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The latest ratings from the Leapfrog Group show gains, losses.

By Rose Hoban

The good news is that half of North Carolina’s hospitals are making the grade when it comes to patient safety.

The bad news is that half are not.

Those are the findings of the most recent hospital safety scores produced by the Leapfrog Group, an organization founded by employers and health care purchasers that has been pushing hospitals to become safer for 15 years.

Leapfrog issues hospital safety ratings in the fall and the spring, and since the last set of ratings in October nine more North Carolina hospitals have achieved an “A” rating.

“That’s a great improvement,” said Erica Mobley, a Leapfrog spokeswoman. “It’s great to see nine more hospitals taking those steps to become safer.”

In this spring’s survey, North Carolina came in 10th among states in the overall percentage of top-performing hospitals, a drop from it’s 8th-place position last fall. The measures rely on data such as the number of people who develop infections in the hospital, how many are readmitted within 30 days of discharge, whether staff reliably wash their hands and hospital safety protocols.

Leapfrog uses a methodology devised by a panel of academic experts to comb through publicly reported data every six months and distill it into a single letter grade.

Not all hospitals get a grade, Mobley explained. Small, “critical access hospitals” in rural communities are excluded, as are pediatric hospitals.

In all, 80 North Carolina hospitals were rated, 39 achieved “A” ratings, 19 received “B” ratings, 17 received “C” ratings and 5 got “D” ratings.

Using ratings

North Carolina Health News reached out to the five hospitals that received “D” grades to get feedback on the scores.

One of those hospitals, Southeastern Regional, responded to our request for comment.

“As a learning organization, we take our vision to advance the health of our community through partnerships, learning, and providing high quality care very seriously,” wrote Amanda Crabtree, from Southeastern’s health system.

“Southeastern Health is working to fully understand Leapfrog’s expansive methodology; as always, we remain fully committed to providing safe and compassionate care to the communities we serve.”

Mobley said that her organization’s intention is not to scold, but to encourage every hospital to come up to higher standards. She’s said that since Leapfrog issued the first safety scores in 2012, all kinds of hospitals have been able to achieve “A” grades.

“We see hospitals that serve very poor communities, have low insured populations, in rural areas that face a lot of challenges, that get an A,” she said. “We see academic medical centers get an A, we see public hospitals get an A, small community hospitals get an A.”

“That really clearly shows that is possible for any hospital.”

Nonetheless, some downplay hospital rating systems.

“Any public rating system is just one tool of many patients can use when making health care decisions,” wrote Julie Henry, a spokeswoman for the North Carolina Hospital Association. “As with any report card, the Leapfrog grades have to be interpreted in context.”


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So many letters and numbers

Hospitals have traditionally resisted being rated. Nonetheless, grading systems have proliferated in the wake of the 1999 U.S. Institute of Medicine report, “To Err is Human,” which publicized the fact that about 100,000 Americans each year died as a result of medical errors.

Since then, that number has been revised upwards.

Federal agencies collect most of the data, and different methodologies have proliferated, giving patients lots of choices on making decisions about treatment.

U.S. News and World Report publishes the annual “Best Hospitals” rating, but that metric has been criticized because part of the rating depends on asking other physicians about “hospital reputation,” said Marshall Allen, who writes about patient safety for the investigative news site Pro Publica. Allen criticized U.S. News’ practice of selling branding materials to hospitals that score well.

There are inherent conflicts of interest with many of the rating schemes, Allen said. For example, another rating company, HealthGrades, has a consulting arm, so people from the company get paid to tell hospitals how to do better.

“Exploring the local variation in hospital quality and safety and selecting the right hospital can dramatically lower risk of harm,” said John Santa, from Consumer Reports, which also publishes hospital grades.

“In addition to consulting the safety score, we’d encourage people to consult other ratings and information that’s available for the specific procedure that they need,” Mobley said. But she said sometimes ratings systems can be difficult to interpret.

For example, the federal Centers for Medicare and Medicaid Services publishes “Hospital Compare,” which rates hospitals on a number of measures, such as the rate of complications after knee surgery.

“For a majority of measures they report, they report hospitals as “no different from the national average,” “above average” or “below average,” Mobley said. “Ninety percent of hospitals are rated as “no different from the national average,” so that’s just not meaningful for the consumer.”

Henry from the NCHA pointed out that some of the data used to calculate Leapfrog’s grades are more than two years old and “may not reflect more recent performance improvement efforts.”

Mobley acknowledged that, indeed, some of the data is old; that’s because CMS data can lag by several years. Leapfrog also uses data from the organization’s own surveys, the CDC and an annual survey conducted by the American Hospital Association.

“We’ve been advocating with CMS for them to start reporting data more expediently,” Mobley said. “We hope that hospitals will join us in that effort in encouraging them to report data in a more timely manner.”

Hot-button issue

The Leapfrog ratings come just days after the Obama administration, bowing to pressure from the hospital industry, decided to delay CMS’s own new star ratings of hospital quality only a day before it was due to launch.

The new star rating from CMS will use 62 measures to devise a unified rating of one to five stars, with five being the best.

But 60 senators and 225 members of the House of Representatives signed letters urging CMS to delay releasing the star ratings, Kaiser Health News reported last week.

“We have heard from hospitals in our districts that they do not have the necessary data to replicate or evaluate CMS’s work to ensure that the methodology is accurate or fair,” the letter from the House members said.

Among the signatories were Republican members of North Carolina’s House delegation, including David Rouzer (7th), Richard Hudson (8th), George Holding (13th), Renee Ellmers (2nd), Walter B Jones (3rd) and Patrick McHenry (10th). Both Richard Burr and Thom Tillis signed the Senate letter.

That action followed another letter, sent by the American Hospital Association and other medical groups, which asked for the delay. The signatories of that letter asked CMS to show hospitals their ratings before public publication and argued the “ratings do not account for hospitals that serve highly complex patients with significant socioeconomic challenges, and that also perform a greater number of complex surgeries.”

CMS responded to Congressional concerns by delaying their star rating launch until at least July.

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