Speaker 1 00:00:00 1 in 4 of the Medicare beneficiaries suffered some form of harm that while at a hospital. I mean, that's horrendous.

Speaker 2 00:00:17 Welcome to Off the Chart: A Business of Medicine Podcast, featuring lively and informative conversations with health care experts, opinion leaders, and practicing physicians about the challenges facing doctors and medical practices. I'm your host, Austin Littrell. This episode features a conversation between Medical Economics senior editor Richard Payerchin and Leah Binder, president and CEO of The Leapfrog Group. They're talking patient safety, along with other big trends in patient care.

Speaker 3 00:00:46 I'm Richard Payerchin, reporting for Medical Economics. With me today is Leah Binder, president and CEO of The Leapfrog Group, a leading national organization that advocates for patient safety. Thank you for joining us today.

Speaker 1 00:01:00 Thank you for having me. It's great to be here.

Speaker 3 00:01:04 And in year 2025, the leapfrog Group is going to have a special anniversary. And we'll talk about that in a moment. I think most of our readers and viewers are familiar with your organization, but just for those who aren't.

Speaker 3 00:01:14 Can you give a brief introduction?

Speaker 1 00:01:17 Sure. We are a national nonprofit. 5401501 C3. A national nonprofit, we were founded in 2000 by employers. So some very large companies that most of us are familiar with like Boeing and Marriott, GE, GM, major companies that came together to try to work together to improve the quality of health care their employees were getting and the American public at large was getting. And so they formed Leapfrog as a way to allow for, comparing hospitals on how safe they were for their patients and making that information available publicly so their employees and everybody could compare among hospitals before choosing one. So really, the idea was to use really a fundamental principle of a free market to try to improve the safety, in particular of health care in the country. So we we still do that 25 years later. We are still publicly reporting on hospitals. And now we also report on ambulatory surgery centers. And we are reporting how safe they are for their patients and making that publicly available. And we still, work very closely with a network of now hundreds and hundreds of employers across the country, as well as patient advocates.

Speaker 3 00:02:38 I know that there are, you know, different academic and scientific studies that come out regarding hospital and health systems safety, either citing some of that research or maybe just in your own words, how would you describe the current status of patient safety in American health care, especially in hospitals and health systems?

Speaker 1 00:02:58 I think there's good news and bad news. So I'll start with the bad news. The bad news is that a lot of the data is quite disturbing. So there's, just a couple of years ago, the Office of Inspector General, which oversees HHS, came out with a study around Medicare beneficiaries using hospitals. And they basically pulled a random set of something like 800 records of Medicare beneficiaries out of hospitals. And they went through them to see how often those patients were harmed during the stay. And the results were really terrible. They were 1 in 4. 1 in 4 of the Medicare beneficiaries suffered some form of harm that while at a hospital. I mean, that's horrendous. I mean, there's just no other industry where a rate of 1 in 4 harmed would ever be tolerable.

Speaker 1 00:03:51 It's just not even close to it. 1 in 1,000,000. If you run a business like a automaker, that 1 in 1,000,000 harms, it would be very high to you. I mean, 1 in 4 is really not good, really bad. So. So there's disturbing data and then we still have, estimates, but they're increasingly, accurate estimates, I would say, on the numbers of people who die from preventable errors and accidents, infections and hospitals. I mean, they're they're not precise numbers, as I said, but they are more accurate than they used to be. And they're they're anywhere from, you know, 2 to 250,000 people, which would make it the third leading cause of death in the country. So that's the bad news. The bad news is it's terrible. It's a terrible situation. And the good news is it's preventable. And we know it's preventable in large part because we see it, prevent it. And we're seeing that from some extraordinarily successful hospitals that are showing us the way.

Speaker 1 00:04:51 And it's not just one hospital here and there. It's a good number of hospitals and even hospitals that are still working on improving and still may not be the superstars in absolutely every aspect of safety are still showing us a pathway forward with 1 or 2 things. I'm seeing just extraordinary light coming from hospitals all over the country, where they're showing us that they can actually accomplish real change. So, for instance, we had a poster session at our annual meeting back in December, and we at the poster session, invited hospitals to show us what are they doing to improve on metrics that leapfrog measures. And we saw extraordinary examples. But I will tell you that not all of those examples came from hospitals that got A's from leapfrog. And we we grade hospitals on how safe they are. And we have a kind of famous hospital safety grade. And some of those hospitals that were at our poster session had CS, and some of them even had a D. And those hospitals showed us, for instance, how they are improving on central line infection rates or how they've shown a reduction in falls.

