A study published in the current issue of JAMA concludes that self-reported Leapfrog hospital safe practices scores just don't correlate with risk-adjusted inpatient hospital mortality rates.  Better Leapfrog scores don't mean lower risk-adjusted mortality rates.  If borne out, this undercuts the whole pay-for-performance premise of the Leapfrog Group and others.  The authors of this study noted that theirs is the first peer-reviewed study to examine the correlation so, of course, "further study is needed." 

The number of NQF measures tracked for this program was cut in half relatively recently, as folks have tried to home in on the key predictive indicators (see the HealthBlawger's interview with Leapfrog Group CEO Leah Binder from last fall), apparently to no avail. 

(There's been a lot of noise coming from JAMA lately, but one would hope that should not impugn this study or its authors.) 

The question is: If Leapfrog-style P4P is a bust, what's the next big thing going to be on the cost containment / quality improvement / value-based purchasing front?

Is it EBM-driven, measuring inputs rather than outcomes?  Seems to me that would make sense, but only if we have some killer data linking the inputs to the desired outcomes.

Update 4/1/09: See Leah Binder's — and the study authors' — comments on this post and see also another study looking at a broader slice of the Leapfrog P4P experience in a more positive light, footnoted in the JAMA study.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting