Hospitals won't have to leap quite as high to attain three ambitious but controversial patient-safety goals promoted by the Leapfrog Group as factors in choosing one facility over another.
The Washington-based coalition of 135 healthcare purchasers last week announced a loosening of the standards it had been requiring of the nation's inpatient facilities in a campaign to accelerate the pace of safety initiatives.
Providers and trade groups, including the American Hospital Association, had criticized the initial Leapfrog set of goals ever since their rollout in May 2001, calling them too expensive and difficult to implement in short order. Leapfrog Executive Director Suzanne Delbanco said the standards were set high on purpose, referring to the goals as "leaps."
Acknowledging a steady stream of concerns from the healthcare industry as well as new research, Leapfrog officials said they revised requirements to make it easier for hospitals to meet qualifications in three areas: operating a computerized system for placing medication orders; using specially trained physicians called intensivists to manage intensive-care units; and meeting high-volume requirements for certain high-risk procedures.
Delbanco forecast those "refinements" two months ago in an exclusive interview with Modern Healthcare, during which she also announced a new working relationship between Leapfrog and the Centers for Medicare and Medicaid Services to broaden the push to reward quality and make providers accountable (Feb. 10, p. 17).
For example, hospitals were given an extra year, until 2005, to begin using an information system in which physicians and other clinicians enter medication orders and are alerted to drug or allergy interactions. Leapfrog also simplified the definition of full implementation and agreed to give hospitals partial credit if they have implemented the system in at least one area of the hospital.
In feedback from hospitals and trade groups, Leapfrog recognized that such multimillion-dollar information technology investments represent a significant line-item expense that requires governing board approval, and the implementation requires advance work to make it acceptable to physicians, said Arnold Milstein, medical director of the Pacific Business Group on Health and a Leapfrog board member.
The coalition also broadened the definition of an intensivist to include physicians who might not be board-certified in that specialty but have a long record of full-time experience in an intensive-care setting. And it yanked a volume-based measure of proficiency in treating one high-risk procedure, carotid endarterectomy, after new research countered previous findings that hospitals doing more procedures had better outcomes.