What healthcare leaders need to know now


Hospital Safety Grade is a simple but powerful way that Leah Binder and Leapfrog Group help make patients safer

By | May 25th, 2017 | Blog | Add A Comment


Leah Binder: “Nothing is as critical as making sure people don’t die from preventable errors. Safety has to come first, every minute of every day. Otherwise, patients will suffer.”


One in a series of interviews with Modern Healthcare’s Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.


Sometimes, the simple things are the easiest to understand. Perhaps that’s one reason that the Leapfrog Group’s Hospital Safety Grade has caught on in such a big way – even with hospitals, who largely weren’t all that thrilled when it was initially launched five years ago.


“The response of hospitals has been one of the brightest spots for me in my career,” Leapfrog President and CEO Leah Binder says. “Hospitals are approaching their Hospital Safety Grade constructively. They’re talking about what they are going to do to improve and how proud they are of this ‘A.’ They talk about how they’re not going to stop their efforts to ensure that patients are safe, and describing what those efforts will be.”


Every six months, Leapfrog assigns an A, B, C, D or F grade to 2,600 general, acute-care hospitals, rating their performance on safety. It uses standardized measures from the Centers for Medicare & Medicaid Services, its own hospital survey, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention and the American Hospital Association.


“Many people – even if they’re on the board of a hospital – don’t realize the problem of safety,” Binder says. “When they look into it, they realize how many things can go wrong in a hospital, and that makes a big difference. That’s why I think it’s been important for us to highlight this in a way that’s easily accessible to laypeople.”


While everybody wants an “A,” Binder has seen unfavorable grades spur some action.


“We see boards get very upset. We see community members get upset. We see repeated articles in newspapers about poor grades,” Binder observes. “We’ve found that it gets their attention, which is a good thing. In fact, we’ve seen hospitals just completely turn around their safety programs when they get a bad grade.”


What people outside the healthcare industry don’t always recognize is that the Leapfrog Group was founded by large employers and groups who purchase healthcare and wanted to see some changes in the quality of the care they were paying for.


“Employers are not in the business of healthcare,” says Binder. “They’re in the business of doing other things. They make airplanes, and they make automobiles and they run retail department stores. And so, they don’t have a staff of 500 to figure out what’s going on in healthcare, so they rely on organizations like us to try to pull all those resources together for them and help them make the right strategic decisions.”


Leapfrog has some compatriots in this area, including the National Business Group on Health, regional groups, and a newcomer called Health Transformation Alliance, in which 20 major employers are teaming up to lower prescription costs, review claims together, structure benefits and create networks.


“There’s probably at least 50 organizations that represent specialties for physicians alone,” Binder says. “I don’t think there are nearly enough organizations that are advancing purchaser concerns about healthcare delivery. The purchasers pay for about 20 percent of the $3 trillion healthcare industry, which is a lot of money.”


Despite the increased scrutiny, Binder says she thinks the healthcare industry has taken its eye off safety, given the myriad deaths still linked to errors each year.


“I think the industry has not been focused on patient safety enough. They’ve been distracted by the compliance with the Affordable Care Act, value-based purchasing, bill payments, new models for financing and delivering care, and change in state and CMS regulations. While those efforts are important, nothing is as critical as making sure people don’t die from preventable errors. Safety has to come first, every minute of every day. Otherwise, patients will suffer.”


Binder is doing her best to keep the priority on patients. – in fact, the organization is broadening its reach at the request of its members to take a closer look at other sticky matters in safety:


  • Maternity. “Employers pay for half of all the births in this country. Childbirth is by far the number-one reason for admission to a hospital. A C-section is the number one surgical procedure performed in this country. So, we now have some incredible data on maternity care, and employers are starting to meet with hospitals and design packages that encourage the use of hospitals with lower C-section rates based on the Leapfrog data.”

  • Outpatient and ambulatory care. “We’re going to start rating outpatient surgical units and ambulatory surgical centers. That’s a big priority for purchasers because they are sending a lot of employees to ambulatory surgical centers because they tend to be lower-priced. That’s great – some of them are excellent – but we don’t have enough good data nationally to compare them on safety and quality.”