Speaker 1 00:06:00 They are working hard and they're getting results. And so that's part of the good news. And we see that in national statistics. So it's not only anecdotal. It's not only what I see just going around the country talking to hospitals all the time. We see it in real data. There was a study that came out a couple of years ago, from, Yale. Yale has a program in health measurement that's just renowned. And they did a study looking at, looking at trends in, hospital safety. The study was talking about, different conditions that people come into the hospital for and how the, complication rates were changing for those different conditions. So as a result, I think people overlooked the significance of the study to patient safety because it was sort of pivoting around these conditions like heart disease. But in fact, what they showed for patient safety was really pretty dramatic. reductions and things like, like central line infections or other kinds of infections and, adverse events, they showed really significant reductions, like 20 and 30 and 40% in some of them over the period of a decade.

Speaker 1 00:07:18 We've never seen change in patient safety before that. I mean, this is one of those issues that for those of us who've been in health, health care for a long time, we've talked about it forever. And the the you know, the lament has always been, oh, patient safety. It never gets better. It never changes. Why can't we do anything about it? You know, pound our our fists on the table. Why can't we do anything about this. That's been the lament. And we sort of do that still. But now we're seeing change and we've started to figure it out. So I think those are the that's the good news, that we're on the right path. We've got we figured something out in this country. We are getting that change. Hospitals are really intent on it, and we need everybody to pitch in because we can we can change this. We can save these lives.

Speaker 3 00:08:04 You know what I think that's a I think is a great segue, because there is an element that I really want to make sure that I, that I touch on here.

Speaker 3 00:08:11 We talked about this just kind of preliminarily, but as more physicians and especially primary care doctors are employed by hospitals and health systems, how do you see their role evolving to improve patient safety in those institutions?

Speaker 1 00:08:26 I think it's very important for physicians to use their voice in and learn how to use their voice in larger systems, to the extent they don't know how to do it now, and many do. So that I'm not saying none of them know how to do it. But I think that for especially for primary care physicians who especially if they come in newly into a health system, they may be navigating some sometimes treacherous political waters. But sometimes it's kind of bewildering. New requirements and new bureaucratic rules and regulations and things like that. And may feel somewhat intimidated or may feel like their voice doesn't matter. Their voice matters a lot. And in fact, their voice is maybe a hundred times more powerful than their patients voice. So every time you speak up, you are speaking for your patients. And that is why it is so critical for you to find that voice, find that niche, find a way to be heard.

Speaker 1 00:09:25 Because I do think primary care physicians are more or tend to be more, patient focused. I mean, the position is not about a particular body part. You know, you're not a specialist in a body part. You're a specialist in a whole patient. And that makes you a real voice for patients and for helping them navigate this larger system. So no matter how bewildering you find it, imagine how your patients find it. So I think that it is really important for for primary care physicians to do that. And I also think it's important for primary care physicians to to the extent they can, to reach out to the business community around them, the employers of many of their patients, for instance. Employers are among the biggest champions of primary care. They mostly believe most the ones that I've talked to and I've talked to a lot of them, they are core constituency. Most of them believe that primary care should be the pivot point for the entire health care system, and want to put much more emphasis on primary care.

Speaker 1 00:10:29 So they are big champions, and they are to the extent that you can get to know them and be part of that movement toward bringing primary care to the fore in our health care system. that you should do it because I do think it's really important that those relationships are built. You know, it's not common for health care providers to build relationships with employers. When I worked at the Franklin Community Health Network, when I worked at the hospital system, we I remember there was a mill in our community that probably drove 30% of the revenues of the health system. It was a very significant it was a major employer in the region, and we at one point had an executive team meeting with lots of folks from all elements of the system, and somebody talked about how they were rumors that the mill was going to close down potentially, or be bought. And somebody said, well, we should call them and find out what's going on. You know, does anybody know anyone over there? And none of us did.

