Media Panel: Healthy Debate on Patient Safety

Good evening. We live in a country that's both defined by and is famous for our adherence to free speech. The safeguard of this hallowed idea is a vigorous and free media. From the muckrakers to Watergate to the recent coverage of the Affordable Care act, we are benefited by this amazing free media our country has. Today. We will examine the media's role in patient safety. We will ask important questions about the current coverage of patient safety, whether it's okay to have journalists advocate in stories they write. We'll discuss hospital rankings and ask how social media and increased transparency are changing the way we COVID patient safety. Because we're blessed with seven amazing journalists. It really is a who's who of national journalists, and I'm also proud to announce they don't agree on very much. So it really is going to be interesting. I'm going to lay out the questions and have three or four each of them respond and. And then the folks who don't get asked can jump in. So let me introduce our panelists and go straight at it. Our first panelist is Marshall Allen, the Pulitzer finalist and patient safety reporter for Pro Republica. Marshall.

Our second journalist is Leah Binder for the from the Huffington Post and Forbes.com and CEO of the Leapfrog Group. Leah.

Next is Lindsey Dunn, the editor in chief of Becker's Hospital Review in Chicago, Illinois.

Peter Eisler, the investigative reporter at a small newspaper called USA Today.

Meryl Guzner, the editor of Modern Healthcare.

Ben Harder, the managing editor and director of healthcare analysis for the US News and World Reports.

And last but not least, Matt Sloan, the former medical producer for CNN and president of Bounce House Creative.

I get the crack.

All right, we're going to start off by having each of you talk for a couple of minutes about what you're thinking about patient safety, what you're covering and doing. Let's start with you, Marshall.

Well, ProPublica is a nonprofit investigative news organization, and I've been writing about patient safety since 2000. But lots of ProPublica reporters actually do healthcare stories. We're big believers in transparency. We believe the public has a right to know about the quality of care that they receive in hospitals or how their doctor prescribes drugs. And so we do projects on lots of different topics related to patient safety. Right now, a project that I'm doing relates to I do a lot of listening to patients. So I've listened, talked to hundreds of patients who have been harmed while undergoing healthcare. We start a Facebook group that's up to almost 2,000 members of patients who have been harmed while undergoing medical care. And then I also listen a lot to providers, doctors, attorneys who work in healthcare, hospital administrators. We call it crowdsourcing, but really it's trying to listen to as many voices as possible so that we focus on the right issues and we write fair and accurate stories.

Excellent. Leah, you've had an amazing career in and around journalism and you've run in a hospital and tell us about your work.

Well, I'm with a group called the Leapfrog Group. This is a non profit organization. We rate hospital quality. Our members are purchasers. So they are large companies, typically that spend a lot of money on health benefits. In fact, many spend more on health benefits than they earn in profits. And so it's a major priority for them to see an improvement in the safety and quality of care. So the Leapfrog Group rates hospitals. We collect data from something called the leapfrog Hospital Survey. And we also have something called the Hospital Safety Score, which gives a letter grade to every general hospital in the country. And as a result of all this, because patient safety hasn't been on the radar the way we think it should have been, a lot of people ask us with the Hospital Safety Score, why are you so concerned about this? What is this issue? So we started writing about it and I started blogging, and that's where I started writing for Forbes and the Huffington Post and now have a regular contributor status with both to really open up the topic of safety and talk about why it's important and why transparency can really make a difference and why individual people have a stake in this and they can do something to protect themselves and their families and in a hospital.

Great. Lindsey, you cover the hospital industry every day. You want to talk about that? Sure.

So we're a trade organization focused on trade, hospitals and health systems. And so we have a unique perspective in that we're not writing for consumers, we're writing for the individuals who are leading these organizations that we're trying to improve. Our goal is to provide, provide content that is informative to them, that helps them improve their organizations, and hopefully through that, improve overall healthcare delivery, which we're all here because we know there are major problems with that, especially when it comes to patient safety. And so our hope is to play a small part in getting the information that they need to improve their organizations. And I think a lot of the discussion today, given the journalists that we have here, will be on consumer facing advocacy. And how do we get consumers and lawmakers to really want to desire to Bring about change. But the point that I'd like to make is that we can't have change unless the leaders of these organizations make that change, either through processes, cultural change, which was mentioned earlier. And so that's a huge part of it and something that my organization and the publications we do hopes to be a part of.

Peter, you have a huge pipe to disseminate lots of information. Tell us your thoughts about patient safety and your interest.

Okay.

So I work on the investigative team at USA Today, and we have a health care team, and they cover the healthcare industry day in and day out. And our job is to sort of go in deeper on whatever we decide to cover. And about 18 months ago, I started focusing on patient safety because we saw a real opportunity here. I think it's really a tremendous time to be covering these issues. First of all, you have a problem that has been legitimized and quantified, beginning with the Institute of Medicine report and with some of these newer reports that have come out. You know, we no longer have to make the case that patient safety is a problem. We're starting from that point, and we can move forward. Secondly, we have more data available and different sorts of data available now than we've ever had before. So we can use this data to.

