VBCH Leapfrog: Recognizing Hospital Achievement

1. VBCH & Leapfrog: Recognizing Hospital Achievement Presented by: Victor Brugh, MD Medical Director Federal Reserve Bank of Richmond

2. Hospital Survey Evolution of The Leapfrog Group 1998 - Group of large employers � �think-tank� Question: How to purchase health care? Question: How to influence health care quality & affordability� 1999 - Institute of Medicine report The Leapfrog founders had initial focus: � REDUCING PREVENTABLE MEDICAL MISTAKES 2000 - Leapfrog Group officially launched � Initial funding came from the Business Roundtable (BRT) and the Robert Wood Johnson Foundation 2001 - Began collecting hospital data by surveying urban and suburban hospitals in 6 regions The Leapfrog Group is an initiative driven by organizations that buy health care who are working to initiate breakthrough improvements in the safety, quality and affordability of healthcare for Americans. Leapfrog is a member supported program aimed at mobilizing employer purchasing power to alert America�s health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded. The Leapfrog Group was founded by a small group of large employers, initially supported by the Business Roundtable (BRT) and launched in November 2000. Leapfrog is supported by the BRT, The Robert Wood Johnson Foundation, Leapfrog members and others. A 1999 report by the Institute of Medicine gave the Leapfrog founders an initial focus � reducing preventable medical mistakes. The report found that up to 98,000 Americans die every year from preventable medical errors made in hospitals alone. In fact, there are more deaths in hospitals each year from preventable medical mistakes than there are from vehicle accidents, breast cancer and AIDS. The report recommended that large employers provide more market reinforcement for the quality and safety of health care. Leapfrog�s founders realized that they could take �leaps� forward with their employees, retirees and families by rewarding hospitals that implement significant improvements in quality and safety. The Leapfrog Group�s growing consortium of major companies and other large private and public healthcare purchasers provide health benefits to more than 37 million Americans in all 50 states. Leapfrog members and their employees spend tens of billions of dollars on health care annually. Leapfrog members have agreed to base their purchase of health care on principles that encourage quality improvement among providers and consumer involvement. If all hospitals implemented just the first three of Leapfrog�s four �leaps� or recommended quality and safety practices: over 65,000 lives could be saved, more than 907,000 medication errors could be avoided (Birkmeyer 2004), and up to $41.5 billion could be saved (Conrad 2005) each year. The Mission The Leapfrog Group�s mission is to trigger giant leaps forward in the safety, quality and affordability of health care by: Supporting informed healthcare decisions by those who use and pay for health care; and, Promoting high-value health care through incentives and rewards. This effort is rooted in four ideas: American health care remains far below obtainable levels of basic safety, quality, andoverall customer value. The health industry would improve more rapidly if purchasers better recognized and rewarded superior safety and overall value. Voluntary adherence to purchasing principles by a critical mass of America�s largest employers would provide a large jump-start and encourage other purchasers to join. These principles should not only champion superior overall value but should initially focus on a handful of specific innovations offering �great leaps� to maximize media and consumer support and adoption by other purchasers. Four Leaps in Hospital Quality, Safety and Affordability A range of hospital quality and safety practices are the focus of Leapfrog�s hospital ratings via the Leapfrog Hospital Quality and Safety Survey, as well as our hospital recognition and reward programs. Endorsed by the National Quality Forum (NQF), the practices are: computer physician order entry; evidence-based hospital referral; intensive care unit (ICU) staffing by physicians experienced in critical care medicine; and the Leapfrog Safe Practices Score. Computer Physician Order Entry (CPOE): With CPOE systems, hospital staff enter medication orders via computer linked to prescribing error prevention software. CPOE has been shown to reduce serious prescribing errors in hospitals by more than 50%. Evidence-Based Hospital Referral (EHR): Consumers and health care purchasers should choose hospitals with extensive experience and the best results with certain high-risk surgeries and conditions. By referring patients needing certain complex medical procedures to hospitals offering the best survival odds based on scientifically valid criteria � such as the number of times a hospital performs these procedures each year or other process or outcomes data � research indicates that a patient�s risk of dying could be reduced by 40%. ICU Physician Staffing (IPS): Staffing ICUs with doctors who have special training in critical care medicine, called �intensivists�, has been shown to reduce the risk of patients dying in the ICU by 40%. Leapfrog Safe Practices Score: The National Quality Forum-endorsed 30 Safe Practices cover a range of practices that, if utilized, would reduce the risk of harm in certain processes, systems or environments of