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Leapfrog Group Addresses Critics in Updated Patient Safety Grades

The Leapfrog Group has taken heat for some time for its patient safety grades, but leaders are primed to defend grading methodology.

The Leapfrog Group has released its fall 2019 patient safety grades, finding this year that patient safety reports have sparked organizational improvements driving toward a culture of zero harm, Leapfrog Group leaders said.

But that hasn’t stopped critics from lambasting the group for what they believe are unfair grading methodologies.

The biannual report, which gives hospitals and health system letter grades for patient safety, found that 58 percent of organizations received either an A or B grade.

The release of this data coincides with the 20th anniversary of the publication of To Err Is Human, the seminal Institute of Medicine study that revealed nearly 100,000 patient lives are lost due to medical error each year.

This report sparked a movement toward zero harm in the healthcare industry, a goal the Leapfrog Group said is increasingly coming into reach. Reports like the Leapfrog Group’s patient safety grades allow healthcare organizations to understand where they are falling short in patient safety and make organization improvements.

“In stark contrast to 20 years ago, we’re now able to pinpoint where the problems are, and that allows us to grade hospitals,” said Leah Binder, president and CEO of The Leapfrog Group. “It also allows us to better track progress. Encouragingly, we are seeing fewer deaths from the preventable errors we monitor in our grading process.”

For example, researchers from the Johns Hopkins University Armstrong Institute for Patient Safety and Quality published data confirming 45,000 fewer patient deaths at the hands of patient safety events. These results may have stemmed from patient safety issues outlined in previous Leapfrog Group reports, the Johns Hopkins researchers suggested.

The fall 2019 grades likewise spell out good news for the medical industry and for patients. Of the 2,600 hospitals included in the report, 33 percent received an A grade and 25 percent earned a B.

Fifty-nine percent of Maine hospitals received an A grade, as well as 56 percent of Utah organizations, 56 percent of hospitals in Virginia, 48 percent in Oregon, and 47 percent in Wyoming, comprising the top A-grade earners in the country.

But there is still progress to be made, the report revealed. Thirty-four percent of all hospitals received a C, 8 percent earned a D, and 1 percent earned an F grade. In Wyoming, Alaska, and North Dakota, no hospitals earned an A rating.

While the Leapfrog Group asserts that these grades mark improvement in the medical industry and can serve as a catalyst for further advancement, they have sparked some controversy among healthcare organizations that do not like the grades they have received.

Upon this most recent report update, hospitals in Naples, Florida, have opened a lawsuit against the Leapfrog Group regarding what the health system says are unfair grading metrics. NCH Healthcare System alleged that publication of their D grade would be “false and misleading,” according to court documents.

The Leapfrog Group stands by its scoring methodology, which includes a peer review by a National Expert Panel and guidance from the Armstrong Institute. The patient safety grades are also peer reviewed and are made transparent to the public.

Binder suggested in a public statement that NCH focus more on the improvement efforts needed to mitigate a low patient safety grade rather than the current argument at hand.

“Naples residents should be very concerned when their hospital system wastes money on a frivolous lawsuit disputing the free speech rights of an independent nonprofit organization,” Binder said. “NCH resources would be better spent on initiatives to improve patient safety. In the United States, over 500 people a day die from preventable medical errors, infections, and injuries, and saving those lives should be the top priority of every hospital. Every hospital should focus on putting the safety of patients first and foremost every minute of every day.”

Binder also responded to specific allegations from NCH, including that the Leapfrog Group analysis did not have sufficient data to grade NCH.

“In their complaint, NCH claims they dislike Leapfrog’s peer-reviewed methodology for grading hospitals on their safety,” Binder stated. “That methodology has been reviewed and refined over seven years by the foremost national experts in patient safety. They complain about missing data, but it was the hospitals’ decision to not freely and voluntarily report this information. Leapfrog can only use the data made available to us. Our own commitment to transparency is evidenced by the highly visible and free access to our full methodology provided on our website and in correspondence with hospitals including NCH.”

This is not the first time the Leapfrog Group’s patient safety grades have come under fire. Earlier this year, an article published in the New England Journal of Medicine Catalyst, the blog of NEJM, asserted that common patient safety and satisfaction ratings systems were flawed.

The article, which also discussed rating systems from the Centers for Medicare & Medicaid Services (CMS), Healthgrades, and US News & World Report, asserted that these systems have flawed methodologies that do not portray an accurate view of patient experience and safety.

“Current hospital quality rating systems often offer conflicting results - a hospital might rate best on one rating system and worst on another,” lead authors Karl Bilimoria, MD, director of the Northwestern Medicine Surgical Outcomes and Quality Improvement Center, said in a statement. “We wanted to provide information on how to interpret these contradictory ratings, so people can better select the best hospital for their needs.”

But the article was also seriously flawed, Binder contended. Her sentiments, which were echoed to varying extents by CMS, Healthgrades, and US News & World Reports spokespeople, asserted that the Catalyst post did not accurately assess the patient safety ratings systems.

“’Rating the Raters’ appears in the Catalyst section of the New England Journal of Medicine because it is an opinion piece, not a peer-reviewed study,” Binder said in a statement. “As a result, it is not designed to offer the evidence and replicability that a traditional study would offer, nor do the authors detail what standards they applied to reach their conclusions about the four ratings programs. That said, the ratings organizations in the piece would not allow themselves the luxury of issuing hospital ratings as random opinions, without basic rigor and transparency.”

Binder also pointed out inaccuracies in how the Catalyst article assessed the Leapfrog Group scoring methodologies and the credibility of certain researchers contributing the to Catalyst article, who Binder said were employed at health systems that have long feuded with the Leapfrog Group.

Ultimately, the Leapfrog Group contends it does important work in boosting patient safety data transparency. This data not only helps consumers make educated healthcare access choices, but also helps low-rating organizations understand key areas of improvement.

“The findings of the IOM report, published two decades ago, laid the foundation of what The Leapfrog Group stands for today,” Binder said of this latest Leapfrog Group report. “We commend others who have joined us in the drive for transparency, including the Centers for Medicaid & Medicare Services, which commits to public reporting of safety data, employers and payors, who put appropriate pressure on facilities to make performance data available, and hospitals that publicly report on their safety and quality.”

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