Provide new information on the scope of problems that we already knew existed, to better define those problems. We can use those data to find and identify new problems that we weren't able to see before. And we have tools now to be able to use these data sets much more effectively, both in terms of our ability to analyze the data and also our ability to present these data in ways that consumers can use them. Interactive graphics and tools that consumers can use to drive to dive into some of these data sets that we're able to get. So it's just a. We just see it as a really good time to be covering this stuff. And then finally, sort of the last component of this is that you have. With the advent of social media and with the increased awareness of patient safety problems, you have a much more engaged and empowered audience, I think, than we've ever had before on these issues. So it's really, I think, kind of a perfect storm in terms of generating interest and generating the incentive to go out there and really dive into this stuff.

Merrill, you run Modern Healthcare. It must have been interesting three or four years to be in your job.

Well, actually, I've been the editor of Modern Healthcare for a little over a year now, and I came out of the mainstream media. I was a reporter For a long time. For the Chicago Tribune and other publications, our magazine covers caters to the leadership of hospitals, not primary all health care providers. Hospitals make up the bulk of the readership of our weekly magazine. We're the only weekly magazine in the space, but we also are increasingly, like most news organizations, increasingly focused on the web. I've got about a dozen reporters. When I took over a year ago, I had one who was on the beat of quality and safety. Today I have three people who are focused on quality and safety. It's a major emphasis under my leadership at Modern Healthcare. We see this as a crucial issue. And I would say that when we talk about patient safety, to us it's quality and safety. There's a huge movement in this country, I think, among hospital leadership. It's being enforced in many ways by the Affordable Care act to change the structure of the way medicine is being delivered, to make it more affordable. The way to do that is to bring higher quality to the system, get unnecessary waste out of the system. All of that will improve the safety profile of the system as well. And, you know, we've put new features. We just redesigned the magazine. We have now a best practice feature we didn't have before. So we're taking, you know, we've increased the map, the person power devoted to the issues, and, you know, have actually oriented a lot of our publication around it.

Ben so I've overseen the hospital rankings at U.S. news since 2010. U.S. news has been publishing hospital rankings since 1990, and for most of those years, the focus has been almost entirely on a very narrow set of patients, those with the most complex and difficult, difficult cases. It's a misapprehension that a lot of people have about the best hospitals rankings, but really we look very explicitly only about 2% of the inpatient cases in the US so a different goal in terms of what we're measuring than, say, leapfrog. The goal of US News, broadly is to give data and decision making tools to consumers, in this case case to patients, and not necessarily not to focus specifically on patient safety or on any other component, but to roll up all of the data that we have at our disposal and put it in front of consumers in a way that they can understand.

Since 2010, we have moved aggressively to expand our footprint. One thing is that in 2011, we began publishing regional rankings of hospitals. These are hospitals that aren't necessarily among the best in the nation. You wouldn't necessarily go traveling across the country for care at one of these institutions, but they are, they do perform very well in our, for the most part, cms. That is government data that we're using to rank them. We've also rolled out in the past few months a complete directory of every physician in the United States, 760,000 practicing physicians. We are working right now on evaluating the qualified health insurance plans that have been created under the aca. All of these are data driven evaluations, again to make consumers decisions more informed. And how does this fit into patient safety? So since in the past five years, for the past five years, we have used the patient safety indicators, also government published data as a component of the best hospitals rankings as well as the best regional hospitals rankings. And I actually have an announcement to make. This has only been being announced by US News today, so if any of you are tweeting, you can go break the news. But we have actually decided this year, on the basis of several years of studying the psis, to double the weight that we assigned to them from 5% to 10% this year.

Great. Matt, you want to follow that?

Not really.

But congratulations. So, yeah, up until last week, I worked for a small news organization called CNN Medical News. And we, you know, we have a fantastic team of about 25 journalists at CNN that focus solely on health and medical news. You're all very familiar, I'm sure, with Dr. Sanjay Gupta, who is our chief medical correspondent. We have a second medical correspondent, our senior medical correspondent, Elizabeth Cohen, who has an MPH and focuses solely on health policy. And her big area of focus is patient safety. She has a franchise called the Empowered Patient, where we spend a lot of time talking to consumers about what they should be doing to take charge of their own healthcare. Back in 2005, myself along with Dr. Gupta and some other people at CNN, we made a decision that we were going to sort of step out of the role of objective journalists and get out and start advocating for people to take charge of their own health care. And it's not something that any of us were that was trained out of us. We were trained to be objective. But we decided that we could no longer say, sit back and sort of watch things happen and not do anything about it. So I actually created a program we have called Fit Nation, which is focused on obesity and health and wellness. And then we helped Elizabeth create her platform for Empowered Patient, where we're actually going out and teaching people what they need to do to take charge, whether it's for their own health, for obesity and other things like that. I made the decision to leave CNN a couple months ago to take that to the next level and start, start this company, Bounce House Creative, which is actually focused around designing, eventizing, sort of taking charge of your health and bringing health to the people. Because as we talked about earlier, health literacy in this country is so low that it's time for people to understand what's happening to them and take charge.