care. Included in the 30 practices are the three leaps above. This fourth leap assesses a hospitals� progress on the remaining 27 NQF safe practices. Our leaps adhere to four primary criteria. (1) There is overwhelming scientific evidence that these quality and safety leaps will significantly reduce preventable medical mistakes. (2) Their implementation by the health industry is feasible in the near term. (3) Consumers can readily appreciate their value. (4) Health plans, purchasers or consumers can easily ascertain their presence or absence in selecting among health care providers. These leaps are a practical first step in using purchasing power to improve hospital safety and quality. Because the health industry needs time to meet these standards, Leapfrog purchasers are working with the provider community to arrive at aggressive but feasible target dates for implementation of Leapfrog�s recommended quality practices. In addition to the Survey, the Leapfrog Hospital Insights measurement tool integrates the first nationally collected set of hospital efficiency measures with standardized clinical measures from JCAHO and the Survey. This broad array of hospital performance measures gives consumers and purchasers a complete picture of overall hospital performance in five clinical areas and is the basis of Leapfrog�s Hospital Rewards Program (see below). Buying Right: Leapfrog�s Purchasing Principles Leapfrog�s member companies agree to adhere to the following four purchasing principles in buying health care for their enrollees: Educating and informing enrollees about the safety, quality and affordability of health care and the importance of comparing the care health care providers give. Initial emphasis on the Leapfrog safety and quality practices. Recognizing and rewarding health care providers for major advances in the safety, quality and affordability of their care. Holding health plans accountable for implementing the Leapfrog purchasing principles. Building the support of benefits consultants and brokers to use and advocate for the Leapfrog purchasing principles with all of their clients. To help advance the purchasing principles, the Leapfrog Hospital Rewards Program allows implementers to reward hospitals that demonstrate excellence and/or sustained quality and efficiency improvement. It is an off-the-shelf pay for performance program that drives improvements in hospital quality and efficiency in five clinical areas while demonstrating dollar savings as performance improves. For more information, visit https://leapfrog.medstat.com/rewards/. Current Progress The Leapfrog Group began collecting hospital data in June 2001 by surveying urban and suburban hospitals in six regions. Today, we operate in 33. (To view the list of regions, visit http://www.leapfroggroup.org/for_members/members_resources/regional_roll_outs.) Leapfrog�s 33 regions cover over half of the US population and 58% of all hospital beds in the country. Currently, more than 1,300 hospitals participate in the Survey. To view hospitals ratings, visit http://www.leapfroggroup.org/cp.The Leapfrog Group is an initiative driven by organizations that buy health care who are working to initiate breakthrough improvements in the safety, quality and affordability of healthcare for Americans. Leapfrog is a member supported program aimed at mobilizing employer purchasing power to alert America�s health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded. The Leapfrog Group was founded by a small group of large employers, initially supported by the Business Roundtable (BRT) and launched in November 2000. Leapfrog is supported by the BRT, The Robert Wood Johnson Foundation, Leapfrog members and others. A 1999 report by the Institute of Medicine gave the Leapfrog founders an initial focus � reducing preventable medical mistakes. The report found that up to 98,000 Americans die every year from preventable medical errors made in hospitals alone. In fact, there are more deaths in hospitals each year from preventable medical mistakes than there are from vehicle accidents, breast cancer and AIDS. The report recommended that large employers provide more market reinforcement for the quality and safety of health care. Leapfrog�s founders realized that they could take �leaps� forward with their employees, retirees and families by rewarding hospitals that implement significant improvements in quality and safety. The Leapfrog Group�s growing consortium of major companies and other large private and public healthcare purchasers provide health benefits to more than 37 million Americans in all 50 states. Leapfrog members and their employees spend tens of billions of dollars on health care annually. Leapfrog members have agreed to base their purchase of health care on principles that encourage quality improvement among providers and consumer involvement. If all hospitals implemented just the first three of Leapfrog�s four �leaps� or recommended quality and safety practices: over 65,000 lives could be saved, more than 907,000 medication errors could be avoided (Birkmeyer 2004), and up to $41.5 billion could be saved (Conrad 2005) each year. The Mission The Leapfrog Group�s mission is to trigger giant leaps forward in the safety, quality and affordability of health care by: Supporting informed healthcare decisions by those who use and pay for health care; and, Promoting high-value health care through incentives and rewards. This effort