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Group Promotes Its Health Agenda


It is perhaps the most influential bloc of health-care purchasers in the nation, spending $52 billion annually on medical coverage for nearly one in 10 Americans.

Now, this 14-month-old consortium of Fortune 500 companies and other private and public organizations is pushing the envelope of reform with its own national agenda for reducing medical costs.

Known as the Leapfrog Group, the consortium includes the benefits managers of such household names as AT&T Corp., IBM Corp., Boeing Co., Exxon Mobil Corp. and General Motors Corp.

But the group also includes state and city insurance and health-care authorities, the Board of Pensions of the Presbyterian Church and the Southern California Schools Voluntary Employees Benefits Assn. Together, they provide health coverage for 28 million retirees and employees and their dependents.

At a time when the nation's managed-care system is unraveling and Washington has proffered few if any systemic solutions, private- and public-sector groups such as Leapfrog are moving ahead with what many say are viable industry reforms, but ones that are on the groups' own terms and not without controversy.

Leapfrog has launched two Web-based efforts that, to a degree, measure hospital performance.

The group's plan eventually is to have a system in which consumers can see detailed information about how well hospitals perform in terms of patient care and medical outcomes.

Many experts say this will help employers that subsidize workers' benefits more effectively control costs, because patients presumably will pick better-run facilities and thus experience fewer medical complications.

Critics maintain that it was employers' insistence on excessive cost controls that caused many of the problems with managed care. Now that costs can no longer be controlled, they say, employers are pushing the costs and responsibility for decisions onto employees.

Regardless, Washington-based Leapfrog is moving ahead. Last week, the group made public a Web site that gives consumers a review of performance ratings for nearly 300 participating hospitals in California, Atlanta, Tennessee, Michigan, Minnesota, the Seattle/Tacoma area and St. Louis. The hospitals were rated according to Leapfrog-devised standards.

About 48% of hospitals that were asked to participate in the Leapfrog survey did so. About half the hospitals are in California.

Leapfrog also has unveiled a private Web site available only to the workers of five large New York-area employers. It ranks top hospitals affiliated with the state's largest insurer both by experience with common surgeries and by mortality rates.


Hospitals Questioned on Systems, Procedures

Leapfrog's measures are basic at this stage. Among the questions it is asking hospitals is whether they are equipped with a computerized system for prescriptions and other physician orders that could prevent, among other things, dangerous medication errors due to illegible handwritten doctors' notes.

One question asks whether the facilities' intensive-care units are staffed only with people specifically trained for that work, which the group advocates.

Another question focuses on the number of procedures a hospital performs, following Leapfrog's "practice makes perfect" belief that hospitals that perform more procedures are better at it.

"Our goal is to save lives and reduce preventable medical mistakes by giving consumers the information they need to make more-informed medical choices," said Suzanne Delbanco, the group's executive director.

"The Leapfrog Group has focused its initial effort on giving consumers information on three proven patient safety practices," Delbanco said. "If implemented in the nation's [urban] hospitals, they could save nearly 60,000 lives ... each year."

Consumer and physician advocates worried about the double-digit rise in premiums and the erosion of benefits warn that any reforms being pushed by powerful health-care purchasers will be motivated primarily by keeping costs low, not improving care.

Though generally supportive, UCLA professor William Pierskalla said the quality-of-care standards "don't get at the real issues, such as medical complications rates and readmissions" because the hospital staff failed to do a procedure right the first time.

The authors of a federal government study in 2001 warned that the three basic standards pushed by Leapfrog "lack sufficient clinical underpinnings" and require more study before their effectiveness as a quality-care measure can be proven.

The report's authors also said further study was needed before it could be said with assurance that computerized systems for doctors would make a real difference at all hospitals.

It will cost money to install new equipment and to train staffers on their use. And staffing intensive-care units with the best people also will cost more, given the shortage of workers in that profession and its high burnout rate. Those costs, some suggest, eventually will be passed on to consumers.

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