Great. Let's start with a quote from the editor of a major news organization. Quote, patient safety is not sexy. How easy is it to do a patient safety story today? Are people interested? What kind of challenges are there? Leah, I want to start with you because you now do this for two different news organizations. So talk to us about how easy it is to get people focused on this.

People do not understand what patient safety is and that is the most important.

Aspect. I will give you an example. I had been talking about this issue with a particular.

Reporter for some time, discussing all the aspects that Leapfrog has been working on with patient safety. And at some point I was talking about the number of deaths associated with safety problems for about the 25th time because it's something that we talk about quite a lot. All of us do.

And then she said, well, don't you think that, that people die in hospitals anyway? And for me, it was a bingo that this reporter, who does a lot of work on patient safety, did not understand that we weren't talking about people going into the hospital and dying of the condition that sent them to the hospital. We're talking about people dying from errors, accidents, injuries, unintended and often preventable problems that happen in a hospital. It wasn't until I clarified that that I realized we need to start over in how we talk about patient safety because people really don't understand what we're talking about. So when we talk about deaths, I now talk about errors, accidents, injuries and infections that are unintended, that are not the reason that someone gets in a hospital. I think part of the reason it's difficult for the media to COVID patient safety is one, we don't understand it. So we do have to clarify and use better language to describe where to talking about. But also because people don't like talking about death in hospitals. It is not a, it's not a topic that everyone loves to talk about in polite company, but we do have to talk about it because a lot of people are dying from this and any of us in five minutes could be sent with an ambulance to a hospital. It is an immediate and urgent problem for all of us to attend. So I think making that case, explaining our language and understanding what we're talking about, I think that will and has been bringing this more to the fore in the media.

Great. Meryl, you've been on both sides. You've covered these stories as a reporter. Now you're assigning them as an editor.

Where do you think things stand today with covering patient safety?

Well, I think that right now it's important for me as an editor, and I remind my reporters all the time, anecdote is not evidence. And we're being inundated with tons and tons of data. And we have always are approached with lots of anecdotes. And the problem is getting good data and marrying it up to good anecdotes to create good stories. The first question you ask is, like, is doing a safety story sexy? Well, the first thing you got to do is you have to get a safety story. Right? And that's the hardest part with the safety stories, from what I said at the beginning, which is that anecdote is not evidence. And it's just an area that right now there's just a whole lot of controversy about what is the good evidence when you're looking at the data. You know, I have people come into my office all the time. We're approached because we are a leadership publication, so we have all the consult. There are hundreds of consultants and major consulting firms running around this country now advising hospital leadership on how to improve their safety profiles. I think there is a deep concern. There isn't a lot of uniformity on, like, how do we get good data that gives us actionable things to do? Because as a lot of people put it, there is no denominator. There is a lot of incident reports of things happening. And so it's very difficult when you get as a reporter into that story to generate something that I think tells a coherent story, but about what really needs to be done. We actually started creating modern healthcare strategies, boxes, best practices. I mean, we want to do all of this stuff. And it's fascinating to me, as somebody who's written stories, all of this for decades, to have reporters coming back and how hard they have to work to do a simple story, to come up with a best practice in a field far harder than I had to do in stories, say, 10 or 15 years ago, when you were just simply trying to throw something out in the newspaper that said, here's some problem. Because now people want to say, here is the solution. People want. My readers want to know what is the solution. And my reporters are having a very difficult time knowing what those are. I mean, it's interesting in a group like this where you say, you know, here are the apps, as they were being called, about what you need to do, and here's the checklist of very specific things. But, you know, there's a handful of things that are like that. And right now, there's a lot of controversy around many of the things that need to be done.

Peter at USA Today, are patient safety stories sexy?

Certainly. I think they're an easy sell. It wasn't my editor, I can tell you, who said that they weren't. You know, we look for stories that affect a lot of people, and, you know, the reader response that we get when we write about patient safety issues is terrific. I think that this is an issue that many, many people out there can relate to, based on my experience. We hear from a lot of people, we write about these problems, and we get a lot of response. Secondly, as an investigative reporter, as someone on our investigative unit, you know, we hear at these conferences, we hear a lot of carrot. We hear a lot of people saying, this is what you should do because this is the right thing to do, and. And you all should be doing it. And to a certain extent, we are the stick.

We are the ones who are supposed to come along and say, what about the people who aren't doing these things? And with respect to best practices.

My.

Personal experience has been that there are no shortage. There is no shortage of problems for which we know what the answers are. For example, let's take C diff. I mean, there are. Everybody knows that if a hospital is committed to reducing its C diff rates, everyone knows what they have to do. There are bundles out there. There are strategies out there that work. They're proved, They've been proved to work, they're effective. And yet we have many hospitals that aren't doing it yet. We have C diff rates that continue to go up in this context. What's our job? Our job is to come out there and to say, okay, people, here's a problem. The problem's getting worse, and we know what the solution is. Why aren't hospitals implementing these solutions? So, you know, you want a sex. You know, the elements of what we would consider to be a sexy story? Those are the elements of what we would consider to be a sexy story. And I think that patient safety issues, you know, they're dead on for this stuff.

Lindsey, you cover the hospital industry from the inside. Where's the line for you on patient safety? How much interest is there among your members about these issues?