is rooted in four ideas: American health care remains far below obtainable levels of basic safety, quality, andoverall customer value. The health industry would improve more rapidly if purchasers better recognized and rewarded superior safety and overall value. Voluntary adherence to purchasing principles by a critical mass of America�s largest employers would provide a large jump-start and encourage other purchasers to join. These principles should not only champion superior overall value but should initially focus on a handful of specific innovations offering �great leaps� to maximize media and consumer support and adoption by other purchasers. Four Leaps in Hospital Quality, Safety and Affordability A range of hospital quality and safety practices are the focus of Leapfrog�s hospital ratings via the Leapfrog Hospital Quality and Safety Survey, as well as our hospital recognition and reward programs. Endorsed by the National Quality Forum (NQF), the practices are: computer physician order entry; evidence-based hospital referral; intensive care unit (ICU) staffing by physicians experienced in critical care medicine; and the Leapfrog Safe Practices Score. Computer Physician Order Entry (CPOE): With CPOE systems, hospital staff enter medication orders via computer linked to prescribing error prevention software. CPOE has been shown to reduce serious prescribing errors in hospitals by more than 50%. Evidence-Based Hospital Referral (EHR): Consumers and health care purchasers should choose hospitals with extensive experience and the best results with certain high-risk surgeries and conditions. By referring patients needing certain complex medical procedures to hospitals offering the best survival odds based on scientifically valid criteria � such as the number of times a hospital performs these procedures each year or other process or outcomes data � research indicates that a patient�s risk of dying could be reduced by 40%. ICU Physician Staffing (IPS): Staffing ICUs with doctors who have special training in critical care medicine, called �intensivists�, has been shown to reduce the risk of patients dying in the ICU by 40%. Leapfrog Safe Practices Score: The National Quality Forum-endorsed 30 Safe Practices cover a range of practices that, if utilized, would reduce the risk of harm in certain processes, systems or environments of care. Included in the 30 practices are the three leaps above. This fourth leap assesses a hospitals� progress on the remaining 27 NQF safe practices. Our leaps adhere to four primary criteria. (1) There is overwhelming scientific evidence that these quality and safety leaps will significantly reduce preventable medical mistakes. (2) Their implementation by the health industry is feasible in the near term. (3) Consumers can readily appreciate their value. (4) Health plans, purchasers or consumers can easily ascertain their presence or absence in selecting among health care providers. These leaps are a practical first step in using purchasing power to improve hospital safety and quality. Because the health industry needs time to meet these standards, Leapfrog purchasers are working with the provider community to arrive at aggressive but feasible target dates for implementation of Leapfrog�s recommended quality practices. In addition to the Survey, the Leapfrog Hospital Insights measurement tool integrates the first nationally collected set of hospital efficiency measures with standardized clinical measures from JCAHO and the Survey. This broad array of hospital performance measures gives consumers and purchasers a complete picture of overall hospital performance in five clinical areas and is the basis of Leapfrog�s Hospital Rewards Program (see below). Buying Right: Leapfrog�s Purchasing Principles Leapfrog�s member companies agree to adhere to the following four purchasing principles in buying health care for their enrollees: Educating and informing enrollees about the safety, quality and affordability of health care and the importance of comparing the care health care providers give. Initial emphasis on the Leapfrog safety and quality practices. Recognizing and rewarding health care providers for major advances in the safety, quality and affordability of their care. Holding health plans accountable for implementing the Leapfrog purchasing principles. Building the support of benefits consultants and brokers to use and advocate for the Leapfrog purchasing principles with all of their clients. To help advance the purchasing principles, the Leapfrog Hospital Rewards Program allows implementers to reward hospitals that demonstrate excellence and/or sustained quality and efficiency improvement. It is an off-the-shelf pay for performance program that drives improvements in hospital quality and efficiency in five clinical areas while demonstrating dollar savings as performance improves. For more information, visit https://leapfrog.medstat.com/rewards/. Current Progress The Leapfrog Group began collecting hospital data in June 2001 by surveying urban and suburban hospitals in six regions. Today, we operate in 33. (To view the list of regions, visit http://www.leapfroggroup.org/for_members/members_resources/regional_roll_outs.) Leapfrog�s 33 regions cover over half of the US population and 58% of all hospital beds in the country. Currently, more than 1,300 hospitals participate in the Survey. To view hospitals ratings, visit http://www.leapfroggroup.org/cp.

