Leah Binder: I expected to join an organization that was at the cutting edge of healthcare quality and safety. I expected to join an organization that was somewhat controversial, but as the result of its controversy, has made some real progress in the healthcare world. And what I found was that not only was that expectation correct, but it was about 10 times more controversial and 10 times more effective than I ever thought it would be. So I've been very gratified by this experience.
Jean DerGurahian: And so, when you were talking about controversy, what were some of the concerns?
Leah Binder: Well, I didn't think that the issue of transparency in healthcare quality was controversial when I started at Leapfrog. I thought that we were sort of over that debate, and everyone now agreed that it's important to have information about the quality of healthcare organizations and individual healthcare providers. That it's important to have that information available. That consumers ought to be able to select among providers based on real information about their quality. I assumed that we were over that debate and now it was about which information should be available. I was wrong. In fact, we're not over that debate. In fact, Leapfrog is pretty much alone in many respects in providing information that consumers can use by provider, by hospital to select by quality.
Jean DerGurahian: So Leapfrog has the results of its survey on the Web site. You make that available for anybody to see. There's also Hospital Compare, which is the national public reporting site. What are some of the differences between what you have on yours and what they're measuring?
Leah Binder: Well, Hospital Compare, I should say, is an advance. And we're pleased to see that CMS and HQA (the Hospital Quality Alliance) have produced Hospital Compare. It is a positive Web site. However, it is nowhere near as robust or interesting, frankly, as Leapfrog, and I'll tell you why. First of all, the metrics on Hospital Compare tend to be very narrow process measures that are very interesting to providers, but not very interesting to my mother.
Jean DerGurahian: Could you give me an example?
Leah Binder: My mother'' doesn't care whether the hospital provides aspirin on arrival at an emergency room. She does care about what Leapfrog has, which is: What are your odds of surviving a bypass surgery at one hospital or another? So and that's what Leapfrog provides is mortality data, data about whether the hospital is doing what it's supposed to be doing to prevent infection or to prevent other kinds of safety problems, whether it's got the right type of staffing in place to prevent mortality. That's—those are the kinds of things that consumers want and need to know, and purchasers really are demanding that information because they are investing so much in different hospitals. Hospital Compare looks at the much more narrow process measures of great interest to providers, and that's partly because it's created by providers. So most of the stakeholders who are involved in deciding what goes on Hospital Compare are providers. Many are not, but most are. And, so, what shows up again is information of interest to those providers. And finally the biggest difference between Hospital Compare and Leapfrog is that on Hospital Compare, all of the hospitals look about average. Or, as I like to say, they look above average because most of the metrics are, you know, the hospitals report in the 90th percentile, but almost all the hospitals report around the same range. What you get from Leapfrog is a sense of the variation among hospitals for each one of the standards that we look at. For example, we look at prevalence of pressure ulcers, or bed sores as many Americans know them to be, and we find a tenfold variation between the hospitals on the bottom 10% and those on the top 10%. There's major variation in quality and safety in American hospitals, and Leapfrog reveals it.
Jean DerGurahian: And consumers need to know that.
Leah Binder: Of course, if you had to pick among hospitals, you want to pick the hospital where you're four times more likely to survive a particular procedure. You need to know that information.
Jean DerGurahian: So there's a lot of discussion around measure development, but you think that it needs to move beyond that. What are some of these alliances doing these days that they should be doing better in your opinion, and where it needs to go from here?
Leah Binder: Well, I think alliances are very important. … I really do think that there are some major efforts, some … efforts on behalf of providers and others to be transparent about some of their metrics. I think that there needs to be even more candor and more boldness because that's what consumers need. They need to know, not, again, process measures, and that tends to be what the alliances often are measuring. They really need to know outcomes. They need to know mortality, and they need to know how it varies significantly among hospitals. And, again, in a sort of more regional level, the alliances have the same problem that we see with Hospital Compare and HQA, which is they measure narrow measures and not demonstrating the variation and the differences among providers. We need that.
Jean DerGurahian: And there is Stand for Quality, which is a document that was signed by many organizations, that Leapfrog did not sign, correct?
Leah Binder: Right. Unfortunately, Stand for Quality didn't really meet our standards for transparency. We believe that transparency ought to be not unmitigated, so when we have information about quality, when we collect information about quality, it ought to be made public by providers in a useful fashion, just like Leapfrog does. Stand for Quality, the language first of all didn't use the word “transparency,” for one thing. But when it talked about public disclosure, it said, public disclosure basically of certain information under certain conditions. That's not a direct quote, but that was basically how it was described in various places in the document. So, that's not the Leapfrog standard. The Leapfrog standard is 100% uncompromised transparency.
Jean DerGurahian: You're going to continue with that mission.
Leah Binder: Absolutely. You know, this is critical for purchasers. It's critical for all of us as Americans, but it's critical for purchasers that healthcare reform go well. If we end up with the uninsured, currently uninsured, being put into a public or private plan that does not manage the issue of quality, then we will actually, potentially, accelerate the problems with quality cost effectiveness that are already very substantial in our country. And that would be just a real tragedy if the … of the efforts around healthcare reform results in a system that's even more out of control than we have now. And we have by far the highest per capita health costs of any country in the world. And our quality just simply does not measure up. So, we know based on Leapfrog results in particular where the problems are. We have to be candid and bold about addressing them. And we can all work together and collaborate, but we need to collaborate toward a new day. Not toward maintenance of the old ways of doing things. And so if healthcare reform doesn't address that, we're going to see some real problems in the future. Our commitment at Leapfrog is to really advance 100% transparency, use outcomes data toward payment reform. So pay for the kind of performance we want to see in the healthcare system. And we also have a great interest in monitoring health information technology. We can't just assume that it just immediately cuts costs or improves quality to install a new computer system. Anyone knows that it takes a lot more than that. And Leapfrog certainly knows from our work with computerized prescriber order entry, we are going to be really focused on IT and making sure that implementation proceeds the way it should.
Jean DerGurahian: Great. Thanks for joining us, Leah. This has been a lot of fun.
Leah Binder: Well, thank you for having us. It's great to be here.
Jean DerGurahian: Jean DerGurahian with Modern Healthcare. Thank you.