Leapfrog CEO on hospital ratings: Public data will only improve healthcare

Leah Binder, Leapfrog Group CEO

While most agree more transparency is needed in the healthcare system, just how quality and costs get measured -- and who is doing the measuring -- is up for debate, according to Leah Binder, president and CEO of the nonprofit Leapfrog Group.

There are a number of different transparency efforts underway across the country, from Leapfrog's Hospital Safety Score to the Overall Star Ratings awarded by the Centers for Medicare and Medicaid Services. But each has their own methodology for measurement, said Binder, speaking at Thursday's Maine Health Management Coalition conference in Portland, Maine.

According to Binder, quality improvement, market incentive and transparency are intricately linked. If the relative quality of a hospital or system is made public and easier to understand, organizations have a market incentive to improve quality in order to grow and retain business.

"Quality should be the first consideration under value based purchasing," said Binder. "Focusing on quality is ultimately going to lead you down the right path."

[Also: ICU physician staffing still lacking in many hospitals, Leapfrog report shows]

A number of different measures are used as yardsticks to determine quality, and increasingly, the measures used by Leapfrog, CMS and others are beginning to align -- such as high-risk surgical outcomes, C-section rates, stewardship of antibiotics and a hospital's overall culture of safety.

Still, said Binder, there are some complaints about measurement in the public domain.

One is that the disparate rating systems show few common scores, potentially generating confusion. U.S. News and World Report, for instance, only considers a hospital if it meets a certain bed count, while Leapfrog doesn't. U.S. News doesn't take into account negative measures, whereas Leapfrog does.

Other potential complications arise with various quality measurement initiatives. There's variation among coding processes, debate about the merits of certain factors, and an imperfect adjustment for risk, said Binder.

[Also: Leapfrog: Many hospitals still fail in preventing 'never event' medical errors]

"No measure, at all is perfect, no matter how tested they are," she said.

She suggested that one possible approach to making sense of disparate quality measures is an aggregation site, similar to how the Rotten Tomatoes website aggregates movie reviews.

"That's the world we live in now," she said. "We've changed, People are accustomed to a variety of perspectives on anything they're going to use or buy."

Regardless of how people make sense of the data, Binder said quality grades are effective, especially if they're mandated by law -- as quality grades for restaurants are in Los Angeles. The restaurant rating system resulted in a 20 percent reduction in hospitalizations due to foodborne illnesses in L.A. since that city adopted the approach, she said, and similar results can be achieved in healthcare.

[Also: Many hospitals failing to meet performance standards for maternity care, Leapfrog says]

As an example, Binder cited the national rate of early elective deliveries, which dipped from 17 percent in 2010 to 2.8 percent last year.

And since the push for quality improvement and transparency came about due to laws passed during both the Bush and Obama administrations, she maintained that this approach will continue to be a focus for healthcare moving into the future.

Twitter: @JELagasse