Well, I'll preface My next comment by saying, you know, patient safety is fundamental and it's so, so important and it's almost in a somewhat shameful state today. But in the trade journalism space, I would say it is somewhat unsexy, especially given all the competing priorities that healthcare executives are facing. We have population, health management, personalized medicine, taking on risk and becoming almost health plans. So they have so many competing priorities that I think it's easy for CEOs to. They need to be these visionaries and certainly they need to move their organizations. But to forget that we have 200,000 deaths. I looked very hard to find how many people are actually hurt. And I had to do some math myself, but I found anywhere from 5 to 9 million are harmed a year were some estimates that I've come up with. So I think as top leaders have to look to the future to prepare their organizations for all these challenges, it can be easy to lose sight of the most fundamental thing, which is we treat the sick, we don't make them sicker.

That makes sense. Let's talk a little bit about advocacy journalism. You know, I have a journalism degree. I went to J school and realized very early I was too partisan and too passionate to stay in journalism. So I had to go be a political hack. But in today's world, government's playing an increased role in health care. And does journalism have a bigger watchdog role in that environment? Is it okay to just be an objective journalist and not call the balls and strikes? How effective is the fear of public shaming that Peter talked about? Can the media play more of a watchdog role and should it? I want to start with you, Matt, because you just made the switch. You decided you were, you know, wanted to go directly and advocate. And so a couple weeks ago you left cnn and that's what you're doing now.

Yeah, and I want to make it clear too that I think CNN does a really good job job of that. And I, you know, still have stock. Well, no, and I'm still freelancing there, actually, so I gotta be nice to them. But no, I mean, I believe strongly in what we do, but I think there's no question that we need to take an advocacy role because we just simply can't sit back and, you know, and call the balls as, you know, as they come. Because, you know, there is so much information out there, particularly around the Affordable Care act, that we need to make sense of all this for people. And when things are happening, we need to sort of give them a little bit of that care to understand how to digest this information. And so, you know, I. Like I said, we sort of, you know, at cnn, I helped, you know, sort of craft this advocacy journalism role. And I think, you know, it's been a really incredible journey because people thank us all the time for, you know, sort of explaining to them what to make of all this. You know, that's our traditional role as a journalist as well. But, you know, we get these questions all the time about, you know, how do I do this? You know, not just should I do this? And, you know, I think it's something that we definitely have a role to play in. And as far as, you know, whether we need to be taking more of a watchdog role, you know, I mean, I think that's traditionally one of the things that we do as journalists. And I think again, in the era of the Affordable Care act, in the era where there's so much misinformation out there, you know, from publications, none of whom are represented here on the panel today.

That are already taking a stand, you know, we need to sort of fight back and take our own stand and say, look, this is the real information. This is what you need to know.

Yeah, I spent a year running the war room inside the White House to pass a health care bill. And my biggest frustration was the press covered it like it was a normal fight. They'd say, one side says there's a death panel, the other side says there's not. And I'd be screaming, there's no death panel. And that's what the data says. But, you know, they weren't calling balls and strikes. Marshall, you work for an organization that was founded to do some of this talk about that line and kind of being an advocate and trying to be an organization that calls balls and strikes.

Well, it depends on how you define advocate. So our name is ProPublica. I mean, we are doing journalism in the public interest. That's our tagline. So with any approach to a healthcare story, I mean, we believe that it's wrong for people to suffer preventable harm in a medical facility or while undergoing medical care. That's not exactly stealing the objectivity from a journalist. I mean, I think we can all agree as human beings that people should not suffer preventable harm. And in terms of calling balls and strikes, that's something that we try and do with every story. I mean, one thing that we do and we value very highly is naming names. So when you do, and that's something that, as you look at, say, the equality improvement within the healthcare industry, which is mainly controlled by the healthcare industry. You don't see a lot of that. And so in terms of playing a watchdog role, for instance, I'll give you an example. The association of Healthcare Journalists called on the Joint Commission to release and publicly report its inspections of medical facilities. That's, you know, the Joint Commission is sponsoring this conference. The Joint Commission could make those things available that would greatly help the public. Our first speaker, the surgeon General, talked about the importance of transparency. And so many studies show that transparency improves healthcare. And yet there's not a lot of transparency that's volunteered by the healthcare industry. So does that make us advocates to, you know, call for that? Well, I mean, I guess that's that in a way. Certainly. Another thing, in terms of.

Calling balls and strikes, you find a lot of conventional wisdom that's passed along in the healthcare industry and repeated over and over again where no one has actually checked it out. And as soon as you start checking it out, you kind of find that the conventional wisdom isn't always true. So that's where you don't want to be a stenographer, where you just, well, this person says this and this person says this. You really need to take the time as a reporter to be very fair but tenacious about tracking down where does this stuff come from? What's the evidence behind what people do? Are people being consistent with what they're saying? For instance, with the transparency issue?

So I guess that's where ProPublica and I would stand on that.

Ben, I want to get your opinion here because we'll talk about rankings in a second, but it seems like you kind of fall in the middle of those two camps. Talk to us about.

