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CONSUMERS ARE INUNDATED WITH INFORMATION ABOUT HEALTHCARE WHETHER THEY GO PERUSING ON THE INTERNET OR HAVE IT BROADCASTED INTO THEIR HOMES, BUT WHAT INFORMATION SHOULD THEY BE GUIDED TOWARD?

Our presidential election is only days away. Forty-eight million people in America are uninsured and healthcare costs are rising two to three times faster than our nation's GDP. Where will America's healthcare system be in five years? Welcome to ReachMD's monthly series focus on Public Health Policy. This month we explore the many questions facing healthcare today.

Consumers are inundated with information about healthcare whether they go perusing on the internet or have it broadcasted into their homes, but what information should they be guided toward. Welcome to the Clinician's Roundtable on ReachMD XM Channel 157, the channel for medical professionals. I am Bruce Japsen, the healthcare reporter for the Chicago Tribune and with me today is Leah Binder. She is the chief executive officer of the Leapfrog Group. The Leapfrog Group uses the leverage of some of the nation's largest employers to initiate breakthrough changes in medical care safety and quality. Ms. Binder is a former hospital executive at her own right who used to work as Vice President of Franklin Community Health Network in Farmington, Maine. Prior to that, she served as senior policy advisor to Rudolph Giuliani where she developed programs to improve care of the uninsured among other key initiatives. She began her career in health policy with the National League of Nursing where she served as public policy director.

BRUCE JAPSEN:

Leah Binder, it is a pleasure to have you on ReachMD.

LEAH BINDER:

Thanks for having me.

BRUCE JAPSEN:

Well, I want to congratulate you on what is still your new job, and I know, we all know the Leapfrog Group in the healthcare industry is a group that is looking out as an overseer, if you will, and working with health plans, hospitals, and doctor groups to ensure that consumers are getting quality and certainly getting bank for their buck, if you will, but I have a question. When you are talking about the consumer information which you guys put out and you try to work as a group that puts out certain data, how is the consumer information out there and where are things headed?

LEAH BINDER:

These are lot of sources of consumer information; some of it is very good. Obviously, I am going to say that ours is excellent www.leapfroggroup.org, but there are also some sources that may not be quite as good, so there is a cacophony. You can probably google and compare hospitals or compare healthcare and you will find probably hundreds if not thousands of listings and again some of them are good and some of them aren't so good. I think what consumers need to do is look for sites that collect their own data and do so in a way that is certified to be evidence based or in some way has some evidence behind it. So for example our website, we use what is called NQF endorsed measures for the most part and we have a team of researchers who are on our website and white papers that describe the research that's behind what we are measuring and how we are comparing the hospitals. Any site that you use on web, you are to hold through similar standards, make sure they have the evidence of why they are collecting these measures and how they collected them on their site. A lot of sites report measures that others have given them and that’s okay as long there is not excessive bias in the way they report it, so you need to be really particularly cautious with sites that are reporting other's data. So I again would caution you to look closely at that, but there is an awful lot of data that's out there and I hope that people do not think and throw up their hands and give up because there are so many sites, but really try to use the best data that's out there.

BRUCE JAPSEN:

When you are talking about evidence based data for some of these quality groups and these rating agencies or rating companies, if you will, some of them are publicly traded on Wall Street, that's a big deal among the physician community and hospitals as well. They want to see that any information that a consumer or any of our listeners out there are getting is evidence based. Could you give an example of what a consumer should look for or even a doctor because the patients come into their doctor's office and they say, oh I saw this or I saw that. Is there any thing that a doctor could tell their patient to look for on these websites? Are they being transparent about the information they are providing, may be they are not, or is there something perhaps they should be looking for when they evaluate these websites?

LEAH BINDER:

I would strongly recommend that they look for websites that have NQF endorsed measures.

BRUCE JAPSEN:

Could you NQF for our listeners who don't know what does that stand for?

LEAH BINDER:

National Quality Forum, which is a really fantastic organization here in D. C. that has assembled pretty much all the stakeholders you could ever imagine who are interested in quality in healthcare from consumers to purchasers like we are, to every kind of specialty physician to group to hospitals, they have assembled all of the stakeholders and they have a very good process for evaluating what kinds of measures we are to be looking at and then they vote on measures that they will then endorse.

BRUCE JAPSEN:

So it's not just an aggregator of information because there are certainly some websites and measures and you might even hear them in a hospital, may even use it; marketing company on their ads or something, so that is an important point, so National Quality Forum measures endorse, that's great.

LEAH BINDER:

You can also look on www.hospitalcompare.com which is a website by CMS and that website has data that you can be very comfortable with it. It comes from our Federal agency that regulates Medicare and Medicaid, and it also comes from another group of providers who have also wedded some of that information called Hospital Quality Alliance. So that website as well has some good data and then as I said from the employer's side, the one that we like is www.leapfroggroup.org. There are a number of others, but there are those kinds of measures that you are going to find on website like ours are going to be wedded through a group of professionals who have really looked at the evidence and said that this measure does tell us something that's important about the quality of care at an institution.

If you are just joining us, you are listening to the Clinician's Roundtable on ReachMD XM 157, the channel for medical professionals. I am Bruce Japsen, the healthcare reporter with the Chicago Tribune, and I am talking with Leah Binder. She is the Chief Executive Officer of the Leapfrog Group, and if you don't know the Leapfrog Group, it's an organization that represents some of the nation's largest employers.