3. Hospital Survey Evolution of The Leapfrog Group TODAY � Leapfrog operates in 43 regions in 2010 - including Virginia Regions cover over half of the US population In 2009, 1,244 Hospitals participated in the Survey Employers of all sizes use the Leapfrog Hospital Survey results in their health care purchasing decisions Leapfrog is supported by its members, partners and others The Leapfrog Group is an initiative driven by organizations that buy health care who are working to initiate breakthrough improvements in the safety, quality and affordability of healthcare for Americans. Leapfrog is a member supported program aimed at mobilizing employer purchasing power to alert America�s health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded. The Leapfrog Group was founded by a small group of large employers, initially supported by the Business Roundtable (BRT) and launched in November 2000. Leapfrog is supported by the BRT, The Robert Wood Johnson Foundation, Leapfrog members and others. A 1999 report by the Institute of Medicine gave the Leapfrog founders an initial focus � reducing preventable medical mistakes. The report found that up to 98,000 Americans die every year from preventable medical errors made in hospitals alone. In fact, there are more deaths in hospitals each year from preventable medical mistakes than there are from vehicle accidents, breast cancer and AIDS. The report recommended that large employers provide more market reinforcement for the quality and safety of health care. Leapfrog�s founders realized that they could take �leaps� forward with their employees, retirees and families by rewarding hospitals that implement significant improvements in quality and safety. The Leapfrog Group�s growing consortium of major companies and other large private and public healthcare purchasers provide health benefits to more than 37 million Americans in all 50 states. Leapfrog members and their employees spend tens of billions of dollars on health care annually. Leapfrog members have agreed to base their purchase of health care on principles that encourage quality improvement among providers and consumer involvement. If all hospitals implemented just the first three of Leapfrog�s four �leaps� or recommended quality and safety practices: over 65,000 lives could be saved, more than 907,000 medication errors could be avoided (Birkmeyer 2004), and up to $41.5 billion could be saved (Conrad 2005) each year. The Mission The Leapfrog Group�s mission is to trigger giant leaps forward in the safety, quality and affordability of health care by: Supporting informed healthcare decisions by those who use and pay for health care; and, Promoting high-value health care through incentives and rewards. This effort is rooted in four ideas: American health care remains far below obtainable levels of basic safety, quality, andoverall customer value. The health industry would improve more rapidly if purchasers better recognized and rewarded superior safety and overall value. Voluntary adherence to purchasing principles by a critical mass of America�s largest employers would provide a large jump-start and encourage other purchasers to join. These principles should not only champion superior overall value but should initially focus on a handful of specific innovations offering �great leaps� to maximize media and consumer support and adoption by other purchasers. Four Leaps in Hospital Quality, Safety and Affordability A range of hospital quality and safety practices are the focus of Leapfrog�s hospital ratings via the Leapfrog Hospital Quality and Safety Survey, as well as our hospital recognition and reward programs. Endorsed by the National Quality Forum (NQF), the practices are: computer physician order entry; evidence-based hospital referral; intensive care unit (ICU) staffing by physicians experienced in critical care medicine; and the Leapfrog Safe Practices Score. Computer Physician Order Entry (CPOE): With CPOE systems, hospital staff enter medication orders via computer linked to prescribing error prevention software. CPOE has been shown to reduce serious prescribing errors in hospitals by more than 50%. Evidence-Based Hospital Referral (EHR): Consumers and health care purchasers should choose hospitals with extensive experience and the best results with certain high-risk surgeries and conditions. By referring patients needing certain complex medical procedures to hospitals offering the best survival odds based on scientifically valid criteria � such as the number of times a hospital performs these procedures each year or other process or outcomes data � research indicates that a patient�s risk of dying could be reduced by 40%. ICU Physician Staffing (IPS): Staffing ICUs with doctors who have special training in critical care medicine, called �intensivists�, has been shown to reduce the risk of patients dying in the ICU by 40%. Leapfrog Safe Practices Score: The National Quality Forum-endorsed 30 Safe Practices cover a range of practices that, if utilized, would reduce the risk of harm in certain processes, systems or environments of care. Included in the 30 practices are the three leaps above. This fourth leap assesses a hospitals� progress on the remaining 27 NQF safe practices. Our leaps adhere to four primary criteria. (1) There is overwhelming scientific