Yeah, I mean, U.S. news by its history, is a consumer news organization. It's objective, but it's also advice oriented. So I don't, I think, like Marshall, I don't necessarily think of the conventional definition of advocacy as part of what we do, but we are expressing an opinion. That's what a ranking is. It's sort of a methodology that weights patient safety and weights mortality and weight, structural measures and waste volume. That's saying these are the things that we think based on our data analysis, on our expert opinion that are important and that patients should be taking into account. So that is, you know, in some sense, that's a watchdog role too. Where we are, it's a carrot, it's a stick. You know, hospitals are going to be held to account. And I think that's what all of us do in some form or another. Whether it's digging into an embarrassing, egregious event that's happened at a hospital or analyzing and publishing large swaths of data to unearth and unmask variations in care. Really, the lever we have as the media to influence patient safety and patient behavior is identified, identifying variation, unwanted and unnecessary variation from hospital to hospital.

Lindsey, weigh in here on this. You have a different role than some of these other folks. How much can you do? Where do you find the line between advocacy and public shaming or those sorts of things to try to make change?

Well, certainly writing for the trade, the trade in writing for hospitals and health systems, we don't seek to shame them, we want to help them improve. But I personally certainly like reading articles that do shame poor performing hospitals and seeing rankings that shame them. And while it's not something in our mission, I think it's something that is very, very useful, obviously to the public, but to the leaders of those organizations. And I may talk more about this later, but I think when rankings come out, when gradings come out, you get an immediate reaction from those leaders. And I think that's helpful and will move us towards improving.

Jim, if I could weigh in for just a second on this. You know, there is a tremendous amount of data coming out now. And so even though we're also in the trade space, we're not. We like using that data. So the readmission rates, we have a stock feature in our magazine called by the Numbers. We do numbers every week.

Week.

Well, now the last couple of years we have readmission rates all across the country. You know, 30 day readmission rates. Medicare is penalizing hospitals. We put up what are the top 10 worst in terms of readmission rates. We put up what are the top 10 best readmission rates. And we do a rank order and post it online. And yes, we're selling the data. We are a business. I get that. But you know, we are going to hospital leadership. They can see where they rank against everybody else. There's also the value based purchasing program out there now in which you have a whole suite of quality indicators and also patient satisfaction measures in which hospitals are either getting penalized or rewarded from cms based on that, we put those numbers up there. We look at who made the, we now have two years of data on this. Who made the best improvement from one year to the next, you know, the top 10 in that regard, who made the worst declines from one year to the next. And we put that out there. My problem has been we don't have enough good data and you know, it's really where CMS has adopted some programs. The problem is that things like, you know, health, you know, the CMS website, where they put all these, you know, you look and look at a state's data, half the hospitals aren't reporting. There is a real reporting problem. There's lack of consistency. I mean, the government could like with a wave of its wand, you know, give us all good data that we need. The problem is that they haven't done it yet. And I think there's a lot of political reasons for in Washington why that doesn't happen. And frankly I'm not. I don't think that the hospital sector is really what stands in the way. I think that it's a very complex question. I'll just give you one point. You have all these vendors out there that are selling electronic health records and they have no interest at all in having interoperability between their different health records. I mean, I've editorialized against this. And so, and so therefore we have this cacophony of noise when it comes to collecting data. And it's very difficult for, you know, hospitals and individuals outside the hospitals to get appropriate data when everybody's got a different system. How do you compare?

Can I say something?

Yeah, Leah, please.

So, Meryl.

I agreed with you until that last part. I'm in Washington and I sit at tables every day where the opposition to transparency is directly coming from the hospital industry. And it's very significant. And I was just thinking, I love all of your publications. I particularly love ProPublica. I love that you just assume that transparency is non controversial or something. It is extraordinarily controversial in Washington. Extraordinary. This is something that my advocacy group spends so much time on, but so do a good number of others in consumer and space. Now one of the organizations I think that's sponsoring this conference also looks at foreign objects left in after surgery. That is a big issue in July. There is a public measure right now of foreign objects left in after surgery. It is slated to be removed from hospital compare. It will be removed if we don't aren't successful in our advocacy to prevent that. That advocacy to get it removed came from the hospital industry. Now.

I think there's many visionaries in the hospital industry. So don't get me wrong and I've worked in the hospital industry and I care about it deeply. But we need to understand the politics that are at play that are preventing the transparency which I think would make all the difference in patient safety.

I just want to add too, and I think this should go without saying, but, you know, because this is largely a health care audience. I mean, I think the impetus behind all of this is benevolent. It's not to call anybody out or publicly shame for the purposes of publicly shaming. I mean, I think we are all here to make patients lives better and to help save lives. And I think that sometimes that message gets a little bit cloudy when you're talking about hospital politics and, and having these sort of contentious relationships with some organizations.

Well, the hard thing is that, like what I found, all the people in the room here are sort of the people who are actually conscientious enough to come to a conference, take your time, spend your resources, make commitments. But very this is a small representative of the thousands of hospitals, nursing homes and other health care facilities and providers around the country.