BRUCE JAPSEN:

Are there just some websites in general that you think are some better than others, and if you feel comfortable naming them, either something that's a company out there or perhaps certain providers better than others, and I'll just go ahead and throw one out, The Mayo Clinic does a heck of a job and you can go on there and you can click on an alphabetized list and are there others that are getting better, it seems that people are getting better at this.

LEAH BINDER:

They are, and would add our own website to that www.leapfroggroup.org. We compare safety and our new data would be coming out in July, meaning our new survey for 2008, we start to release that data and we will have to redesign actually of our consumer site and that's available again in the middle of July, our results will start to come out. I mean 95 million Americans or about 80% of anyone who has been online, is using it as a tool to get health information, but only about 3% report that they are getting that direction to go online from their physicians. So I think it's very important for physicians to become more aware of what is online, what their patients are looking at and to get online themselves to see what it is and to talk to your patients to say, are you getting online to get information and where are you getting your information because people often may not tell their physician, well I am taking some supplement because I read online, that's what you are supposed to be doing, but they might not tell their physician that; they might figure out the detail or he will think I am crazy or whatever it is, they may not tell the physician, but if the physician asks they are likely to find that out and then they have an opportunity to get online themselves and see where that information lies and whether it is evidence based so that they can alert their patients if it is not evidence based and at the same time they can advise if it is they can say, well, you can really look at I am referring you to this hospital and if you look at the Leapfrog Group website, you will find that that hospital is one of the top hospitals or gets a very high rating for your procedure or something like that. I think that gives physicians an opportunity to really offer that evidence based at. I think consumers are increasingly looking for, although I wish they would look for a little bit more, but they are increasingly interested in.

BRUCE JAPSEN:

You bring out the really good point in the fact that consumer involvement is something that Leapfrog Group emphasizes. May be you could address why people tend to believe they are so powerless when it comes to healthcare and the fact that they can, even though they might not think so. They can turn to their employer for help in this regard because there is a lot more information out there that is aggregated through groups like the Leapfrog Group that is helpful.

LEAH BINDER:

Traditionally, we are brought up, or at least I was brought up, may be I am old enough to say I was brought up, that you follow doctor's orders and that that was it and if you didn’t understand something what your doctor said, you ask for clarity. You didn’t separately go the library usually or go online. You certainly couldn’t go online when I was growing up, but you didn’t go off on your own and try to find the information. If your physician said go to this hospital or this physician, even if you knew that information was available on the quality of care provided by that hospital or that doctor you wouldn’t have sought it out anyway. I mean, it just wasn’t done. Since the culture of healthcare in our country is really about the relationship between physician and patient being paramount and it should be that way, but so much so that we as patients or consumers don’t think of ourselves as being in charge of our own health. I think that's where we have gotten a ride in the healthcare system because if you think that you are supposed to be passive in the healthcare system as a patient and just let them all do what they seem to know what they are doing, you may be in some trouble because the healthcare system doesn’t always work completely to the benefit of patients. We wish it did, and everybody is striving to get there, but it doesn’t, so you as a patient really have to take control and take leadership over your own healthcare, which by the way is a good principle to live your life by. I mean, we all have to try to stop smoking and lose weight and live our lives in as healthier way as possible. No doctor can force us to do that. We have to take charge of our own health in a general way. We have to do that also even in the healthcare system. So I think it is part of the larger emphasis on getting people excited about leading their own healthcare and doing that in a hospital. It is a very scary place to do it, so we certainly understand that it's not going to happen overnight, but hopefully by giving people information that they can look up and also by getting employers behind efforts to really make it easier for patients to assert their rights in a healthcare system, then we will make a difference and get there.

BRUCE JAPSEN:

Also, on your website, could you give us just a quick run down of what a consumer could look for and where they would go to find consumer information?

LEAH BINDER:

On our website, they would click on the section on the top that says for consumers and they will see some charts and it will lead them through how they can pick which hospitals in their area for example that they would like to look at or compare and it compares them on several indicators, one, for example, is safe practices. So we score hospitals on whether or not basically their environment, the protocols they use in their delivery of care are safe, so do they have a kind of hand washing program, is there infection control program according to certain regulations, etc. We look at 30 of those and if all have been endorsed through NQF, the same body I just mentioned, so it has been looked at by a wide range of professionals. So we score them on those safe practices. I think that's a pretty strong indicator. If UCA Hospital that has the highest score on safe practices, you can feel very comfortable going to that hospital because that means that everyone there, not just your physician, not just your nurse, but everyone, the admitting clerk, the billing person, and every single person that you will encounter at that hospital cares about safety and has put that as a priority. Is it a guarantee, absolutely not, but it does give you a very good indication and I know from my family I am going to be looking for those high scorers on the safe practices on no matter what procedure I want to go to a hospital for, I am going to look for that because I want to know that my family member is safe, the medications are safe, things are safe in the way that things go when someone is in the hospital because you are very vulnerable.

BRUCE JAPSEN:

Well, with that I would like to thank Leah Binder who has been our guest. She is the CEO of the Leapfrog Group and the website for consumer information on their ratings of hospital and other information they have about hospital safety is at www.leapfroggroup.org and I would like to thank her again for being our guest. I am Bruce Japsen of Chicago Tribune your host.

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You have been listening to Public Health Policy in America, a special ReachMD XM157 interview series with our nation's top thought leaders in public health.

This month, ReachMD XM157 will be discussing the many issues challenging Public Health Policy in America. For a complete schedule of guests and programming information, visit us at www.reachmd.com.