evidence that these quality and safety leaps will significantly reduce preventable medical mistakes. (2) Their implementation by the health industry is feasible in the near term. (3) Consumers can readily appreciate their value. (4) Health plans, purchasers or consumers can easily ascertain their presence or absence in selecting among health care providers. These leaps are a practical first step in using purchasing power to improve hospital safety and quality. Because the health industry needs time to meet these standards, Leapfrog purchasers are working with the provider community to arrive at aggressive but feasible target dates for implementation of Leapfrog�s recommended quality practices. In addition to the Survey, the Leapfrog Hospital Insights measurement tool integrates the first nationally collected set of hospital efficiency measures with standardized clinical measures from JCAHO and the Survey. This broad array of hospital performance measures gives consumers and purchasers a complete picture of overall hospital performance in five clinical areas and is the basis of Leapfrog�s Hospital Rewards Program (see below). Buying Right: Leapfrog�s Purchasing Principles Leapfrog�s member companies agree to adhere to the following four purchasing principles in buying health care for their enrollees: Educating and informing enrollees about the safety, quality and affordability of health care and the importance of comparing the care health care providers give. Initial emphasis on the Leapfrog safety and quality practices. Recognizing and rewarding health care providers for major advances in the safety, quality and affordability of their care. Holding health plans accountable for implementing the Leapfrog purchasing principles. Building the support of benefits consultants and brokers to use and advocate for the Leapfrog purchasing principles with all of their clients. To help advance the purchasing principles, the Leapfrog Hospital Rewards Program allows implementers to reward hospitals that demonstrate excellence and/or sustained quality and efficiency improvement. It is an off-the-shelf pay for performance program that drives improvements in hospital quality and efficiency in five clinical areas while demonstrating dollar savings as performance improves. For more information, visit https://leapfrog.medstat.com/rewards/. Current Progress The Leapfrog Group began collecting hospital data in June 2001 by surveying urban and suburban hospitals in six regions. Today, we operate in 33. (To view the list of regions, visit http://www.leapfroggroup.org/for_members/members_resources/regional_roll_outs.) Leapfrog�s 33 regions cover over half of the US population and 58% of all hospital beds in the country. Currently, more than 1,300 hospitals participate in the Survey. To view hospitals ratings, visit http://www.leapfroggroup.org/cp.The Leapfrog Group is an initiative driven by organizations that buy health care who are working to initiate breakthrough improvements in the safety, quality and affordability of healthcare for Americans. Leapfrog is a member supported program aimed at mobilizing employer purchasing power to alert America�s health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded. The Leapfrog Group was founded by a small group of large employers, initially supported by the Business Roundtable (BRT) and launched in November 2000. Leapfrog is supported by the BRT, The Robert Wood Johnson Foundation, Leapfrog members and others. A 1999 report by the Institute of Medicine gave the Leapfrog founders an initial focus � reducing preventable medical mistakes. The report found that up to 98,000 Americans die every year from preventable medical errors made in hospitals alone. In fact, there are more deaths in hospitals each year from preventable medical mistakes than there are from vehicle accidents, breast cancer and AIDS. The report recommended that large employers provide more market reinforcement for the quality and safety of health care. Leapfrog�s founders realized that they could take �leaps� forward with their employees, retirees and families by rewarding hospitals that implement significant improvements in quality and safety. The Leapfrog Group�s growing consortium of major companies and other large private and public healthcare purchasers provide health benefits to more than 37 million Americans in all 50 states. Leapfrog members and their employees spend tens of billions of dollars on health care annually. Leapfrog members have agreed to base their purchase of health care on principles that encourage quality improvement among providers and consumer involvement. If all hospitals implemented just the first three of Leapfrog�s four �leaps� or recommended quality and safety practices: over 65,000 lives could be saved, more than 907,000 medication errors could be avoided (Birkmeyer 2004), and up to $41.5 billion could be saved (Conrad 2005) each year. The Mission The Leapfrog Group�s mission is to trigger giant leaps forward in the safety, quality and affordability of health care by: Supporting informed healthcare decisions by those who use and pay for health care; and, Promoting high-value health care through incentives and rewards. This effort is rooted in four ideas: American health care remains far below obtainable levels of basic safety, quality, andoverall