Speaker 1 00:11:36 So here we were, senior executives in a very small community, really, dependent for for a huge percentage of our revenues. And I don't know if it's 30. It was a lot on this mill, and nobody really knew them, so. that's common that health system leaders, individual physicians may not know the employers, not the health plans, the employers who are ultimately paying for the care they're delivering. And so it's really important to try to build those relationships, and particularly for primary care, because there's a lot of common, common cause between employers and primary care doctors. so I think I would just strongly encourage that to go to go forward.

Speaker 4 00:12:31 This is all well and good, but what if someone is looking for more clinical information? Oh.

Speaker 5 00:12:36 Then they want to check out our sister site, Patient Care Online. Com. The leading clinical resource for primary care physicians. Again that's patient care online. Com.

Speaker 3 00:12:49 Based on the grades and and the different measures that you use. This was one thing I had in the questions was in terms of maybe trends.

Speaker 3 00:12:58 Can you describe any different trends or anything you've noticed in recent times, or maybe over the years about any conditions you'd mentioned, for example, illnesses or I'm sorry, infections, accidents, errors? Have there been any trends indicating certain conditions that have gotten much, much better over the years, or maybe some that are getting worse?

Speaker 1 00:13:20 Well, there's two things. There's two particular procedures that we've focused a lot of attention on, and we've seen real progress. And those are in the maternity care area. One is a piece of this is this is a procedure that's performed during a vaginal birth, where the vaginal passages cut open during the birth. It's it used to be fairly commonly performed. And then Acog said, no, it should we shouldn't be doing them. They're they're unsafe. And there's other ways. So they're really discouraged now. I mean, sometimes they're necessary. And so occasionally they do need to happen, but it should only be on a very rare, rare event. So when we first started reporting on a piece Rates by hospital, which we did, I think it was about ten years ago.

Speaker 1 00:14:11 we found a rate that was pretty high, pretty upwards of 10%, and now it's down to 3%, which is really just that emergency rate, just that rate that Acog was looking for, which is rare. So over time, we've seen a steady decrease in these in in episiotomy, which is just very, heartening to see. It's a it's A7I think it's 75% reduction in episiotomy rate. That is very substantial. And, you know, again, as someone who's been in health care for a long time, we don't see we don't see dramatic change like that very often. And we've seen it with this. The other, the other one that we saw major reduction in was early elective deliveries. We started reporting those also about ten years ago or more than that. These are deliveries that are scheduled without a medical reason prior to 39 weeks gestation. And, they used to be fairly common. And when we first started reporting on it, it was like 17%, something like that. And now they're they're basically at 2 to 3% also.

Speaker 1 00:15:19 So another one where the the decrease was like very dramatic and pretty pretty rapid considering how most things improve in healthcare, which is very slow. This was not slow. This was a rapid decrease. And there were a lot of others who got involved in that and had been involved in trying to reduce early elective deliveries for a really long time, like March of Dimes, Acog they've been very active in trying to reduce them. I think, again, what happened that I think was special is that Leapfrog started reporting by hospital on rates. There's just something very powerful when you find out as a, let's say, a physician at a hospital, that your hospital has a rate of 20% and the hospital next door has a rate of 2%, and you're wondering why? I mean, suddenly it becomes very real to you to understand why, why you have this, the rate that you do, how you compare and what you can do to to get better, just it's more compelling. It pushes it pushes the momentum forward.

Speaker 1 00:16:20 And that's what we saw with early deliveries as a great example of what transparency can do in galvanising a change. So we're very proud of those. And then we have seen just really maybe not as dramatic as those two particular procedures, but we've seen really impressive improvements on, hospital acquired infection rates and certain adverse events. We've seen, much more, deployment, Deployment much greater deployment of technology to improve safety. We have measured some computerized physician order entry systems since the beginning. So for 25 years we've been asking hospitals, are you entering orders through CPO? And about ten years in, we started asking hospitals that were entering orders through CPO systems. We asked them to test the systems to make sure that they're catching common errors. And so we have that test. So what we've seen from that test and from just the adoption of technology is real improvement in those systems being able to catch common errors, they're still not where they should be. So I always encourage hospitals if they've never done the test, do it right now because it's a it's the greatest one of the greatest values you're going to get from a participation in a leapfrog survey is being able to test whether your system picks up common errors that could really harm your patients.

