Can You Minimize Health Care Costs by Improving Patient Safety?

Session 1: What Is the Business Case for Patient Safety?

Presentation by Dolores Mitchell

Via the World Wide Web and telephone, this first session of a Web-assisted audio teleconference series occurred on September 20, 2002. The User Liaison Program (ULP) of the Agency for Healthcare Research and Quality (AHRQ) developed and sponsored the program.

This is the text version of the slide presentation.

Slide 1

Image of Dolores Mitchell, Executive Director of the Massachusetts Group Insurance Commission.

Slide 2

How the Leapfrog Group interprets Institute of Medicine (IOM)—

• IOM report: up to 98,000 people die in United States hospitals yearly from medical errors.
• Business leaders decide to join forces as health care purchaser to deal with this issue.

Slide 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 improvement in safety.
  • Hold health plans accountable for Leapfrog implementation.
• Three initial methods to improve patient safety.
  • Computer physician order entry.
  • Evidence-based hospital referral.
  • Intensive Care Unit (ICU) physician staffing.

Slide 4

The Group Insurance Commission joins Leapfrog in 2001:

• Public commendation.
• Implementation is the hardest part.
• Limitations of best practices and protocols.

Slide 5

Challenges to implementation include:

Structural barriers:

• Purchasers contract with health plans, not hospitals.
• Must use plans as vehicles to get data.
• Put data collection in health maintenance organization (HMO) contracts.
• Include financial penalties for failure.
• Include financial rewards for moving admissions to complying hospitals.
• More than $1 million on the table.

Slide 6

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 three leaps.
• Some resentment at outsides interfering in the business.

Slide 7

The log jam begins to lift:

• Benefit consultant acts as a go between.
• Dana Faber reports.
• Acting as a 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.

Slide 8

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 softy and carry a big stick."

Slide 9

Patient Safety

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

Slide 10

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 with Computerized physician order entry (CPOE) would not report.
• Partial data collected by more aggressive HMOs.

Slide 11

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).

Slide 12

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.

Slide 13

Education:

• Used our newsletter to discuss importance of measures.
• Used our Web site, including links to other Web sites.
• 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.

Slide 14

Purchasing principles:

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

Slide 15

"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.

Slide 16

"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 admissions have adverse events; 28% avoidance).

Current as of March 2003

Internet Citation:

Presentation by Delores Mitchell. Can You Minimize Health Care Costs by Improving Patient Safety? Session 1: What Is the Business Case for Patient Safety? Text Version. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/costsafetele/sess1/mitchelltxt.htm

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