  • Children’s hospitals. “There’s a lot of people who would never travel outside their community for their own healthcare, but will travel if they have a very sick child. This year, we added two new measures. We ask pediatric hospitals to do a CAP survey for children’s hospitals. The other thing we’re looking at is exposure to radiation. Sometimes, children have repeated imaging and it can really add up.”

    Although it is Leapfrog’s job to act as a watchdog for employers and patients, Binder says she does see some positive movement.


    “There are bright spots,” she says. “There is a Partnership for Patients program that just concluded with CMS that has demonstrated some real impact. We see reductions in certain kinds of infections and real changes in the ways that hospitals are approaching patient care to address safety. CMS has tracked some saved lives as a result of those changes, and we certainly appreciate those numbers. We’re going in the right direction; we just need a lot more push.”



    SIDEBAR: Making a difference with the mundane


    Hospital deaths and injuries from errors are not always obvious.


    “When someone dies from an error or an accident, it’s not easy to track,” says Leah Binder, president and CEO of the Leapfrog Group. “It often doesn’t show up in claims. It can be complicated – the death might be attributed to something else even though, say, there was clearly an infection that hastened the death. It’s just kind of the course of business in the hospital.”


    Nearly two decades after the ground-breaking report “To Err is Human,” far too many people are still being killed and injured in healthcare settings, Binder says.


    “More than 200,000 people are dying every year from preventable accidents in hospitals,” she says. “We believe that’s a low estimate. There’s lots of accidents and problems in hospitals we can’t measure because no one is tracking them. An example of that would be medication errors, which are the most common errors in hospitals. There’s not a standardized way of tracking that, so we don’t even know how many deaths or adverse events result.”


    What is especially frustrating for Binder and her team is that many injuries and deaths happen in spite of the fact the healthcare industry knows how to prevent them. “The fact is, patient safety requires a disciplined, persistent commitment to the mundane habits that save lives,” she says.


    “How much more mundane can it possibly be than to say, ‘Everybody needs to wash their hands all the time’? ‘We need to wear the right protective clothing.’ ‘Follow the rules – every single rule every single time.’ ‘We need to do the same checklist every time we do a surgery.’


    “Let’s face it, these sound boring. But done systematically, they save lives. And everyone in patient care needs to be disciplined about doing them.”





    Delaware Valley ACO’s Katherine Schneider uses population health to improve patients’ lives, one at a time

    By | May 16th, 2017 | Blog | Add A Comment


    Katherine Schneider: “I’m seeing opportunities to transform the healthcare system to improve population health outcomes. That’s been my career niche since the day I finished my residency training.”


    One in a series of interviews with Modern Healthcare’s Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.


    Katherine Schneider, MD, the president and CEO of the Delaware Valley ACO in the Philadelphia region—an accountable care organization owned by Main Line Health and Jefferson Health—has long been ahead of the game in whatever pursuit she has chosen.


    She was part of the first group of U.S. physicians to earn subspecialty certification in clinical informatics. She led the implementation of value-based payment models at Middlesex Health System in central Connecticut, long before “value-based” was a common adjective in the healthcare lexicon. She was the senior vice president of health engagement at AtlantiCare, leading its pioneering move to accountable care and co-designing a value-based insurance benefit for 10,000 employees. She also served as executive vice president and chief medical officer for Medecision, which provided population health technology for health systems and health insurers.


    That’s a lot of trailblazing but, to Schneider, it’s just a steady progression along the path of transforming care.


    “Whether you call it community benefits, clinical integration, population health or accountable care, this concept of a health system being responsible for more than just transactional care is really what this is all about.”


    Major achievements started early for Schneider, who skipped from sixth to ninth grade as an adolescent, ending up in college at 15 and in medical school four years later.


    “When I was 11, we moved from New York City to Austria due to my father’s work,” she says. “I went from a very good private school in Manhattan to a very small, hands-on international school.


    “I had the threat of ending up at an Austrian convent school hanging over me,” she jokes, “so I did really well.”


    Though she was much younger than her medical-school classmates, she can’t resist some more self-deprecation.


