Leapfrog’s Safety Grades Give 372 Hospitals Straight As, but 5 Get an F

Even amid an ongoing controversy, the Leapfrog Group released its semi-annual safety rankings, with hundreds of hospitals earning top marks, while just 5 got an F.

Four states have the highest percentage of top-scoring hospitals in the ranking: Connecticut, Virginia, South Carolina, and Utah. More than half of scored hospitals in those states earned an “A” in Leapfrog’s spring edition of its Hospital Safety Grades.

The rankings assess performance on 22 metrics, including ICU physician staffing, nursing care hours per patient day, medical errors, healthcare-associated infections, and hand hygiene.

“For a very long time, those of us deeply concerned about patient safety lamented that it never seems to get better. Today we can say that has changed,” Leah Binder, Leapfrog’s president and CEO, told MedPage Today. “Across 17 patient safety metrics we see sustained unmistakable improvement nationally.”

The latest scorecard showed 372 hospitals received not just an A, but a “Straight A,” having sustained the highest grade for more than 2 years.

Only five hospitals received the lowest score, an F. They are CAMC Teays Valley Hospital in West Virginia; Roseland Community Hospital in Chicago; South Central Regional Medical Center in Laurel, Mississippi; Weirton Medical Center in West Virginia; and WVU Fairmont Medical Center in West Virginia.

Not all hospitals in the U.S. are scored, but among those that were graded, 917 received an A, 740 a B, 646 a C, and 55 a D.

Leapfrog’s A-through-F scoring system for the nation’s general acute care hospitals, which launched in 2012, now faces a significant setback. In March, it lost a lawsuit filed by five Tenet hospitals in Florida’s Palm Beach County. The hospitals alleged deception in the way Leapfrog calculated its grades, and stopped submitting data to an annual Leapfrog survey that it uses for many of its metrics.

The plaintiffs claimed that because they refused to participate, Leapfrog assigned them lower scores “resulting in artificially deflated overall grades with no basis in fact and no correlation to a hospital’s actual safety performance.” In effect, its “imputation” methodology “was designed to punish non-participating hospitals,” the hospitals alleged.

A U.S. District Court Judge for the Southern District of Florida agreed, calling Leapfrog’s method “unfair and deceptive” and “in violation of the Florida Deceptive and Unfair Trade Practices Act.” He ordered Leapfrog to remove scores for those five hospitals.

Although Leapfrog is appealing that decision, it also removed scores for another 445 hospitals that did not submit metrics to Leapfrog’s survey. They now are scored as “GNA,” or grade not assigned.

Instead of 2,813 general acute care hospitals, today’s scorecard rated 16% fewer, or 2,363.

“We wouldn’t change our methodology for just 5 hospitals so we applied the court’s injunction nationally,” Binder said. “We disagree with the ruling, but of course in the meantime we are complying with it.”

In March, Leapfrog issued a statement calling Middlebrooks’ decision “a threat to patient safety.”

In its motion for reconsideration to the court filed last week, Leapfrog argued the court’s decision is at odds with the First Amendment, which “protects subjective evaluations.” Leapfrog warned that such a ruling could extend to many other online grading services, “which often rely on a subjective weighing of objective data.”

Further, the motion maintains there was no factual misrepresentation in how it described its methodology. Even if there were, the plaintiffs would have had to prove malice, the motion said.

“Leapfrog respectfully urges the Court to take account of Plaintiffs’ post-judgment efforts to anoint themselves as censors who could use the Court’s order as a template to warp and silence unfavorable reporting by any healthcare or press organization, even beyond Safety Grades,” the motion maintained.

“Absent the requested relief, this may become a case study in how Florida’s law of ‘unfair trade practices’ can be deployed to shut down and penalize candid, incisive public reporting — and how judicial power may be co-opted by deep-pocketed, litigious, for-profit corporations so as to bring under heel a nonprofit reviewer whose ratings displease them,” it said.

Other metrics used in the algorithm include the hospital’s use of computerized physician order entry, bar code medication administration, CMS-required patient experience survey results, and whether the hospital has structures encouraging a culture of leadership. Some of the metrics come from required reports to CMS, while some come from the Leapfrog survey.

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