And there's this huge variation that we all know about and the studies show. And so as long as that's sort of cloaked, then the people who do well also don't get the credit for the good that they do. And then the people who do poorly continue to operate as the status quo benefits them. So then more and more programs and policies and quality measures are created. So the people who are doing well and sort of are, the good kids in the class are being as earnest as they can and pouring more resources into trying to figure out all these things. And it's almost creating. I mean, I've talked to a lot of providers about this patient safety fatigue that people are suffering. Like they have to measure and report like hundreds of different quality measures. And then meanwhile you have the healthcare providers who are not as conscientious, who just go, well, why would I report in my data a hospital acquired condition to Medicare? I can just say that that was present on admission and then it doesn't count as a hospital acquired condition. And then I look really good on hospital compare and I don't get penalized by Medicare in the payment for that. So they can game the system very easily.

Okay, I got to keep us moving. And now to the fun part. Let's talk about hospital rankings. So, Meryl, I want to go back to something you said earlier. We have all this data and, and Ben just made news by talking about increasing the percentage of.

What they're going to do on safety. I want to talk and ask you a very simple question that most of us won't agree on. What role does high profile published hospital rankings play in public safety and patient safety? Marshall, I want to start with you.

Well, I think one of the really complex things about it is like I just mentioned the hospital acquired conditions. I mean, those are based on billing data. The billing data is very easy to game. And so you could have a really conscientious hospital accurately reporting their hospital acquired infections, and their rate of hospital acquired infections would look a lot worse than a hospital that is not even looking for infections, not even identifying them, and then therefore not reporting them. And so, therefore, the people who are doing the best efforts to reduce infection infections look worse than the people who are not even paying attention to infections at all. And so that's a real problem when it comes to something that Medicare has approved, that it can easily be gamed.

So you're saying no rankings?

No rankings, yeah. No, I think it's important. I mean, you know, you got to do the best you can with what you have, but you have to have methodologies that are really sound and that takes a lot of work and it's very difficult to do that.

I think you need to. Ben, you spend a.

Just to jump in. You also need to have data transparency, because that kind of fraud that you're describing can be identified, but only if the people who are able to identify it are looking for it. And if it's buried in a government data vault, it's not going to be found.

That particular kind of fraud is actually very difficult to identify. There are grand juries investigating this all over the country. HMA has been, you know, major scandals surrounding them for, you know, doing these kinds of things. We actually also, you know, we use Truvan Analytics. We publish our hundred top hospitals. They have 40 different data points. They publish the entire methodology. You know, we go with that. They make a very strong effort and we back that, to not publicize it. You know, in other words, this, this is. We're really aimed at the hospital leadership themselves. It's a way of benchmarking themselves against other hospitals across 40 indicators. That's the way they were supposed to be used.

Some hospitals, I think, do game the system. I think it's possible to be gamed because the data can for precisely the reasons that Marsha was talking about. And some hospitals also, they'll put it in their press releases, they brag about it. And the reality is that in a benchmarking system, you can look good even though that you're subpar in a lot of different areas.

Peter, you've been skeptical of these things in the past.

Well.

My feeling about it is that I don't have a problem with the rankings themselves because I think that if you Take away the rankings, whatever incentive there is to improve the quality of the data vanishes. In other words, if people in the industry are pissed off because some people are gaming the system and others aren't, the only way that that problem is going to be addressed is if those numbers are put out there and there's some incentive for the industry to police itself and to find solutions to this problem. So it's not that I object to rankings, it's just that, you know, again, and I think that this is sort of a universal opinion here. You have to be careful about, you know, as careful as you possibly can be about the measures that you use and the way that you present that and the caveats that you, you present with them.

Leah, you produce rankings and ratings. Are you careful?

Yes.

Surprise answer. Transparency is a disinfectant. Sunshine is a disinfection. So we actually publish two kinds of ratings. One is the Leapfrog hospital survey. And I will tell you, first of all, we scrub that and we, we check and review it. But we're not the joint commission. We don't do the on site review. We don't do that. But what we do get are phone calls. So we'll get a phone call from a hospital and say, I noticed that my competitor across the street said this on one of your measures. There's no way that's true. We get those calls all the time and we check them out, we investigate. And frankly, about 99% of the time it's, it is a true measure. Once in a while it's not. But transparency itself brings about the kind of overall candor that we're seeking out of the healthcare system. It's really hard to get away with it when it's publicly reported over and over. It isn't perfect by any means. I have to agree that. I'm sure many hospitals can game it, but it's very, very hard to do. It's harder to game it than it would seem.

Lindsey, where do you come down on this?

Well, I do think rankings and listings play a role in improving patient safety because they grab the attention of the leaders. I'm sure you have gotten questions about your methodology and they want to know, how do I rank higher, provide better care. But I think when it all comes to ratings, it can move the needle. But where do consumers fit in? Do they know these ratings exist? I think US News and World Report is fairly well known, but that is for the sickest patients who need the most care. So you know, my mother who has actually, in healthcare didn't even know about hospital compare being out there. So these are out there. You know, there's questions about data. We want more data. But if our whole point is to help patients, I don't know if they're necessarily as informed as these resources exist.