customer value. The health industry would improve more rapidly if purchasers better recognized and rewarded superior safety and overall value. Voluntary adherence to purchasing principles by a critical mass of America�s largest employers would provide a large jump-start and encourage other purchasers to join. These principles should not only champion superior overall value but should initially focus on a handful of specific innovations offering �great leaps� to maximize media and consumer support and adoption by other purchasers. Four Leaps in Hospital Quality, Safety and Affordability A range of hospital quality and safety practices are the focus of Leapfrog�s hospital ratings via the Leapfrog Hospital Quality and Safety Survey, as well as our hospital recognition and reward programs. Endorsed by the National Quality Forum (NQF), the practices are: computer physician order entry; evidence-based hospital referral; intensive care unit (ICU) staffing by physicians experienced in critical care medicine; and the Leapfrog Safe Practices Score. Computer Physician Order Entry (CPOE): With CPOE systems, hospital staff enter medication orders via computer linked to prescribing error prevention software. CPOE has been shown to reduce serious prescribing errors in hospitals by more than 50%. Evidence-Based Hospital Referral (EHR): Consumers and health care purchasers should choose hospitals with extensive experience and the best results with certain high-risk surgeries and conditions. By referring patients needing certain complex medical procedures to hospitals offering the best survival odds based on scientifically valid criteria � such as the number of times a hospital performs these procedures each year or other process or outcomes data � research indicates that a patient�s risk of dying could be reduced by 40%. ICU Physician Staffing (IPS): Staffing ICUs with doctors who have special training in critical care medicine, called �intensivists�, has been shown to reduce the risk of patients dying in the ICU by 40%. Leapfrog Safe Practices Score: The National Quality Forum-endorsed 30 Safe Practices cover a range of practices that, if utilized, would reduce the risk of harm in certain processes, systems or environments of care. Included in the 30 practices are the three leaps above. This fourth leap assesses a hospitals� progress on the remaining 27 NQF safe practices. Our leaps adhere to four primary criteria. (1) There is overwhelming scientific evidence that these quality and safety leaps will significantly reduce preventable medical mistakes. (2) Their implementation by the health industry is feasible in the near term. (3) Consumers can readily appreciate their value. (4) Health plans, purchasers or consumers can easily ascertain their presence or absence in selecting among health care providers. These leaps are a practical first step in using purchasing power to improve hospital safety and quality. Because the health industry needs time to meet these standards, Leapfrog purchasers are working with the provider community to arrive at aggressive but feasible target dates for implementation of Leapfrog�s recommended quality practices. In addition to the Survey, the Leapfrog Hospital Insights measurement tool integrates the first nationally collected set of hospital efficiency measures with standardized clinical measures from JCAHO and the Survey. This broad array of hospital performance measures gives consumers and purchasers a complete picture of overall hospital performance in five clinical areas and is the basis of Leapfrog�s Hospital Rewards Program (see below). Buying Right: Leapfrog�s Purchasing Principles Leapfrog�s member companies agree to adhere to the following four purchasing principles in buying health care for their enrollees: Educating and informing enrollees about the safety, quality and affordability of health care and the importance of comparing the care health care providers give. Initial emphasis on the Leapfrog safety and quality practices. Recognizing and rewarding health care providers for major advances in the safety, quality and affordability of their care. Holding health plans accountable for implementing the Leapfrog purchasing principles. Building the support of benefits consultants and brokers to use and advocate for the Leapfrog purchasing principles with all of their clients. To help advance the purchasing principles, the Leapfrog Hospital Rewards Program allows implementers to reward hospitals that demonstrate excellence and/or sustained quality and efficiency improvement. It is an off-the-shelf pay for performance program that drives improvements in hospital quality and efficiency in five clinical areas while demonstrating dollar savings as performance improves. For more information, visit https://leapfrog.medstat.com/rewards/. Current Progress The Leapfrog Group began collecting hospital data in June 2001 by surveying urban and suburban hospitals in six regions. Today, we operate in 33. (To view the list of regions, visit http://www.leapfroggroup.org/for_members/members_resources/regional_roll_outs.) Leapfrog�s 33 regions cover over half of the US population and 58% of all hospital beds in the country. Currently, more than 1,300 hospitals participate in the Survey. To view hospitals ratings, visit http://www.leapfroggroup.org/cp.