    “Yes, I was 19 when I went to medical school, but I made up for it because I spent nine years in medical and graduate school,” she says of the combination MD-PhD program she enrolled in. “To make a long story short, I became much more interested in public health and policy. So, I actually switched into the epidemiology program at Columbia University.”


    She also chose family medicine, not one of the higher-paying specialties.


    “Family medicine seemed to me a great fit for someone interested in population health and policy,” Schneider says. “It’s womb to tomb, broad clinical experience.”


    That made giving up the practice of medicine difficult when she eventually had the opportunity to potentially impact more lives in a different kind of role. Not that she doesn’t have some regrets about not seeing patients anymore.


    “I do miss it,” she admits. “But there are a lot of really good doctors out there. I was a good doctor too, but I have a skill set that not a lot of people have, which is a combination of the population-health aspects and the clinical experience. I’m seeing opportunities to transform the healthcare system to improve population health outcomes. That’s been my career niche since the day I finished my residency training.”


    Schneider finds her role leading one of the nation’s leading ACOs to be inspiring, but also challenging at times.


    “I was recently at a fireside chat featuring Michael Dowling, the CEO of Northwell Health, and he said that, to be in healthcare, you have to be an optimist but you almost have to be chronically unhappy with the status quo.”


    Schneider says she wouldn’t describe herself as an optimist, but says she “is pretty resilient and determined,” traits she learned from her mother who fought—and beat—tuberculosis as a young woman. “What I learned from my mom is the power of perseverance against the odds.”


    The perseverance these days comes from battling that persistent status quo—part of the marching orders for an ACO—where so many factions in healthcare have lobbyists to protect their interests, even when change can streamline care or bring about better outcomes.


    “What one person calls waste is someone else’s lunch,” she says. “If you’re going to get waste out of the system—even through innovation—that’s still taking money away from someone and they’re going to fight it tooth and nail. We’re not going to solve this problem unless we’re willing to admit that and take it on.”


    Schneider, for one, is ready to wade into the fray.


    “I truly believe that we can do better and that most of us want to do better to serve our community and our country.”



    SIDEBAR: In a sea of data, the power of stories


    Katherine Schneider is a national leader in clinical informatics, but she’s a big believer in the power of stories. That’s why she and her team at Delaware Valley ACO open their meetings with a value-based story of impacting the life of a patient or a provider.


    “You can talk all you want about care management and Triple Aim but, ultimately, if you can tell the story of how you’ve changed a patient’s life or a physician’s practice, people get it,” she says.


    One example: A 92-year-old woman has been to the emergency room numerous times because she can’t get out of her bathtub. She calls her friends from the tub, who call 911. Over and over. Delaware Valley steps in and, within 24 hours, has connected her to free services in her community that come in and install grab bars and railings and retrofit her home. She doesn’t need to call for help anymore.


    “Not everything we do is that simple,” Schneider cautions. “We also work with some extremely overwhelming, complex patients and make some small wins for them. A win is not like a cell in a spreadsheet. It’s not a graph on a PowerPoint. It’s really in the stories.”





    Wharton Healthcare Quarterly features article on developing physician leaders by Clarke, Mazzenga

    By | May 5th, 2017 | Blog | Add A Comment



    The latest issue of the Wharton Healthcare Quarterly is out, and it features a pertinent article from Furst Group’s Bob Clarke and Joe Mazzenga on the challenge and reward of developing physician leaders to lead the entire enterprise, not just a clinical department.


    Published by the Wharton Healthcare Management Alumni Association at the University of Pennsylvania, the latest issue of the Quarterly also features articles on the transition to value-based payment, the coming challenges posed by post-acute care, and creating a culture of value.


    Clarke is the chief executive officer of Furst Group and NuBrick Partners. Mazzenga is managing partner of NuBrick Partners, our leadership consulting firm, and a Furst Group vice president.


    The authors acknowledge that both administrators and physicians have work to do to achieve success in this endeavor and that, ultimately, “True leadership is about building teams who create an empathetic and collaborative culture.”


    To read the complete article, click here.