Skip to main content

Leapfrog Hospital Safety Scores 'Depressing'

 |  By cclark@healthleadersmedia.com  
   May 09, 2013

In the Leapfrog Group's third release of hospital safety grades, overall scores rose minutely, but more hospitals got worse than got better. "So far, these numbers aren't really moving," says CEO Leah Binder.

The Leapfrog Group unveiled its third controversial hospital safety report card Wednesday showing miniscule improvement over last November's grades.

"So far, these numbers aren't really moving," said Leapfrog Group president and CEO Leah Binder. "It's depressing," she added, because even though the scores for acute care facilities reflect measures from 2011 and 2010, long before her group launched the safety score last year, hospitals for years have been saying they are trying to make care safer.

For example, she said, "we have demonstrated that hospitals can get to zero central line infections, yet we're still seeing thousands of them reflected in this score.

"And it's very disturbing to still see 'never' events, like air embolism or retained objects in surgery. We understand that things that should never happen sometimes do. They should be extraordinarily rare, but that's not what we're seeing. They're far more common than they should be."

Scores for the 2,514 hospitals break down like this:

  • A - 780
  • B - 638
  • C - 932
  • D - 148
  • F -  16

To the decimal point, Binder said, overall scores actually rose slightly since November's release, from 2.973 to 2.977. But in fact, more hospitals got worse than got better.

While 73.9% of hospitals saw no grade change, 14.08% of hospitals saw their scores go down one grade and only 9.39% of hospitals saw their grades improve one grade. About 1.2% of hospitals saw grades improve by two or more grades, but .64% saw grades decline by two or more.

A significant defect in this and other hospital quality ranking efforts is their failure to reflect systemic safety issues so serious, that recent federal or state investigations have raised questioned about whether a hospital should continue to receive federal Medicare or Medicaid payments.

For example, Exeter Hospital in New Hampshire received an A in the Leapfrog score, up from a B last fall. But federal reports last year noted lax infection control practices that may have led to a technician allegedly infecting some three dozen Exeter patients with hepatitis C.

Parkland Hospital in Dallas came close to losing hundreds of millions in annual Medicare payments after a series of federal investigations revealed critical quality issues in 2011 and 2012. Yet Leapfrog's scorecard gives Parkland an A, up from a B last fall.

Binder acknowledged the issue. Leapfrog is "probably the nation's leading advocate for the availability of more and better data," but, she says, much of what goes wrong in hospitals is not yet publicly reported. "From what we do have, we can say this hospital has performed well or not, but obviously, it's missing some key elements."

She added consumers should not, even with a scoring system like Leapfrog's, "assume any hospital is perfectly safe. There's lots we can't measure."

The Leapfrog Group's score is probably the most controversial scorecard of its type because of the perceived pejorative tone of a C, D, or F grade, as opposed to other hospital ranking systems that only highlight the "best" hospitals. Last year, numerous hospitals and health system trade organizations blasted the group for what it said was a biased methodology that favored hospitals that participated in Leapfrog's own separate and voluntary reporting system.

Leapfrog rebalanced that methodology last fall so that similar data not reported to Leapfrog, but to the American Hospital Association, may be used for hospitals not participating in Leapfrog's programs. Also, about 100 fewer hospitals were included in the score this year because they did not meet Leapfrog's new minimum patient counts for many measures.

Binder says that while she knows hospitals and their trade organizations publicly criticize Leapfrog's scoring system, she's sure these reports are driving hospitals to try harder, especially when hospitals are compared with their regional competitors.

"We continue to be pleasantly surprised at how many hospitals use this score constructively," Binder said. "We get literally hundreds of call from hospitals, some of them not graded well, who really, really want to go over their data and understand it, and set goals for improvement, which makes it all worthwhile.

"Whatever hospitals say publicly in the media is one thing, but what they tell us in one-on-one conversations is encouraging. They say they're working on this; that it matters to them."

Hospital Safety Ranking by State
The hospital quality organization also ranks states. The top state this year is Maine, with 80% of its hospitals getting an A, followed by Massachusetts with 70.5%.

For all other states, fewer than 46% of hospitals received an A. And at the bottom of the state list, fewer than 11% of the hospitals in Oklahoma, Idaho, Nevada, Kansas, Oregon, West Virginia, and New Mexico received an A safety score.

