The latest round of scores that measure rates of errors and infections, indicators of safe practices, shows an increase in the number of hospitals that earned the lowest score. Leapfrog's CEO Leah Binder calls that "a troubling trend."
The Leapfrog Group released its fourth safety report card for general acute care hospitals Wednesday noting that overall, there's been "very little improvement" in how well providers are preventing patient harm.
"I am surprised, because we would have hoped for more significant change than this, given the emphasis on patient safety we've seen for the past few years," said Leah Binder, Leapfrog president and CEO, in a phone interview. "Overall scores for these measures are only slightly better, and a couple of measures are slightly worse, but slight is the operative term."
A total of 2,539 acute care hospitals were graded. Leapfrog's weighted algorithm gave 813 hospitals an A, indicating hospitals with the safest practices and low rates of errors and infections; 661 received a B; 893 a C; 150 a D; and 22 hospitals received the worst grade of F. Of the 22 lowest-rated hospitals, eight or 36% are in California, something Binder could not explain.
The F is for hospitals with more than 3 standard deviations below the mean, "which is very significant," Binder said during a news briefing. "In the last round (in May, 2013), we had 16 hospitals with an F that were that far below the mean." The fact that there are now six more, she called "a troubling trend."
"New research from the Journal of Patient Safety, a peer-reviewed journal, estimates that as many as 440,000 Americans are dying annually from these preventable errors. That's equivalent to the population of a city like Miami or Oakland, and it puts medical errors as the number three cause of death in the United States."
The score is divided into two parts. There are 15 structural measures, such as whether the hospital has a full-time intensivist in the ICU, and 13 preventable adverse outcome measures, such as a patient death or serious injury due to an intravascular air embolism or a retained surgical object.
The report includes two new preventable outcome measures—surgical site infections resulting from colon procedures and catheter-associated urinary tract infections.
One bright spot of improvement, Binder says, is that more hospitals have adopted computerized physician order entry (CPOE) systems, incentivized by government incentive payments, and which she says which helped improved their scores.
Because of Leapfrog's safety scores, which were launched in June of 2012, and every six months since, more hospitals are contributing data to Leapfrog's annual survey, she says. And even those hospitals who complained the loudest at their initial scores are now trying to improve.
"We're building relationships with hospitals that we never had before, and in many cases with hospitals that didn't do well. And that has made a big difference because we're seeing results," she said during an interview. "We're not doing this as a punitive thing, but because we want to protect the public. We want to give hospitals a reason to improve."
Binder lauds Maine and Massachusetts, states with the highest percentage of hospitals scoring an A. On the other end are New Hampshire, Arkansas, Nebraska, and New Mexico, states with the lowest number of A-rated hospitals.
One serious flaw with the Leapfrog score is that it can award high grades to hospitals involved in terrible, headline-getting scandals of mishaps and patient mistreatment. For example, Exeter Hospital in New Hampshire, where a catheterization lab tech is said to have infected more than 33 patients with hepatitis C via syringes he used on himself and later on patients, received a B this time around, down from an A this spring.
Parkland Memorial Hospital in Dallas, where safety violations uncovered by state and federal surveyors triggered an "immediate jeopardy" declaration in 2011, received a C in this round of scoring, down from an A six months ago.
Missy Danforth, Leapfrog senior director of hospital ratings, acknowledged in an e-mail, that capturing those very public events "is a real challenge. Unfortunately certain errors are not reflected in the data we use to calculate the safety score" because the system still lacks an adequate way to capture such public reports.
As expected, however, officials for some of those hospitals were upset with their scores and said they were inaccurate, unfair, or outdated, and therefore not meaningful.
"Leapfrog's data is consistently old and outdated," says Terry Osborne, CEO for American Legion Hospital in Crowley, LA, which received an F. "[The score is] not reflective of our current practices.
And some hospital officials argue that the measures Leapfrog says are important are not necessarily the same ones where hospitals have placed their emphasis.
Jonathan Aquino, who was named chief quality officer for 222-bed Kern Medical Center six months ago, says that since his safety-net facility mainly treats Medicaid (Medi-Cal) patients, it has focused more on measures required by the state's Delivery System Reform Incentive Payment Program instead of the Centers for Medicare & Medicaid Services' quality measures, and that may partly explain why Kern received an F, the second this year.
"We just received an award from the California Hospital Association as an improvement leader… for reduction of hospital harm across five or more categories," says Aquino.
"Some hospitals in California may have had other priorities, and are now shifting to these Leapfrog measures," he says.
Paul Antonecchia, chief medical officer of 406-bed St. John's Riverside Hospital in Yonkers, NY, also blasted the report card for using data from between 2009 and 2011.
"The disconnect for us is that within literally the last year's time, we have been acknowledged as a top performer by Consumer Reports, and U.S. News & World Report in nephrology and orthopedics, and we received a gold star from the New York Department of Health.
"We've seen incremental improvements in all our patient safety and quality metrics. The Leapfrog quality scores stand out as not being aligned with all the good things that have happened at St. John's over the last few years," he says.
"I don't think you can judge a hospital on the basis of a handful of self-selected metrics. Out of CMS' 24 metrics, they picked three."
Antonecchia emphasizes that he is "not challenging or debating Leapfrog's methodology. Just that informed consumers need to look at many sources of information, and Leapfrog is just one that exists."
And Emily Cannon, RN, director of quality improvement for 30-bed Wallace Thompson Hospital in Union, SC, says she's "so mad at Leapfrog I can't even think." Even one deep vein thrombosis, she says, can make Wallace Thompson look bad because of its size. And, she says, small rural hospitals like hers, 25 miles from larger tertiary hospitals, shouldn't be scored by the same measures as bigger hospitals.
"Blue Cross Blue Shield just gave us a rate increase, and we had no injuries from C-sections and no falls. We have excellent safety data, so we're frustrated. We feel like Leapfrog isn't being fair."
Binder explains that many of the measures Leapfrog includes in its scorecard are "never events. They should never happen. I don't care who you serve."