4. The Leapfrog GroupHospital Survey in Virginia Coalition of Employers (Purchasers) and other Stakeholders Leapfrog Regional Roll-out Leader since 2003 90 Hospitals were targeted to participate in 2009 38 Hospitals participated, or 42% (just over 50% of targeted beds in region) 30 Urban hospitals, or 50% 8 Rural hospitals, or 16% �Evidence-Based� Leapfrog asks hospitals to report on evidence-based measures that matter to purchasers Body of research showing that measurement & public reporting improves quality

5. Leapfrog Hospital Survey 2009 VBCH Leapfrog Hospital Survey Report cards presented during educational programs www.LeapfrogGroup.org/cp distributed electronically to VBCH employers and their thousands of employees Employers design health benefits around Leapfrog transparency/fully meeting leaps Numerous press releases distributed about survey results Consumer Reports story on Central Line Associated Blood Stream Infection rates

6. Leapfrog Hospital Survey 2009

7. Recognition for Progress �Appropriate ICU Staffing� Hospitals that �Fully Met� Bon Secours Maryview Medical Center Riverside Regional Medical Center Sentara Bayside Hospital Sentara Careplex Hospital Sentara Leigh Hospital Sentara Obici Hospital Sentara Virginia Beach General Hospital Sentara Williamsburg Regional Medical Center Winchester Medical Center Inc

8. Recognition for Progress Evidence-Based Hospital Referral (EBHR) �Process + Volume + Outcomes = Quality� Hospitals that �Fully Met� Bon Secours Maryview Medical Center (BAR) CJW Chippenham Campus (CABG, PCI, AAA) CJW Johnston Willis Campus (AAA, ESOPH) Henrico Doctors� Hospital (CABG, PCI, PAN, DEL) Lewis Gale Medical Center (CABG) Mary Washington Medical Center (CABG, AAA, ESOPH) Riverside Regional Medical Center (CABG, PCI, DEL) Sentara Norfolk (CABG, PCI, AVR, AAA, PAN, BAR, DEL) Sentara Virginia Beach (PCI, AAA, PAN, ESOPH) Sentara Careplex Hospital (AAA, PAN, ESOPH, BAR) Sentara Leigh Hospital (ESOPH) Virginia Baptist Hospital & Lynchburg General (CABG, PCI, AAA) VCU Health System (PCI, ESOPH, DEL) Winchester Medical Center (BAR)

9. Recognition for Progress �Common Acute Conditions � Heart Attack� Hospitals that �Fully Met� CJW Chippenham Campus Henrico Doctors' Hospital Henrico Doctors' Hospital - Parham Campus Lewis-Gale Medical Center Montgomery Regional Hospital Riverside Regional Medical Center Sentara Bayside Hospital Sentara Careplex Hospital Sentara Norfolk General Hospital Sentara Williamsburg Regional Medical Center Virginia Baptist Hosp & Lynchburg General Hospital

10. Recognition for Progress �Common Acute Conditions � Pneumonia� Hospitals that �Fully Met� Alleghany Regional Hospital Bon Secours DePaul Medical Center Chesapeake Regional Medical Center CJW Chippenham Campus CJW Johnston Willis Campus Clinch Valley Medical Center Henrico Doctors' Hospital Henrico Doctors' Hospital - Parham Campus John Randolph Medical Center Lewis-Gale Medical Center Mary Washington Hospital Continued..

