The Leapfrog Group’s latest batch of Hospital Safety Grades is out, and with it a new focus on high performances among system-affiliated hospitals.
The watchdog group’s twice-annual grading, now in its twenty-fifth year, assigned an “A” through “F” letter grade to more than 2,800 acute care hospitals based on patient safety data submitted to the federal government or voluntarily sent to the group through its regular surveys.
The grade includes up to 22 patient safety measures, including a 10-part Medicare composite of reported patient safety and adverse events. Data collected for the grading reached as far back as July 2021 for certain safety measures, including for those collected through Medicare.
This time around, Leapfrog awarded an “A” rating to 899 hospitals (32%), a “B” to 734 (26%), a “C” to 934 (33%), a “D” to 224 (8%) and an “F” to 23 (1%). Compared to the spring’s release, that represents a slight uptick in “C,” “D” and “F” grades.
Against a backdrop of policy conversations around the pros and cons of increasing healthcare consolidation, Leapfrog also looked through its ratings to see whether there are any safety-related trends among hospitals operating within a health system, which represented 90% of its graded facilities.
“For the first time we’re looking at how consolidation impacts patient safety,” Leapfrog President and CEO Leah Binder said in a release. “We want to understand if system leadership accelerates patient safety or not.”
Here, the group noted that 94% of its “A” hospitals were affiliated with a hospital, as were 95% of “Straight A” hospitals that had received a top score for more than two consecutive years. All 11 hospitals that have earned “A” grades from 2012 onward are also part of a health system.
Some of the nation’s largest health systems had dozens of member hospitals awarded “A” grades, Leapfrog added. These included HCA Healthcare (51 hospitals), CommonSpirit Health (49 hospitals), AdventHealth (29 hospitals), Kaiser Permanente (27 hospitals), AdvocateHealth (24 hospitals) and Prime Healthcare Services (24 hospitals).
Leapfrog, in an FAQ, noted that “further research is needed to better understand this trend, as many independent hospitals, including rural and safety net facilities, also continue to earn ‘A’ grades.”
A panel discussion hosted by Leapfrog between Binder, Gary Kaplan, M.D., who is a member of Leapfrog’s Hospital Advisory Committee as well as the CEO emeritus of Virginia Mason Health System (now part of CommonSpirit Health), and David Banks, president and CEO of AdventHealth, dug deeper into the affiliation and safety question.
Kaplan affirmed that independent and smaller hospitals are capable of high marks with leadership alignment, effective communication and transparency, though both he and Banks outlined systems’ increased resources as a clear leg up for safety initiatives.
“[Larger organizations are] able to make the system investments, like barcoding and [computerized provider order entry] and building into the EMR, just some of the hardwiring that makes it more possible for our front-line clinicians to get it right,” Banks said. “It allows us to really focus on like-size hospitals. It allows us to also then align our leadership incentives and all those things that just create a consistent cascade and an expectation for performance.”
Criticisms of hospital consolidation have largely focused on increased spending and prices. A recent Government Accountability Office review of available literature on the subject found supportive evidence of those claims, while findings related to consolidation and quality were supportive but limited.
Tenet Healthcare hospitals' methodology litigation moves forward
Leapfrog’s latest release comes as a lawsuit from disgruntled hospitals criticizing its methodology pushes closer to the courtroom.
In the spring, five plaintiff hospitals within the Palm Beach Health Network, a Tenet Healthcare subsidiary health system, filed a complaint accusing Leapfrog of a methodology change that “deliberately” fails and defames hospitals that decline to participate in the voluntary surveys that contribute to gradings. The safety watchdog defended its methodology and characterized the hospitals’ “frivolous” lawsuit as “an attempt to shoot the messenger” instead of addressing the poor patient safety outcomes that led to a low rating.
Both sides have recently filed motions with the court for summary judgement.
The plaintiffs’, filed Oct. 28, outlined internal communications that appear to suggest changes to increase survey participation would increase the value of its ratings and, subsequently, help the organization financially. It also focused on internal discussions surrounding the grade methodology change and, citing deposition testimony, claims “that Leapfrog’s Safety Grade Expert Panel—publicly touted as approving the methodology—neither reviewed nor endorsed the Fall 2024 changes, contrary to Leapfrog’s public representations.”
“Over the past year, Leapfrog has deliberately changed its Hospital Safety Grade scoring methodology to punish hospitals that decline to participate in its survey—without scientific basis or expert report, and instead for commercial reasons,” the plaintiff hospitals said in a Wednesday statement on the lawsuit and the fall grades release. “The result is a system built on inaccurate data and pressure tactics that mislead the public and damage hospitals’ reputations. These rankings benefit only Leapfrog, at the expense of patients and the broader healthcare system.”
Leapfrog, in a Wednesday court filing in support of its own motion for summary judgment, said it made the 2024 methodology change “in consultation with experts and after public comment.” The change was made because prior imputed cohort scores from participating hospitals increased annually and gave hospitals an incentive not to respond to the survey, according to the filing.
Leapfrog wrote that the methodology changes were disclosed in publicly available online materials, and the plaintiff hospitals were advised of the changes and their grades during a pre-release embargo period. The group also noted that consumers using its online tools may explore specific hospitals’ scores on various measures contributing to the overall grade, where a notice explicitly informs consumers of areas where hospitals decline to report their performance and how the score was assigned.
A trial in the case (Good Samaritan Medical Center, Inc., et al., v. The Leapfrog Group) is scheduled for January.