That was more agreement than I thought we would see out of that. Let me switch here and ask you all to do what Matt and I have done and become consultants for a second. Everyone in this room wants to better communicate patient safety issues. You've all said in your various ways these are hard issues to explain. It's not always an analogy. You need more heart data. Give folks in the room advice about how to communicate these issues to you and to the general public. Lee, you do this every week, so I'm going to make you start first.

Me?

Yep.

Don't talk in health speak. We have got to start talking in language people understand. We've got to tell stories, to Meryl's point, we've got to tell the stories alongside the data, but we've really got to explain what we mean by safety. Another aspect of safety I think people don't understand, which we found just by talking to people, is a lot of times when you talk about patient safety to people who aren't familiar with the issue, they think you mean, do you have the right fire drills in place? I think it's about fire and police. Do you have the right criminal protection and things like that. I mean, that's what people think of safety. So we have a long way to go in our language. I see so much.

Written about patient safety in the literature that is just not English, frankly. It's just not understandable to the average person, and that's a real disservice. People need to protect themselves.

Peter, you spend a lot of time going through this data and talking to people and talking to advocates in this room who are pitching you. Give us some advice here.

Well, there are a couple of things. First of all, you know, there are two audiences that really hate it when you simplify their issues, doctors and engineers. But you have to simplify these issues. You want to know how not to convey patient safety issues. Find the best journal article that you can about a patient safety issue, hand it to someone who's not in the medical profession, and see how far they get in that story.

And the calls that we get from people are often the people who are writing these articles and they're saying, put this in your newspaper. And I say.

I can't put it in that way.

So what we try to do is we try to take a step back and to put ourselves in the shoes of average people and say, okay, what is the problem writ large? Are there solutions out there? And are these solutions being produced, pursued? That is a structure that people can understand. And, you know, so, for example, we recently did a story on mrsa, and I'm getting all these calls from doctors. You know, I'm getting calls from some doctors who say, in our hospital, you know, we're doing active detection and isolation, and this is way better than universal decolonization. And then we get other calls from people saying, you know, we're doing universal decolonization and it's way better than adi. And we, you know, we want you. We think you really, really should get in. You know, what patients don't care about any of that stuff. What patients care about is the 75% of hospitals that aren't doing either. That's where my interest lies. I'm less interested in, you know, this stuff at the margins, you know, these sort of solutions at the margins as I look at them. So I think that people need to understand that they need to look at the solutions. You know, when we talk about retained surgical objects and this effort to take that measure away, we did a story where we looked at retained surgical objects. And there are these technologies, these scanning technologies and so forth that have been around for about 10 years now. And they work, they're effective, and they're relatively inexpensive. And there are three or four companies out there that are doing this stuff. We went out there and we. We got all of them to tell us how many hospitals they had as clients. Fewer than 15% of the hospitals in the country are using any of these technologies. That's the story to me, Marco. So that's where I would go.

Yeah, I would say that make patients part of the process. You know, there are some healthcare facilities around the country that bring in patients to have kind of a patient committee or something like that. I would say, you know, in the media, the top media, media outlets have, like, an ombudsman, where it's basically a professional journalist, usually someone who's very experienced, very respected, who they bring in, and they give them access to the entire journalism organization, and they pay their salary and they allow them to write whatever they want about any of the coverage that that organization has provided. So NPR has this. The New York Times has this. It's usually just the bigger outlets. So imagine if you took patients who had been harmed in some way and you brought them into every healthcare institution and you said, how should we communicate these things? How should we talk about these things? I mean, they would immediately be able to kind of raise their hand and raise a red flag and say, you know what? I don't even understand what you're saying here. And I've been sitting here listening to you. No one's going to understand. Or how about we make the reports public?

How about we just say it, oh, there's a doctor here who's looking at the variability is extremely poorly performing. What are we doing about that? How about we notify the public about this person's record of outcomes? Or how about we start tracking outcomes in the first place, which is not even done for lots of surgeries out there. So I think if you brought patients into the process and gave them free reign to speak openly, that could bring about a great change.

We got about 10 more minutes. I'm going to make us go a little bit faster here. You talk about how complex these issues are and how we need to boil it down. Let's talk about boiling it all the way down, which is social media. You know, people are more and more turning to social media is the only thing that matters. How do you deal with patient safety issues in a social media environment? Matt, you go first.

Well, I think you have to put it in a little bit of context that I just read a stat earlier today that 130 million people a month are looking at Buzzfeed, right? So they're looking at the 27 cutest cat videos of the month or whatever. And that's what people are reading on a regular basis. And so I'd say sort of to the point that you guys were all making is I think you really have to make it digestible. You know, social media, you have a very finite space. And, you know, as much as I hate to, I shudder at the thought of doing list journalism. You know, the top five things you should know when you walk into your doctor's office. I think people understand that. I mean, I think that's completely opposite of looking at a journal article and not having any idea what to make of it. And so I think there is a fine line to walk between. Sort of sensationalism is a little bit of a strong word, but sort of boiling it down to its very lowest common denominator, but making it super digestible so that anybody off the street whose favorite website may be the 27 cutest cat videos from the last year can say, look, I read this online and I understood it, and I have this question for you. My doctor and I think that sort of informs the conversation. And it's a powerful tool to do that because a lot of people are using it. And while I also heard recently, too that.