Speaker 1 00:17:46 It's the best. It's really, really helpful. It's totally free. Everything we offer hospitals is free, so they can just simply take the test and find out for themselves if, you know, they might not be picking up all the dose miscalculations or something like that. There's lots of errors. As anyone knows who's worked in health care, there's lots of errors that can happen with medications. And this is really the only independent. It's the only test I know of that does this at all. But it's certainly the only independent test that's I mean, maybe there's a vendor out there somewhere who's offering this kind of test, but it's going to not be as independent as what Lee is offering. But either way, it's it's very valuable. And most hospitals do not are shocked that they don't get all of the answers right in the first time and that their systems are not picking up some of these errors. So it's really important to take the test then anyway. CPE and CPE, used to prevent medication errors and technology in general has been a bright spot.

Speaker 1 00:18:45 We have seen lots better deployment of technology to the benefit of patients.

Speaker 3 00:18:50 Really, artificial intelligence has taken healthcare and many, many aspects of our economy, you know, in society by storm. How do you anticipate artificial intelligence and other advances in technology could contribute to better patient care in the future?

Speaker 1 00:19:08 I think there's a number of ways. I could have a major impact on patient safety. I my biggest concern right at this moment is that it's being deployed that way, that I think that I there's a lot of interest in AI for other aspects of hospital operations, such as maybe billing or something like that, but I'm not sure it's being focused on as much around patient safety. And I think again, there's opportunities. So one opportunity is for, AI to be able to synthesize EMR records fast and in real time, alert clinicians to potential problems that their patients are about to have. So in other words, be able to sort of trigger when there's a there's a hazard ahead for a patient or when some certain lab values or certain combination of factors has come to play for that patient that the clinician might not otherwise notice.

Speaker 1 00:20:06 That suggests that there's about to be, a complication or a problem. I, you know, there's lots of companies out there that are looking at exactly how to do that. So, I would love to see that, play out in hospitals. That could make a huge difference. I'll just prevent these incidents from even happening. And that would just be amazing. I think the other the other real opportunity around AI is the fact that I can synthesize, you know, tons and tons of records in general and information for clinicians because it's it's got to be unwieldy as a clinician when you're trying to make a diagnosis or you're trying to decide what to do on the fly. For some, you know, some situation that just suddenly got just suddenly emerged. And having AI available to quickly synthesize through records and through literature, or just through the vast array of information that is potentially available to inform a clinician in any kind of situation, to be able to do that quickly and, and offer a summary is could be really life saving.

Speaker 1 00:21:16 I mean, it's it's and also could mitigate against some of the problems with burnout and things like that that we're seeing with physicians, because it's got to be really difficult to try and do that on the fly all the time, all day when I, which is imperfect and it's not always right when it synthesizes, but can help to synthesize through a lot of information. It can also take notes for you. It can also really help in patient encounters, where you want to be able to have a personal interaction with the patient and still be able to again synthesize through all their history quickly and be able to really get to the root of the issue that the patient is there for. Then I has a lot of applications that can really help with that, and can reduce some of the burden on clinicians for note taking and trying to dig through charts to figure things out all the time. And really, that problem of of having to be staring at a computer screen instead of the patient when they're, when they're in the room with them.

Speaker 1 00:22:15 I have some applications that may be able to help with that, so I'm cautiously optimistic that we'll be able to deploy them. There's going to need to be guardrails on how we do it. A lot of guardrails. But I think I think there's opportunity.

Speaker 5 00:22:33 Oh you say you're a practice leader or administrator. We've got just the thing. Our sister site Physicians Practice. Com your one stop shop for all the expert tips and tricks that will get your practice really humming again. That's physician's practice.

Speaker 3 00:22:50 And given the timing of the anniversary right now, we're still relatively young in the new Congress. And the second administration of President Donald Trump. And the white House has already taken some executive order action to improve price transparency in healthcare, especially for patient safety. What policy solutions would you like federal lawmakers to consider to enhance patient safety and improve that health care quality and price transparency?

