The Leapfrog Group Response to the Iowa Healthcare Collaborative
October, 2009

The Iowa Healthcare Collaborative (IHC) is advising Iowa hospitals not to respond to the Leapfrog Group annual hospital patient safety survey. Four points are listed in the IHC position. We shared this information with The Leapfrog Group who assisted us in preparing this response. Below please find each of IHC’s four points followed by our combined response in italics.

  1. The Iowa Health Collaborative has significant reservations about the value of Iowans of reliance on proprietary surveys or quality measurement tools, such as Leapfrog. It therefore does not endorse such proprietary products. IHC and Iowa hospitals’ experience with TMIT, the precursor to the Leapfrog survey, leaves significant hospital to hospital scoring reliability questions, which, in our view, dramatically weakens validity and usefulness of the Leapfrog data.

    First, the Leapfrog Group is a not-for-profit patient safety advocacy organization sponsored by employers and healthcare purchasers, and is not proprietary. The Leapfrog Hospital Survey materials are transparent to all users and consumers and the survey is offered to hospitals at no charge. The results of the survey are made available to all website users and we never charge for consulting or other activities related to the survey.

    Second, the Leapfrog Group treats TMIT as it does other experts from across the country. We do not provide financial support to them, nor do we endorse their services. We have been the recipient of materials from them, as we have from other research entities.

  2. IHC endorses the National Quality Forum’s 30 Safe Practices and prefers to focus on evidence-based metrics that promote quality and safety improvement.

    We respect your preference. However, your customers are asking for this public reporting and greater accountability. There is growing consensus in Iowa and nationally that driving health care improvement will be: (1) consumers using performance information to choose providers and treatments, (2) purchasers building performance expectations into their contracts and benefit designs, and (3) providers acting on their desire to improve, supported with better information.

    The Leapfrog Group includes 13 of the Safe Practices in its survey, but urges healthcare providers to address all 30 in their quality improvement activities. Originally, the Leapfrog Group had included all the safe practices in our survey, but feedback from hospitals regarding the burden of reporting resulted in reducing the number to 13.

  3. Consumers are increasingly gaining access to better, reliable, quantifiable data describing healthcare provider performance. The IHC reports publicly on CMS measures, AHRQ and through the HAI Reporting Initiatives.

    We would not expect Leapfrog data to serve as a substitute for the quality reporting of collaborative entities like Iowa’s, but Leapfrog is an important supplement since it measures issues of direct concern to consumers and purchasers. For example, to address this same issue, the Wisconsin Healthcare Collaborative includes Leapfrog measures in its reporting. (Note: The measures the IHC mention such as CMS are already in the public domain. Thus, IHC is reproducing this publicly available data.)

  4. The IHC has become an unprecedented focus of engagement of Iowa’s healthcare provider community in initiatives to improve the quality and safety within our healthcare delivery system. It has accomplished this by involving providers in the selection of evidence-based metrics with the goals of public transparency, statewide quality and safety measurement, and improvement. Iowa’s healthcare providers are already very engaged in patient safety and quality improvements as evidenced by the work of the Collaborative.

    It is disappointing that IHC is not interested in responding to Leapfrog, the consensus quality evaluation tool used by consumers, employers and purchasers nationally and within Iowa. As a participant in the IHC, you may want to encourage Iowa hospitals to reconsider their approach. According to a significant body of peer-reviewed literature, hospitals that report to Leapfrog are higher quality, and those that decline to report tend to have higher mortality rates. Declining to respond to purchaser requests for Leapfrog data thus sends messages we are sure are unintentional: an implication quality may not be competitive, and a message of disregard to employers and consumers.

Our intention in this document is to clarify the issues so we hope that all Iowans take this in the spirit of open and candid dialogue. The Leapfrog Group is intended to serve as a constructive tool and is used by many hospitals not only as a means of responding to the inquiries of consumers and purchasers, but also as a quality improvement instrument that Leapfrog believes--and many thought leaders concur-- is second to none. We would be glad to put interested persons in touch with any of the hospitals that gave The Leapfrog this feedback. The IHBA and HPCI hope to see Iowa hospitals more present on the state and national healthcare quality reporting landscape in the future.