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Leapfrog's 'License Fees' for Promoting Hospital Scores Rankle

 |  By cclark@healthleadersmedia.com  
   June 14, 2012

The Leapfrog Group's Hospital Safety Scores released last week have many hospital officials in quite a lather, but not just because half of 2,600 hospitals got an embarrassing C, D, or F letter grade.

The industry is now rumbling because the non-profit group requires any hospital that wants to boast its high score—say on a banner or in a paid media ad—to first pay a "licensing fee" of between $5,000 and $12,500. That's a conflict of interest for both Leapfrog and the hospitals that buy the rights to boast this recognition, some hospital groups are saying.

I had some concerns about conflicts in Leapfrog's licensing fees too, at first. But I checked around and discovered such strategies are quite common. In fact, Leapfrog's marketing strategy is similar to what HealthGrades' does with its "Patient Safety Excellence Awards," which it announces annually for "the safest 5%" of the nation's hospitals, determined by HealthGrades' algorithms.

And it's similar to the marketing campaign that U.S. News & World Report employs for its "Best Hospitals Badge."

I asked the Greater New York Hospital Association, which represents 143 hospitals, what it thinks of Leapfrog's sales pitch. I thought the group might have a problem with it, since of the 149 hospitals in New York scored by Leapfrog, nine got a D or F and 100 got a C, and since few New York hospitals participate in Leapfrog.

But Lorraine Ryan, GNYHA senior vice president, didn't find it unusual or surprising.

"These public reporting systems are kind of commoditized to a certain extent, and I don't think what they're doing is different than what some of the others do," meaning HealthGrades or U.S. News & World Report , she said. 

But some hospital officials say the Leapfrog sales campaign is different because a portion of the score is derived from measures that only Leapfrog's 1,000 participating hospitals voluntarily give Leapfrog; all other measures come from the Medicare database. Hospitals that don't participate in Leapfrog are scored on Medicare data alone.

Therefore, critics say, Leapfrog's data-volunteering hospitals have a better crack at getting a higher score because of the comparative weights Leapfrog's measures are given. 

"This is some information that is starting to make the rounds in the hospital circles.  It appears that if you did not participate in Leapfrog, then you were penalized," says David Perrott, MD, senior vice president and chief medical officer for the California Hospital Association. "This deserves more questions and explanation from Leapfrog if correct."

Leah Binder, Leapfrog's CEO, vehemently denies that, saying that hospitals with complaints "are really grasping at straws; hopefully they will soon focus on the most important thing, which is improving their safety.

Binder insists that "any hospital that is among the safest in the U.S. could get an A, whether they report to Leapfrog or not," and in fact, "146 hospitals that don’t report to Leapfrog got an A. Two that come to mind: NYU Medical Center and the Cleveland Clinic in Florida."

Binder says Leapfrog "considered not allowing commercial use of the score at all. But a major purpose of the score is for hospitals to compete on safety, so we don’t want to discourage advertising. And requiring licensure for commercial use of something is standard practice in every industry. Try selling your own Obama or Romney campaign baseball caps and see how quickly campaign lawyers will be sending you a bill," she says.

The idea that Leapfrog and the hospitals that buy its marketing packages have a conflict of interest, Binder says, "is absurd. Do you reject the findings of a Gallup Poll because Gallup itself collected the data? The development of the score was an objective, thoughtful, and unbiased process."

But apparently, some in the hospital industry won't let the issue drop. Discussions are continuing this week at the American Hospital Association and affiliated state associations, about how to strategically discredit the Leapfrog score.

According to one internal hospital group memo distributed in California, the AHA's executive team held a staff meeting Monday to discuss the concern "that data used by Leapfrog is indeed skewed in favor of hospitals that participate in Leapfrog's survey.

"AHA believes this is true – but they are currently engaged in a data analysis to be sure that they are on solid ground in making this claim," the memo says.

"Right now, we are in the process of evaluating the methodology," AHA spokeswoman Jennifer Schleman said Wednesday.  She repeated last week's statement from Nancy Foster, AHA vice president, that the AHA "has supported several good quality measures, but many of the measures Leapfrog uses to grade hospitals are flawed and they do not accurately portray a picture of the safety efforts made by hospitals."

The Greater New York Hospital Association also doesn't think Leapfrog's methodology is a good way to compare hospital safety because hospitals that participate in Leapfrog are scored differently than hospitals that don't. "It's not comparing apples to apples," Ryan says.

Binder reiterated that a nine-member panel of national hospital safety experts decided on the 26 measure sets based on "strength of evidence and impact to the patient." They didn't even pick all Leapfrog measures, just those that "met their standards," she says. "I will be interested to see AHA release a new statement and give us a new round of publicity for the score!"

Binder forwarded Leapfrog's licensing fee materials, which say the cost is $5,000 for hospitals with 300 or fewer beds and $12,500 for hospitals with 301 or more beds through November, 2012, when a new annual fee will apply.

A hospital doesn't need a license to announce its grade to staff, the board, and others and grades may be used in press releases and on web sites. But if hospitals want to use their scores in a paid media ad, marketing materials or signs, they have to pay.

The license does not entitle hospitals to publish other hospitals' scores, and may only be used for the hospital that received the grade. They "must not state or imply that the Hospital Safety Score measures or describes any other quality, e.g., patient satisfaction, quality of care provided, overall performance, etc."

I'm not a statistician, so I guess I'll have to wait for the AHA or another hospital group to explain why Leapfrog's methodology favors Leapfrog participating hospitals or why Leapfrog is wrong to sell hospitals the rights to use this particular score for promotion. It occurs to me that maybe the hospitals' protests are just part of the normal five-stage grieving process, starting with denial. 

When HealthGrades launched hospital scores a decade or so ago, "Initially there was—let's call it angst—around information that's being made publicly available," says Pete Sheehan, HealthGrades' director of hospital products and internal advocacy.

However, he says, "I think we've also seen there is a lot of power in making this information public and in moving quality in a path that benefits patients... It actually brings down the cost of care if you do quality correctly."

U.S. News & World Report could not be reached for comment.

While I wait for some resolution to the Leapfrog dustup, I'll be busy here with my e-mail, cleaning out the many dozens of press releases from hospitals across the country that want to boast to the world that they got a Leapfrog A because they're safer.

 

 

 

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