What’s New in 2010: The Leapfrog Hospital Survey

1. What’s New in 2010: The Leapfrog Hospital Survey Survey Townhall CallsApril/May 2010

2. 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

3. Why Complete Leapfrog Survey?Unique in the Milieu • 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

4. 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.

5. Behind the Changes in 2010 Goals for the new survey— Expand coverage to more hospitals Keep burden as low as possible Align with other performance measurement groups (such as CDC-NHSN; CMS; Joint Commission) Maintain consistent measurement structure for LHRP and for improvement purposes Incorporate Safe Practices changes from maintenance work Update measures with guideline changes and measures that have topped off Maintain measures meaningful to purchasers and consumers

6. 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

7. Survey Submission Logistics, Timeline, Website Resources

8. 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?”

9. 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.

10. 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

11. Website Resources See online survey home page for links to: • Leapfrog Hospital Survey Reference Book (NEW!) • Measure specifications (volume, process, resource utilization) • Frequently Asked Questions • Scoring Algorithms • Hardcopy survey including explanatory “end notes” • Other links on home page • “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

12. Leapfrog Hospital Survey Reference Book • Medical Coding for High-Risk Procedures and Conditions (EBHR)Procedure code, diagnosis codes and other specifications for counting high-risk surgery volumes • EBHR Publicly Reported Outcomes for CABG and PCIFor 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). • EBHR Process Measures -- SpecificationsDetailed specifications for Leapfrog’s procedure-specific process measures of quality for CABG, PCI, AAA Repair, and high-risk deliveries. • EBHR Resource Utilization Measures – SpecificationsDetailed 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

13. 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 – SpecificationsSpecifications 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 • Early Delivery outcome measure • Process measures: Bilirubin screening, DVT prophylaxis for C-sections • Hospital-Acquired Conditions (HAC) – Specifications

14. What’s New for 2010

15. Survey Changes: The Details Safe Practices updated language EBHR Changes: Dropped AAA process measure—Beta Blocker at Discharge—no longer supported by guideline Updated Isolated CABG definition IPS Changes: Hospitals classified as “rural” can earn partial credit for 24x7 tele-intensivist coverage Common Acute Conditions Elective Deliveries specifications aligned with Joint Commission Dropped smoking cessation measures from AMI and Pneumonia Updated scoring thresholds for AMI and Pneumonia process measures Hospital Acquired Conditions New CLABSI scoring for 2010 Addition of CUSP Quality Improvement Program for some credit on CLABSI Pressure Ulcer measure aligned with CMS Never Events Eliminated commitment

16. 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 Safe Practices

17. 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

18. 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: • Intensivists manage or co-manage patients in all adult and pediatric medical and/or surgical ICUs and neuro ICUs • Tele-intensivist presence 24 hours a day/7 days a week • 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

19. 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)

20. 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

21. 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

22. 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

23. Never Events • Removed 60-day commitment to Never Events policy—given that hospitals are in the 3rd cycle of reporting this

24. Transparency Indicator • Removed Section 8 (Transparency Indicator) from the survey; very little variation in hospital responses • Reduces hospital response burden

25. 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

26. Questions?

27. 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