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Leapfrog: Health system affiliation linked with patient safety
In its fall 2025 Hospital Safety Grades, The Leapfrog Group flagged a link between health system affiliation and A-ratings in patient safety.
Nearly 95% of the hospitals receiving an A grade for patient safety this fall are affiliated with a health system as opposed to being an independent organization, according to The Leapfrog Group.
As part of the patient safety ratings group's Fall 2025 Hospital Safety Grades, researchers flagged a link between health system affiliation and good patient safety grades, as well as identified the health systems with the highest number of A-rated hospitals.
The Leapfrog Group releases its Hospital Safety Grades twice each year to assign a letter grade to participating hospitals. According to the group, the patient safety grades are meant to be an easy-to-understand indicator of hospital quality that can help healthcare consumers make decisions about where to access care.
This year, set against a backdrop of increasing hospital consolidation, The Leapfrog Group looked at how health system affiliation influences patient safety grades.
"The Leapfrog Group was founded 25 years ago to improve American healthcare through transparency, and the Safety Grade has been a cornerstone of that effort," Leah Binder, president and CEO of The Leapfrog Group, said in a press release. "As we mark this milestone year, for the first time we're looking at how consolidation impacts patient safety. We want to understand if system leadership accelerates patient safety or not."
Is hospital affiliation linked with patient safety?
According to Leapfrog, 90% of hospitals receiving a fall 2025 Safety Grade is part of a health system, which the group defined as "a network of healthcare facilities that are owned or managed under a single parent organization."
As noted above, A-rated hospitals were more likely to be affiliated with health systems. Of the A-rated hospitals this fall, 95% were affiliated with a hospital system. Of the 358 hospitals considered a Straight A hospital -- meaning it's received an A grade for more than two years in a row -- 95% were part of health systems. Finally, all 11 hospitals earning A grades since the ratings inception in 2012 have been affiliated with health systems.
Nationwide, the health systems with the highest number of A-rated hospitals include the following:
- HCA Healthcare (51 hospitals)
- CommonSpirit Health (49 hospitals)
- AdventHealth (29 hospitals)
- Kaiser Permanente (27 hospitals)
- AdvocateHealth (24 hospitals)
- Prime Healthcare Services (24 hospitals)
- Defense Health Agency (18 hospitals)
- Lifepoint Health (16 hospitals)
- Northwell Health (15 hospitals)
- Sutter Health (15 hospitals)
It is important to note that correlation does not equal causation. Although there's a link between health system affiliation and good performance on The Leapfrog Group's Hospital Safety Grades, it does not mean that health system affiliation caused that good performance.
But some separate studies do outline some clinical benefits of hospital merger and acquisition activity.
One 2021 assessment linked hospital mergers in rural areas with serious decreases in mortality rates. Meanwhile, the American Hospital Association has outlined data showing that hospital mergers and health system acquisitions can save millions for those involved.
Still, some experts question whether hospital mergers are beneficial. Hospital mergers can sometimes lead to a loss of healthcare services, while other data has indicated health system mergers and acquisitions can lead to greater provider burden.
These latest patient safety grades from Leapfrog add to the debate weighing the pros and cons of hospital consolidation.
In addition to assessing patient safety grades in the context of health system affiliation, The Leapfrog Group also analyzed grades by state. Utah, Virginia, New Jersey, Connecticut and North Carolina had the highest proportion of A-rated hospitals. Conversely, Iowa, North Dakota, Vermont and Wyoming had no A-rated hospitals.
Sara Heath has reported news related to patient engagement and health equity since 2015.
