What’s New in 2010:
The Leapfrog Hospital Survey
Survey Townhall Calls
April/May 2010
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Town Hall Call Overview
• Introduction
– Survey Team
– Leapfrog and the Leapfrog Hospital Survey—why complete?
– Goals for 2010 survey
• Survey Submission Logistics/Timeline/Website Resources
• What’s New for 2010
• Detailed review of survey questions
– Evidence-based Hospital Referral (EBHR)
– ICU Physician Staffing (IPS)
– Common Acute Conditions (CACs)
• Normal Deliveries
• AMI and Pneumonia
– Hospital Acquired Conditions (HACs)
• Central line associated blood stream infections (CLABSI)
– Never Events
• Transitions
• Q&A
• Schedule for Town Hall Calls
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Why Complete Leapfrog Survey?
Unique in the Milieu
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Serves interests of large employers, purchasers, and employees
(consumers)
Provides public accountability and transparency of performance
Provides data for rewarding high performance and improvement
Consists of high impact performance measures “not the low hanging
fruit” (e.g., CPOE, IPS, EBHR, HACs, Deliveries)
Provides full range of measures—structural, process and outcome (but
focused on outcome)
National and regional in scope, and provides all payer information
Utilizes standardized measures to assure “same fruit” is sampled
Harmonized with other major national performance measurement
programs—but shows more complete picture of care delivery. For
example, CMS AMI measures are used, but adds resource use to show
efficiency of care
Significant hospital input on survey revisions
CPOE Evaluation Tool is a one-of-a-kind opportunity to check
meaningful use—before payments are affected
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Survey Review Process
Steps in the process to revise the survey have
included:
• (November, 2009) - Public review and comment
period – hospitals and other stakeholders were
invited to share comments and feedback on the
proposed changes for the 2010 Leapfrog Hospital
Survey.
• (January, 2010) - Pilot test of revised survey – 25
hospitals were asked to test a draft of the 2010
Leapfrog Hospital Survey and provide feedback to
Leapfrog.
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Behind the Changes in 2010
Goals for the new survey—
1. Expand coverage to more hospitals
2. Keep burden as low as possible
3. Align with other performance measurement groups
(such as CDC-NHSN; CMS; Joint Commission)
4. Maintain consistent measurement structure for
LHRP and for improvement purposes
5. Incorporate Safe Practices changes from
maintenance work
6. Update measures with guideline changes and
measures that have topped off
7. Maintain measures meaningful to purchasers and
consumers
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How did we do?
• 2009 survey was 76 pages— down to 73 survey
question pages
• Bulk of survey remains identical to 2009
• Introduced Survey Reference Book – provides new
efficient survey documentation; replaces many
separate documents—decrease submission burden
• Updated process measures in EBHR and CACs that
are topped off or no longer have guideline support
• Aligned language in Safe Practices to updated 2010
version
• Updated CLABSI scoring to match methods used by
Consumer Reports/CDC
• Eliminated transparency indicator—no variation in
responses
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Survey Submission Logistics, Timeline,
Website Resources
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Survey Security and Integrity
• Core principle: hospital self-certification
• Executive authority and accountability
• Survey security and integrity are critical:
– 16-digit security code
• Authorization to access granted only to:
– CEO . . . can provide code directly to any delegate(s)
– CEO-authorized delegate . . . Help Desk can email security
codes. See survey home page link, “Need security code?”
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Survey Helpdesk Available
• Survey Helpdesk -- designed to respond within 1-2
business days (unless it requires an expert panel
member to respond)
• Link on survey homepage
https://leapfrog.medstat.com/helpdesk.html
• Other tips:
– Survey must be completed before CPOE Evaluation. Help
Desk cannot respond in real time. Plan to complete early.
– Don’t wait until late June. If you have a problem, you likely
will not make deadline.
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2010 Timeline
• April 1, 2010 – Launch of 2010 Survey
• June 30, 2010 -- RRO-targeted hospitals report or be
listed on Leapfrog’s website as “Declined To
respond”
• July 21, 2010 -- Leapfrog website lists new results
• Top Hospitals List –
2010 recognition programs/ initiatives begin as
early as mid-September
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Website Resources
See online survey home page for links to:
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Leapfrog Hospital Survey Reference Book (NEW!)
– Measure specifications (volume, process, resource utilization)
– Frequently Asked Questions
– Scoring Algorithms
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Hardcopy survey including explanatory “end notes”
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Other links on home page
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“What’s New in 2010?”
Updates: Notable changes to survey or specs since 4/1/10 release
Excel tool for computing Geometric Mean Length of Stay
Supplemental info re: Resource Utilization scoring
Ordering info for NQF’s Safe Practices for Better Healthcare: 2010 Update
Fact sheets on each Leap (including bibliography information)
White Papers on Severity-adjustment for LOS, and Survival Predictor
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Leapfrog Hospital Survey Reference Book
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Medical Coding for High-Risk Procedures and Conditions (EBHR)
Procedure code, diagnosis codes and other specifications for counting high-risk
surgery volumes
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EBHR Publicly Reported Outcomes for CABG and PCI
For hospitals in CA, MA, NJ, NY and PA – publicly reported risk-adjusted mortality
rates for responding to survey questions about PCI (MA, NY only) and CABG (all five
states).
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EBHR Process Measures -- Specifications
Detailed specifications for Leapfrog’s procedure-specific process measures of quality
for CABG, PCI, AAA Repair, and high-risk deliveries.
