Leapfrog Safe Practices: A Case Study

Number of patients
• Number of patients requiring a return to surgery
• Number of patients resulting in readmission
• Mortality number
At least 75% of surgical cases are followed one year post-operatively.
Program provides an organized program of aftercare and follow-up for patients for at least 12 months.
In-Patient Facility: Rating for the Leapfrog Safe Practices Score (SPS).
The Leapfrog SPS summarizes a hospital’s adherence to 13 safety practices endorsed by the National Quality Forum, such as maintaining a culture of safety, hand hygiene, nursing workforce and prevention of infections.
In-Patient Facility: Rating for implementation of Leapfrog’s medication error prevention (CPOE) standard.
CPOE systems are electronic prescribing
systems that intercept errors when they most commonly occur — at the time medications are ordered
At a minimum, the program has been performing bariatric surgery continuously for the most recent 12 calendar months.
Facility has Full Approval as:
American College of Surgeons (ACS) Bariatric Surgery Center Network
(BSCN): Level 1 or Level Outpatient, and/or
American Society for Metabolic and Bariatric Surgery (ASMBS) Bariatric
Surgery Center of Excellence® (BSCOE).
If the inpatient facility is not accredited by ACS or ASMBS, it must have all of the following medical services present:
• Anesthesiology
• Cardiology
Additional Evaluation Criteria
• Number of patients
• Number of patients requiring a return to surgery
• Number of patients resulting in readmission
• Mortality number
At least 75% of surgical cases are followed one year post-operatively.
Program provides an organized program of aftercare and follow-up for patients for at least 12 months.
In-Patient Facility: Rating for the Leapfrog Safe Practices Score (SPS).
The Leapfrog SPS summarizes a hospital’s adherence to 13 safety practices endorsed by the National Quality Forum, such as maintaining a culture of safety, hand hygiene, nursing workforce and prevention of infections.
In-Patient Facility: Rating for implementation of Leapfrog’s medication error prevention (CPOE) standard.
CPOE systems are electronic prescribing systems that intercept errors when they most commonly occur — at the time medications are ordered.
Evaluation of Aetna members’ current utilization, cardiac care needs and geographic access as measured by average travel distance to emergency and non-emergency health care services in Aetna’s participating network.
Evaluation of cost per risk-adjusted case based upon Aetna data – this data uses the last 24 months of Aetna cost data and is adjusted to take into consideration relevant risks, such as age, sex and other conditions of the patient using a product known as Symmetry Episode Risk Groups®
If one facility is more cost-effective than other comparable facilities, the more cost-effective facility will be selected – depending on network access, capacity and other competitive needs, Aetna may designate other facilities that have met the other evaluation criteria
IOQ cardiac care facilities include comprehensive heart and vascular treatment centers that provide both inpatient and outpatient procedures. They also offer medical care for cardiac conditions that do not involve surgery or procedures.
Aetna’s IOQ cardiac care program designations include:
• Cardiac medical interventions
• Cardiac rhythm disorders
• Cardiac surgery
We may designate a facility for one or more IOQ cardiac care program designations. Selected facilities meet the following criteria:
• Show evidence of significant experience in cardiac care, including a minimum of 200 open heart procedures, 200 angioplasty or
stent procedures, and 125 cardiac resynchronization therapy implantation procedures ( pacemakers and ICD) in the most recent 12 calendar months • Use evidence-based and recognized standards for clinical outcomes, processes of care and patient safety
• Provide ongoing follow-up programs and support for their cardiac patients • Demonstrate efficiency in providing care based on overall cost of care, readmission rates and comprehensiveness of program
IOQ 9 Fact Book | Cardiac Care Facilities
Complete program requirements Our IOQ cardiac care program includes designations in three areas: cardiac medical interventions, cardiac rhythm disorders and cardiac surgery.
A facility may be designated in one or more of these areas. Each service line will be evaluated individually on components relevant to that service line.
1. If a facility performs CMI and no CV surgery, the facility is still eligible if they meet the criteria for CMI.
2. If a facility performs CMI and CV surgery, the facility must meet criteria for
BOTH service lines to be selected as an IOQ.
I. Requirements for consideration
Volume:
To be eligible as an IOQ cardiac care facility, 12-month procedure volumes must meet or exceed the following:
• Cardiac medical intervention IOQ designation – 200 percutaneous coronary interventions (PCIs) (also referred to as angioplasty or stent procedures) • Cardiac surgery IOQ designation – 200 open heart surgery cases
(for example, coronary artery bypass graft surgery and heart valve replacement surgery)
• CardiacRhythm disorder IOQ designation – 125 cardiac resynchronization therapy implantation procedures (for example, pacemaker, defibrillator)
Participating status of facility and physicians delivering cardiac
care:
Facility/facilities must:
1. Be credentialed by Aetna, participate in Aetna’s provider network for all products offered in the market and be accredited by appropriate external entities. 2. Provide applicable on-site availability (seven days a week) to cardiologists, cardiovascular surgeons and electrophysiologists. An acceptable
IOQ 10