2. Use of unreliable measures
The AHA says that eight of the 26 measures used in the Leapfrog score have not been endorsed by the National Quality Forum. "To the best of our knowledge, it (Leapfrog's survey) has not been assessed for its reliability and validity by any independent organization."
Of the scoring methodology's 11 outcome measures, "nine are proposed for retirement from the Hospital Compare website in 2014 because studies have shown them to be unreliable." Regarding those that are hospital-acquired conditions (HACs), the Measure Applications Partnership or MAP has recommended they be removed because the lack of risk adjustment makes them inappropriate to compare hospitals.
"Despite this, The Leapfrog Group's methodology gives these measures higher weights than the demonstrably more reliable measure assessing prevention of surgical complications," Umbdenstock wrote.
The AHA contends that if some hospitals didn't supply data or answer all the questions, weights were shifted to the remaining questions unequally. "We believe this means hospitals’ grades are being calculated based on disparate weighting systems, and the results are not comparable," Umbdenstock wrote.
Binder replied that nine unbiased experts in hospital safety included measures based on "strength of evidence, opportunity for improvement, and impact to the patient," adding that the Leapfrog Survey which collects data "is as reliable and documented a data collection and public reporting tool as any health data collection effort in the United States, short of a full-scale accreditation process.
As for the criticism about the inclusion of HAC measures, Binder said that if the measures are retired, "they will be removed," but for now the safety score panelists believe they are useful.
With respect to unequal weight shifting from questions hospitals didn't answer, Binder replied, "Your analysis is incorrect," and impossible. She asked Umbdenstock to look again at the scoring methodology.