A letter-grade system based on patient-safety measures has riled up hospitals that received low or average scores.
The Leapfrog Group, a not-for-profit that represents employer groups and purchasers, compiled hospital safety scores for 2,635 hospitals in the U.S. using publicly available data and information supplied by hospitals that participate in an annual Leapfrog Group survey.
The results—about 42% of hospitals earned a C grade or lower—triggered a wide range of reactions within the healthcare community. About a quarter of the hospitals received an A.
High-performing hospitals issued news releases promoting their A grades, while lower-performing hospitals, the American Hospital Association and other groups questioned the validity of the methodology and which measures were selected to compute the scores.
“We are, and have long been, in favor of sharing good reliable quality information with the public,” said Nancy Foster, vice president of quality and patient safety policy for the AHA. “That said, we find many of these measures to be unreliable and scientifically invalid, so we think this methodology needs a lot more work before it becomes something that the public should actually rely on to guide any of their decisionmaking.”
The Leapfrog Group brought in nine patient-safety experts to develop the hospital safety scoring system over a nine-month period.
The score is calculated using 26 measures and patient-safety indicators. Fifteen measures use data from the CMS or the Agency for Healthcare Research and Quality, and 11 measures were drawn from the Leapfrog Group's own annual hospital survey, which gathers self-reported information from participating hospitals at no cost.
“We recognize it's not perfect,” said Leapfrog Group President and CEO Leah Binder, “but I think we're all confident that we've given consumers a fair assessment of the relative safety of hospitals.”
Using data from both the CMS and the Leapfrog Group's own survey is one cause for concern. Rachel Sorokin, chief patient-safety and quality officer at Thomas Jefferson University Hospital in Philadelphia, said she is concerned that the scores for the process measures are weighted toward hospitals that participate in the Leapfrog Group's annual survey.
The 856-bed hospital, which received a C rating, has not participated in the survey. Sorokin said the safety scores are “primitive and not too accurate.”
Binder disputed concerns that there is a connection between hospitals that participate in the organization's annual survey and those that received better scores. “That is not the case, and I want to make that absolutely clear,” she said.
Many hospitals are confused about the methodology, which computes the safety score as a “z-score” that generates a number showing how far the hospital is from the mean, Binder said. It's not a point score.