Some, I Forget what, maybe 20 or 30% of households in the US don't have computers, but that something like over 90% of people have access to mobile devices, and that's where people are looking at this stuff, and that's where we need to be putting this stuff in a very digestible format.

Peter?

Well, I mean, I think social media is terrific. I mean, as a tool for us both to find people and as an echo chamber for the work that we do, I think that it has been an absolute game changer.

Does it have its drawbacks? Certainly it has its drawbacks. But, but overall, you know, I mean, ProPublica has done some of the best stuff out there in terms of bringing patients together, allowing them to communicate. It's a way that we can find stories that we might not hear about otherwise. It's a way for us to get stories out there. It's a way for us to find people who have been affected by the problems that we're writing about. So I'm all for it.

So let me ask one last question. Does increased access to government danger data help the media tell the stories so patients can make more informed decisions? And how does privacy fit in here? You know, at the very beginning of the Obama administration, we put all this data on the Internet and then you all did these huge stories exposing some dumb things government had done. And Rahm Emanuel storms into my office and says, how did that leak? And I said, well, we put it all on the Internet and he begins screaming F words and, and then explained he was against transparency. But the fact is, it has probably been a very good thing in general. But there are lines and we're all dealing with privacy and privacy on the front page of the paper every single day. So, Peter, I know you have been a huge advocate of all the transparency and data that's now available. Where's the line?

Well, it depends on what data set you're talking about. But you know.

My bigger concern, and I'm echoing something that Marshall's already talked about, is all the data that's collected that isn't put out there right now and the amount of good that could be done with it if we were a little more transparent. I mean, data are painful and people don't like it. And data are sensitive because.

Data can lie and data can mislead. But you have to, you have to do the best you can with it. And you have to look at the overall balance. And on balance, my argument would be that the more information that the public has to ask the right questions and to make informed decisions, the better that that will be. And the other thing that I would point out is that by and large the government does a pretty crummy job of making its data accessible and useful. We've now reached the point where news organizations have the ability to take, take the raw data and to put it in a much more user friendly form, searchable databases, things that allow people to very simply get in and use those data. So I think that.

My position is bring it on. I want more, I want more of the data out there.

Why are state medical boards so opaque? Why can't people figure out if their doctor is one of the 2% that is responsible for a hugely disproportionate number of malpractice payments? Why can't people find out if their doctor, you know, why can't people get access to the national, at least certain components of the national practitioner database to get important information? You can find out more about a car dealership than you can about a doctor in many cases.

I think it's awful. Meryl, Most of the data is de identified and you know, that's where you draw the line is you simply insist that data be de identified. But I just want to point out very quickly that when you talk about government data, you're talking about Medicare data essentially. And don't forget Medicaid data is only one portion of this. There's the 159 million Americans who are insured by private insurers who are collecting all kinds of data, which are claims data.

But Meryl, that's government data too. I mean, the national inpatient sample has, you know, I could evaluate the under 65 population if I could identify the hospitals in the national inpatient sample. But there are restrictions in what journalists, what any publishing organization can do with some of the government data. So I mean, the current administration has talked a big game about transparency and they have made some big strides. I wish that I could say that their data is the gold standard, that the administration, that CMS data in general is the gold standard. I wish I could say it was a silver standard or a bronze standard. I think maybe it's the catastrophic standard.

This is the problem. Even more than the transparency. I can deal with a lousy interface on a state website. If I need the data enough, I'll pull it down, I'll reformat it. It's an opportunity.

We could fix that.

Yeah, but I can't necessarily fix if the data itself is poor quality. In fact, one of the reasons we held off on the decision that I just announced to increase the patient safety indicator weight was that for a number of years, we couldn't identify what whether the event had actually the condition had been present on admission. It's only been last year, really, that the entire data set that we were using, we've been able to rule out cases where in fact, it wasn't the hospital's fault, it didn't happen in the hospital's watch. So that sort of. There are a lot of problems with the data that even are transparent. And then there are a lot of data, as Merrill says, that are of limited transparency.

All right, the final point I was going to make on that was that that it's claims data, and claims data is not actual clinical data. And for many things, what we really, and especially when you're talking about patient safety, we need clinical data. And so the question really, that's where I was trying to make the point about electronic health records earlier. There is, you know, all entirely in the private sector. You know, between the hospitals, between the EHR vendors, there is talk of interoperability. I think we need a push to create true interoperability so we can get de identified, large databases where we can learn what's going right and what's going wrong. What is the best treatment for C Diff? If we don't know, then maybe data can help us. Say there's just a huge big data project that is on the horizon if we can, you know, and to me, it's not about trying to create enemies in this. It's trying to help push people along to get to that place, because that's what's going to help create a better health care system.

All right, we have to wrap up. I know there's people in the room who are dying to ask questions. The journalists have all agreed to stay and take your questions. And since they usually ask you stuff, I think it's important that you pepper them with questions tonight, especially after they've had a couple glasses of wine. Thanks, everybody.

Thank you.

Sa.