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EBHR Resource Utilization Measures – Specifications
Detailed specifications for Leapfrog’s CABG and PCI including:
• Coding for counting eligible cases
• Coding and other criteria for identifying cases with risk factors
• Specifications for reporting geometric mean length of stay
• Criteria for identifying cases followed by readmission
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Leapfrog Hospital Survey Reference Book
– Volume Standard Coding: Medical Coding for Chronic Acute Conditions (CAC)
Procedure/diagnosis codes and other specifications for counting AMI and Pneumonia
volume
– CAC Process Measures – Specifications
Specifications for Leapfrog’s nationally-endorsed condition-specific process measures
of quality -- for AMI, Pneumonia, and Normal Deliveries.
– CAC Resource Utilization Measures – Specifications
Detailed specifications for Leapfrog’s Common Acute Conditions (AMI and Pneumonia)
including:
• Coding for counting eligible cases
• Coding and other criteria for identifying cases with risk factors
• Specifications for reporting geometric mean length of stay
• Criteria for identifying cases followed by readmission
– CAC Normal Deliveries Measures – Specifications
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Early Delivery outcome measure
• Process measures: Bilirubin screening, DVT prophylaxis for C-sections
– Hospital-Acquired Conditions (HAC) – Specifications
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What’s New for 2010
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Survey Changes: The Details
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Safe Practices updated language
EBHR Changes:
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Dropped AAA process measure—Beta Blocker at Discharge—no
longer supported by guideline
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Updated Isolated CABG definition
IPS Changes:
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Hospitals classified as “rural” can earn partial credit for 24x7 teleintensivist coverage
Common Acute Conditions
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Elective Deliveries specifications aligned with Joint Commission
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Dropped smoking cessation measures from AMI and Pneumonia
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Updated scoring thresholds for AMI and Pneumonia process
measures
Hospital Acquired Conditions
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New CLABSI scoring for 2010
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Addition of CUSP Quality Improvement Program for some credit
on CLABSI
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Pressure Ulcer measure aligned with CMS
Never Events
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Eliminated commitment
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Safe Practices
• The NQF Safe Practices have been updated by the NQF Maintenance
Committee
• Leapfrog has updated language where needed—
– Safe Practice #2 Culture Measurement –time period for survey of
culture extended to 24 month period versus annual survey of
employees
– Safe Practice #5 Consent forms—in the preferred language of
patient vs primary language
– Safe Practice #19 Hand Hygiene vs Hand-washing and hospital
acquired infections vs nosocomial infections
– Safe Practice #21 central venous catheter-related bloodstream
infection vs the central line bloodstream infection
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High Risk Procedures
• Abdominal Aortic Aneurysm Repair
– Dropped process measure—Beta Blocker
at Discharge—no longer supported by
guideline.
– Down to only one process measure for
AAA
• Isolated CABG
– Added exclusions for major organ
transplant cases
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IPS Partial Credit for “Rural” Hospitals
• Hospitals classified as “rural” in the Leapfrog Hospital
Survey can earn score of “Substantial Progress” (3
bars) on the IPS Leap for having the following:
o Intensivists manage or co-manage patients in all adult and
pediatric medical and/or surgical ICUs and neuro ICUs
o Tele-intensivist presence 24 hours a day/7 days a week
o On-site daily care planning done by on-site intensivist,
hospitalist, anesthesiologist, or physician trained in
emergency medicine
• Standards for Fully Meeting IPS Leap have not
changed
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Common Acute Conditions
• Process measures related to smoking
cessation dropped from survey for both
AMI and Pneumonia
– Measures had topped out
– No longer endorsed by NQF
• Updated AMI & Pneumonia scoring
thresholds for 2010 (used national Joint
Commission data from 3Q08-2Q09 for
thresholds)
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Common Acute Conditions
• Elective Deliveries Before 39 weeks
– Updated specifications to match Joint
Commission following testing of measure
that was time-limited
– Aligned with the NQF endorsed measure
– Denominator will be smaller
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Hospital Acquired Conditions: CLABSI
• New scoring methodology -- called
SIR—Standardized Infection Ratio--for
CLABSI
– Aligns with Consumers Union, CDC
• Addition of CUSP Quality Improvement
Program for some credit on CLABSI
• Children’s Hospitals can get credit for
participation in NACHRI CLABSI
project
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Hospital Acquired Conditions
• Pressure Ulcer measure now focused
on third and fourth degree pressure
ulcers
– Aligns with CMS hospital measures
– More easily identified as POA
– Rates should go down from this past year
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Never Events
• Removed 60-day commitment to Never
Events policy—given that hospitals are
in the 3rd cycle of reporting this
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Transparency Indicator
• Removed Section 8 (Transparency
Indicator) from the survey; very little
variation in hospital responses
• Reduces hospital response burden
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Survey Partner Transition
• Over next four months, Leapfrog will be transitioning survey
partners (new partner: Quantros, Inc.)
• Goal is to have survey experience a seamless experience for
hospitals
– During transition, hospitals will contact Help Desk in same way
– Same 16-digit security codes
– Same survey homepage (https://leapfrog.medstat.com)
• End of August, submitted surveys migrated to new partner;
NOTE: Saved responses, that are not yet submitted, will not be
migrated
• Early September – survey down for 4-7 days, while transition
complete
– New survey homepage (users will be auto-directed from current
survey homepage)
– New Help Desk contact methods
– Details will be forthcoming via e-mail
• Big THANK YOU to Thomson Reuters Healthcare for their 10+
years of outstanding support of the Leapfrog Hospital Survey
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Questions?
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Dates of Town Hall Calls
• Thursday, April 22, 2010 @ 2 pm ET/11
am PT
• Tuesday, May 4, 2010 @ 1 pm ET/10
am PT
• Wednesday, May 12, 2010 @ 3 pm
ET/12 noon PT
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