapfrog tool ‘se­ri­ously flawed’ ” (Aug. 5, p. 16), un­happy with Leapfrog Group’s cal­cu­la­tor that helps pur­chasers iden­tify the mil­lions of dollars in sur­charges they are pay­ing for hos­pi­tal er­rors. Pur­chasers have a right to know how much er­rors are cost­ing them when their em­ploy­ees visit the hos­pi­tal, and we hope the cal­cu­la­tor—which earned the rare Gold Stan­dard des­ig­na­tion by the Dis­ease Man­age­ment Pur­chas­ing Con­sor­tium— will serve as a use­ful tool for pur­chasers mak­ing im­por­tant health­care de­ci­sions.

Be­cause we don’t dif­fer­en­ti­ate be­tween “to­tal cost,” “charges in­curred” and “es­ti­mated ad­di­tional cost,” the AHA sug­gests pur­chasers aren’t jus­ti­fied in iden­ti­fy­ing the mil­lions of dollars they pay for hos­pi­tal er­rors. But thanks to some good re­search in the past few years from the Agency for Health­care Re­search and Qual­ity and the CMS, pur­chasers no longer have to al­low the smoke and mir­rors of hos­pi­tal fi­nance to ob­scure the cold re­al­ity that they are pay­ing real dollars for harm to their em­ploy­ees.

The stud­ies we used to define the sur­charges, which are all made pub­licly avail­able through our cal­cu­la­tor method­ol­ogy and orig­i­nated from re­li­able sources such as JAMA and AHRQ, iden­ti­fied what Medi­care paid for er­rors. By de­vel­op­ing the sur­charge cal­cu­la­tor based on what Medi­care paid, we found that on aver­age, hos­pi­tals with a Hos­pi­tal Safety Score of A had fewer such er­rors than hos­pi­tals with a B, C, D or F. Since the er­rors cost Medi­care money, and since pri­vate pur­chasers pay rates higher than Medi­care, we log­i­cally sur­mised that they cost pur­chasers even more money.

The AHA also as­serts that the cal­cu­la­tor does not ac­count for pa­tients with mul­ti­ple med­i­cal con­di­tions and the ad­di­tional treat­ment they re­quire. But in fact, the cal­cu­la­tor is pow­ered by the num­ber of ad­mis­sions rather than the num­ber of pa­tients. Be­cause em­ploy­ers use their own claims data, they can es­ti­mate their sur­charge based on cur­rent us­age pat­terns for em­ploy­ees ad­mit­ted to hos­pi­tals, re­gard­less of the com­plex­ity of their con­di­tions.

The beauty of the cal­cu­la­tor is that it is fully trans­par­ent and cus­tom­iz­a­ble. If a pur­chaser be­lieves, as the AHA does, that cer­tain vari­ables or as­sump­tions don’t cor­re­late to its per­for­mance, with a few clicks of the mouse that as­sump­tion can be taken out of the cal­cu­la­tion.

For ad­di­tional “ref­er­ence points and val­ida- tion” be­yond what is re­ported in Mod­ern Health­care, I would en­cour­age the AHA and oth­ers to visit our web­site, leapfrog­group.org/em­ploy­er­s_pur­chasers, for ci­ta­tion of the stud­ies that val­i­date our cost es­ti­mates and the as­sump­tions we used. You can also visit the Dis­ease Man­age­ment Pur­chas­ing Con­sor­tium to view the cal­cu­la­tor’s Gold Stan­dard val­i­da­tion of Leapfrog’s method­ol­ogy, dis­mgmt.com/gold-stan­dard/list­ing.

In re­cent years, the AHA has demon­strated lead­er­ship as an ad­vo­cate for in­creased trans­parency and pub­lic re­port­ing, and their lead­er­ship in pa­tient safety is im­pres­sive. We ap­plaud th­ese ef­forts. The more in­for­ma­tion we have on health­care qual­ity and costs, the fewer as­sump­tions we’ll have to make about the ex­tent of the prob­lem. But in the mean­time, we have more in­for­ma­tion than we ever did be­fore, and pur­chasers and con­sumers de­serve to know all that they can about pro­tect­ing their lives and their pock­et­books.

Leah Bin­der Pres­i­dent and CEO Leapfrog Group

Wash­ing­ton

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