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The Leapfrog Group's looser standards; the National Hospital Discharge Survey from the Centers for Disease Control and Prevention; the "Bridges to Excellence" pay-for-quality initiative




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The Leapfrog Group has loosened three of its stringent patient safety standards for hospitals in response to health care industry criticism that the original requirements were too expensive and difficult to implement in such a short time frame.

The Washington-based coalition of employers has given hospitals an extra year — until 2005 — to install online computerized prescribing systems that instantly alert clinicians to possible drug or allergy interactions. The group also defined "full implementation" as meaning that 75 percent of a hospital's prescriptions are ordered through this system.

Leapfrog also widened its definition of intensivists to include physicians who might not be board-certified in a particular specialty but do have extensive records of full-time experience in intensive-care settings. Hospitals can also now use risk-adjusted clinical process and outcomes measures to assess the quality of high-risk procedures, rather than simply reporting their volume of coronary artery bypasses and other operations.

Chiropractic care can be as beneficial as medical care for reducing disability from low back pain according to recent research supported by the Agency for Healthcare Research and Quality. Also revealed: Adding physical therapy to medical care is only marginally more effective than medical care alone.



More than half of all inpatients stayed in the hospital for three days or less in 2001, while roughly a quarter stayed for four to seven days, and just 16 percent stayed put for more than a week, revealed a recent National Hospital Discharge Survey from the Centers for Disease Control and Prevention. CDC noted that the past three decades have seen a steady decline in the average stay from 7.8 days in 1970 down to 4.9 days in 2001.

Besides technology and drug therapy advances, other factors contributing to the decline include pressure on hospital stay lengths, Medicare's shift from a cost-based system to prospective payment for hospitals in the '80s, development and improved coverage of past-acute care, growth in utilization review programs, and an increase in managed care and other cost-containment programs.

Of the 41 million inpatient procedures performed in 2001, heart disease was the leader with 4.3 million. Other leading reasons for hospitalization were births (3.8 million), psychoses (1.6 million), pneumonia (1.3 million) and fractures (1.0 million). Roughly 25 percent of procedures on women were obstetrical, and over 20 percent of those on men were cardiovascular.

Enrollees in Medicare+Choice pay an average premium of $37 per month, up from $32 in 2002 and $23 in 2001, according to a new report from The Commonwealth Fund. Sixty nine percent of enrollees have drug coverage, down from 72 percent in 2002.



At least that's the theory behind "Bridges to Excellence," a new pay-for-quality initiative launched by large employers, health plans, the National Committee for Quality Assurance and the MEDSTAT Group.

The not-for-profit organization aims to encourage quality care by recognizing and rewarding physicians who provide safe, timely and efficient patient care. Under the new program, top-performing doctors may earn bonuses equaling up to 10 percent of their income. They'll also be spotlighted in provider directories, helping employees identify those doctors with exemplary records or support systems. Jon Conklin of Medstat, which manages the program, points out that Bridges is unique because the financial reward will go to the individual physician rather than to the group, and the check comes from the employers who pay the bills rather than from a health plan.

Bridges will initially focus on encouraging improvements in diabetes care, cardiovascular care and patient care management systems. It is being introduced in Cincinnati, Louisville and Boston — three metro areas heavily populated by employees of corporate supporters Ford, General Electric, Procter and Gamble, UPS, Verizon, Humana and Cincinnati Children's Hospital and Medical Center. Participating health plans are Aetna, Anthem Blue Cross and Blue Shield of Kentucky and Ohio, BC/BS of Illinois and Alabama, Humana, Tufts, Harvard Pilgrim and United Healthcare.

Meanwhile, Empire Blue Cross Blue Shield and four major employers — IBM, PepsiCo, Verizon and Xerox — launched an incentive program last year that rewards hospitals for rapidly adopting CPOE systems or increasing the use of intensivists, as per the Leapfrog Group's patient safety recommendations. Apparently it's working, as the program paid out nearly $200,000 in bonuses to 29 hospitals in 2002.

A multi-state coalition has launched a nonprofit pharmacy benefit manager to compete with for-profit PBMs in the hopes of bringing down Rx costs. Organized by nine states (mostly from the Northeast) and the District of Columbia, the group hopes to reduce spending by negotiating volume purchase prices and countering direct-to-consumer advertising. The coalition also plans to offer coverage for mail-order drugs from Canada, a tactic the Bush administration adamantly opposes.


News & Trends.

Business and Health

May 15, 2003;21.

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