Speaker 1 00:23:21 Well, we supported President Trump's executive order. I will say there there's language in there about quality as well. And that's good. We you know obviously we wanted that there and it's there.

Speaker 1 00:23:33 so and President Trump did make remarks about the importance of quality as well. So I think we want to make sure, as I said earlier, that we think it should be first and foremost, before you even think about price. You start with quality, but either way, they need to come together because nobody wants to buy that care. And it's important that we look and have a full and open, transparent marketplace for health care. So we fully support all of those efforts. I think for us, the agenda is, and I think one that we will be working closely with the administration on is expanding transparency in general. So including pricing but also quality there. CMS currently reports on safety and quality metrics for hospitals. They also report some for nursing homes, for ambulatory surgery centers and for other settings, but not as much. And it's not as robust. And we want to see much better reporting. and that I think there's many opportunities to do that. The other thing is there's a lot of opportunity for improving the way we measure.

Speaker 1 00:24:38 So right now, a lot of measurement of quality and safety that is publicly reported by CMS. comes from claims data. They just take it directly from claims, which is billing data. Billing data was never really designed to measure quality, but we've found ways to do it. But I think in the future, what we ought to be doing is, is taking it directly from EMRs and having ways to almost in real time, be able to inform quality across whole health systems and across the country. We ought to be able to download information again in real time, out of EMRs or other other digital mechanisms that will allow us to really monitor quality in a much more robust way and less burdensome way, so that hospitals just automatically, you know, calculated for you if you have an infection, it's reported through the EMR, and then it's calculated automatically as part of an overall rate for the hospital in the system and everybody else. I mean, those are the kinds of things that we actually do have the capacity to do now.

Speaker 1 00:25:43 And I know CMS has been looking at it. I hope that we can definitely improve on all of those methods, I think. Hopefully in a few years we'll have a very different enterprise wide way of monitoring quality and safety in hospitals and and just across the delivery system.

Speaker 3 00:26:02 Like I said, thank you for taking the time. I've enjoyed our conversation, and we could talk about at least a half dozen other topics, I'm sure. What did I not ask about that you would like our readers and viewers to know.

Speaker 1 00:26:13 I would like them to know that those of us who are not clinicians are grateful to you, that you make a difference in our lives, and that that is why all of us collectively, as as a citizens, as a policy makers together, have put a lot of emphasis on health care. It's why it's one of the largest industries in this country, because we care deeply about our health care system. And so I think we get frustrated with it. And I think people can be very, bitter and vitriolic sometimes about it and very critical.

Speaker 1 00:26:57 We hear all those things. But it is also because we care so deeply about it that we act that way. And we hold health care to such high standards.

Speaker 3 00:27:08 100%. 100%. You know what? I'm going to let you get back to the rest of your afternoon here. I just am grateful for your time. I enjoyed our conversation, and hopefully we'll get a chance to talk again real soon.

Speaker 1 00:27:19 Great. Richard, thank you for reaching out. This is really interesting. Thank you for the in-depth conversation.

Speaker 3 00:27:26 Oh, yeah. Again, just many thanks and hopefully we'll talk again real soon.

Speaker 1 00:27:29 Okay. Take care. Thanks. Bye bye.

Speaker 2 00:27:41 Again. That was medical economics senior editor Richard Payerchin with Leah Binder, president and CEO of The Leapfrog Group. My name is Austin Littrell, and on behalf of the whole Medical Economics and Physicians Practice teams, I'd like to thank you for listening to the show and ask that you please subscribe on Apple Podcasts and Spotify so you don't miss the next episode. Also, if you'd like the best stories that Medical Economics and Physicians Practice publish delivered straight to your email six days of the week, subscribe to our newsletters at medicaleconomics.com and physicianspractice.com.

Speaker 2 00:28:08 Oh, and be sure to check out Medical Economics Pulse, a quick hitting news podcast that offers concise updates on the most important developments affecting your practice, your bottom line, and the broader health care landscape delivered by the editorial team at Medical Economics. Off the chart: A Business of Medicine Podcast is executive produced by Chris Mazzolini and produced by Keith Reynolds and Austin Littrell. Medical Economics, Physicians Practice and Patient Care Online for all members of the MJH Life Sciences family.

Speaker 6 00:28:34 Thank you.