As in two prior reports in June and November, there were numerous surprises. Some hospitals with the most respected national reputations received grades lower than an A or B.

Big Names, Low Scores
For example, the Cleveland Clinic Foundation received a C, up from a D last November. Intermountain Medical Center in Murray, UT received a C. New York Presbyterian Hospital, Columbia, and New York Presbyterian Hospital, The Allen Pavilion in New York City both received a C, both down from A last fall.

Gundersen Lutheran Medical Center in LaCrosse, WI, received a C, down from a B. And Barnes-Jewish Hospital in St. Louis, MO received a C, the same score as last fall.

Some poorly scoring hospitals last fall improved, including the University of California Los Angeles Ronald Reagan Medical Center, which last fall received an F, but this time improved to a D.

Reaction
Some hospitals that received an F score responded to HealthLeaders Media's requests for comment:

We are disappointed, but not surprised by the latest Leapfrog rating and know that it does not reflect in any way the quality of care the Ronald Reagan UCLA Medical Center provides its patients. In fact, UCLA Medical Center, Santa Monica received an "A" rating from Leapfrog. The timeframe Leapfrog used of 7/1/2009 to 6/30/2011 continues to include 1 occurrence, which dramatically affects our overall rating. We expect to see significant improvement going forward based on newer data as well as full implementation of our electronic health records system."
—David Tate, spokesman, UCLA Ronald Reagan
At Memorial Hospital, safety and quality outcomes are always a top priority. Our hospital has never participated in a Leapfrog Survey; however, our publicly reported CMS/Hospital Compare data demonstrates that care at Memorial Hospital is provided in a safe environment that is equal to, and in many areas better than, national safety scores of peer institutions."
—Pam Jensen, president, 186-bed Memorial Hospital of Fremont, OH

Nancy Foster, Vice President of Quality and Patient Safety Policy for the American Hospital Association, wrote in an email: "Leapfrog is one of many organizations that issue hospital quality rankings. While some of the survey data they use is current, much of the data they use from Hospital Compare is at least three years old, which in this era of rapid change and quality improvement, does not accurately reflect the current state of hospital safety."

Leapfrog's 26-measure algorithm includes data reported to its voluntary quality program, to the Centers for Medicare & Medicaid Services' pay-for-reporting programs, or to the American Hospital Association. They include:

  1. Two structural measures such as whether the hospital has intensivist professionals working in its intensive care unit, a measure shown to reduce ICU mortality, and whether a hospital uses a computerized physician order entry system.
  2. Eight safe practices, such as care for patients on ventilators, hand hygiene, and steps taken to assure medication reconciliation.
  3. Five Surgical Care Improvement Project (SCIP) measures, such as whether appropriate antibiotics are given to patients undergoing surgery and whether a urinary catheter is removed after day one or day two of the procedure.
  4. Eleven outcome surgical or procedural measures, including foreign objects retained, air embolism, falls and trauma, postoperative pulmonary embolism or deep vein thrombosis, and accidental punctures or lacerations.

The Leapfrog Group was formed in the year 2000 as a non-profit watchdog by employers and others concerned that payers needed a better way to track avoidable hospital errors that caused harm to their insured employees. Asked if providers might now start to see their Leapfrog safety score influence their third party contract rates, Binder said that they might.

"Providers can use their score in contract negotiations, and they should, because it's backed by and created under the guidance of the foremost experts on safety. On the other hand, does a poor score mean they'll be punished by payers? I don't see that happening yet, but it may in the future."

Leapfrog does not charge hospitals to be scored, but if they want to use their A or B scores in commercial marketing campaigns or advertisements, Leapfrog charges $12,500 for hospitals with 300 or more beds, and $5,000 for hospitals with fewer.

The Leapfrog Group's eligible list excludes hospitals that have 25 or fewer beds (critical access hospitals) specialized hospitals, children's hospitals, outpatient surgery centers, or are located in Maryland.


See Also: Abundance of Healthcare Quality Awards Weakens Marketing Value

Healthgrades Releases Clinical Excellence Hospital Rankings

Consumer Reports Expands Hospital Ratings List

U.S. News & World Report Best Hospitals List Shifts Methodology

Truven Top 100 Hospital Scores Measure 'Leadership Impact'


Tagged Under:


Get the latest on healthcare leadership in your inbox.