11. Recognition for Progress �Common Acute Conditions � Pneumonia� Hospitals that �Fully Met� �Continued Montgomery Regional Hospital Pulaski Community Hospital Reston Hospital Center Retreat Hospital Riverside Tappahannock Hospital Inc Riverside Walter Reed Hospital Sentara CarePlex Hospital Sentara Norfolk General Hosp Sentara Virginia Beach General Hospital Sentara Williamsburg Regional Medical Center Virginia Baptist Hosp & Lynchburg General Hospital

12. Recognition for Progress �Common Acute Conditions � Normal Deliveries� Hospitals that �Fully Met� Bon Secours DePaul Medical Center Bon Secours Mary Immaculate Hospital CJW Chippenham Campus CJW Johnston Willis Campus Culpeper Regional Hospital Inc Lewis-Gale Medical Center Montgomery Regional Hospital Riverside Regional Medical Center Sentara Norfolk General Hospital Sentara Williamsburg Regional Medical Center Winchester Medical Center Inc

13. Recognition for Progress �Steps to Reduce Harm� Safe Practices Score (SPS) Hospitals that �Fully Met� Alleghany Regional Hospital Henrico Doctors� Hospital Henrico Doctors� Hospital � Parham Campus John Randolph Medical Center Lewis-Gale Medical Center Montgomery Regional Hospital Retreat Hospital

14. Recognition for Progress �Managing Serious Errors� Adherence to �Never Events� Policies Hospitals that �Fully Met� Alleghany Regional Hospital Bon Secours Maryview Medical Center CJW Medical Center - Chippenham Campus CJW Medical Center - Johnston-Willis Campus Culpeper Regional Hospital Inc Fauquier Hosp Henrico Doctors' Hospital Henrico Doctors' Hospital - Parham Campus Continued..

15. �Managing Serious Errors� Adherence to �Never Events� Policies �Continued Hospitals that �Fully Met� CJW Johnston Willis Campus CJW Chippenham Campus John Randolph Medical Center Lewis-Gale Medical Center Montgomery Regional Hospital Prince William Hospital Pulaski Community Hospital Reston Hospital Center Retreat Hospital VCU Health System Recognition for Progress

16. Recognition for Progress

17. Recognition for Progress

18. Recognition for Progress

19. Leapfrog 2009 Hospital Survey SPECIAL RECOGNITION - AWARDS: Highest �Safe Practices Score� John Randolph Medical Center Congratulations!

20. Leapfrog 2009 Hospital Survey SPECIAL RECOGNITION - AWARDS: Rural Hospital with the most �Fully Met� Leapfrog Standards Riverside Tappahannock Hospital Congratulations!

21. Leapfrog 2009 Hospital Survey SPECIAL RECOGNITION - AWARD: Effective Implementation�Computerized Prescriber Order Entry� Sentara Health System Bayside Hospital Leigh Hospital Virginia Beach General Hospital Norfolk General Hospital Congratulations!

22. Leapfrog 2010 Hospital Survey Leapfrog Hospital Survey ~2010 Goals for 2010 Leapfrog Hospital Survey Increase in Urban and Rural Hospital participation Increase # of hospitals that fully meet Leapfrog�s target for Rate of Central Line Infections Increase # of hospitals that meet Leapfrog�s target of 12% for Rate of Elective Deliveries (Normal Deliveries) Increase # of hospitals that fully meet Leapfrog�s Never Events Policy Benefits of Transparency: Recognition Financial Rewards Summary Performance Reports Other reports on hospital�s quality improvement Patient steerage Employers and employees will love you! Contact VBCH for details or visit www.myVBCH.org

23. Leapfrog 2010 Hospital Survey Leapfrog Hospital Survey ~ 2010 Letters and Security Code packets mailed April 2 by Regional Roll-out Leader, Virginia Business Coalition on Health Survey Submission Deadline: June 30th Results go live at www.Leapfroggroup.org Hospital update results �.monthly through March 2011 Have Survey related Questions? Email the Helpdesk at Leapfrog@Quantros.com

24. Leapfrog Hospital Survey Thank you! Transparent Hospitals Virginia Business Coalition on Health