The Leapfrog Group promised to change hospitals' relationships with employers when it was founded in 2000. The Group's mission was to leverage the buying power of employers to drive hospitals to install computerized physician order entry systems (CPOE) that attempt to reduce the incidence of and cost attributed to medical errors. The landmark 1999 Institute of Medicine report titled To Err is Human report placed the price tag on these errors in the U.S. at $20B per year. Ten years later, with medical errors still rampant, the American Recovery and Reinvestment Act (ARRA) attempts once again to address the problem by offering incentives to hospitals to adopt EMRs, which have CPOE as a critical component and also promise reductions in medical errors as well as gains in efficiency.
The Leapfrog Group was formed by Fortune 500 employers that wanted to set safety standards that required institutional investment in CPOE by hospitals, and the safety standards were to be enforced with the collective healthcare services buying power of the employers. The end goal of the employers was to both reduce costs and drive access to safer hospitals for their employees. There was strong, early momentum for the Leapfrog Group's initiative. However, as time went on, hospitals failed to meet the safety standards of the Leapfrog Group and employers did not follow through with cutting off access and payment for employees' care at noncompliant institutions. The Leapfrog Group made standards more flexible as the barriers to implementation became clear. There were issues with feasibility given the complexity and immaturity of available CPOE solutions. In most cases, CPOE initiatives were launched by hospitals and failed or stalled, and the noncompliance of a hospital was provided as information to employees, but the employers' powers to withdraw patients was never invoked due to a lack of options for care in most communities.
Today, 10 years after the Institute of Medicine report, the Leapfrog Group has published a new survey indicating that only 7% of U.S. hospitals fully meet its CPOE and error prevention standards. In most cases, hospitals cited the lack of a business case for investment in CPOE as a reason for the failures. While the Leapfrog Group intended to use a "stick" to drive CPOE adoption with the threat of employers withdrawing their employee patients from hospitals, today we are seeing the U.S. government attempt to use a "carrot" in the form of incentive payments to drive CPOE and EMR adoption under ARRA. An eventual "stick" will be invoked with Medicare reimbursement penalties beginning in 2015 for those who do not demonstrate meaningful use of an EMR.
What do you think - will the approach under ARRA make a difference? Do you think the incentives and penalties under ARRA are big enough to drive EMR adoption?
Access the Leapfrog Group's survey online at http://www.leapfroggroup.org/media/file/leapfrogreportfinal.pdf
Article by Judy Hanover for 