Hazel Hawkins Memorial Hospital received a failing grade for its hospital safety score from a group whose methods of comparing hospitals were called “neither fair nor accurate” by the American Hospital Association when preliminary scores were released last June.
The Leapfrog Group, formed in 2000 by a group of employers who purchase healthcare with support from BRT, the Robert Wood Johnson Foundation, and other funding sources, the group rated more than 2,600 hospitals in the United States on a scale from A to F. The hospitals were graded on 26 measures, though some hospital officials say their hospitals were unfairly scored because they did not participate in a voluntary survey conducted by Leapfrog that rated 11 of those measures.
“Hazel Hawkins Memorial Hospital takes strong exception to the recently published, inaccurate and misleading Leapfrog data scores on patient safety,” said Frankie Gallagher, the director of marketing and public relations for the local hospital, in a statement. “We do not submit data to Leapfrog, nor do we participate in most voluntary surveys like Leapfrog.”
Gallagher said Hazel Hawkins Hospital does not participate in voluntary surveys because the cost to participate can be expensive and it takes a lot of staff time to pull the statistics for such surveys.
“We didn’t participate in the Leapfrog survey so we did not expect we were going to receive a grade from that,” she said, noting they first heard about the failing grade two weeks ago. “We do take this very seriously. Our reputation in the community means everything to us.”
Lois Owens, the vice president of nursing, said the San Benito hospital adheres to the standards set forth by the Centers for Medicare and Medicaid Services.
“They are the big guns of healthcare nationally,” Owens said. “They dictate the benchmarks by which we design programs in order to meet or beat their standards.”
According to Gallagher, those hospitals that did not participate in the Leapfrog survey automatically lost points so they could only achieve a maximum score of a C.
“There are no guarantees that a hospital participating in the Survey will score better,” said Amanda Cullari, a media specialist from Leapfrog, via email. “But, the more data points a hospital has to be scored on, the better its opportunity to achieve a higher score. Secondary data sources are consulted to give hospitals with missing data as much credit as possible towards their score, and there is no penalty for declining to report to Leapfrog.”
Despite the low score based on Leapfrog’s rating, Gallagher said Hazel Hawkins Memorial Hospital ranks at or above average in all areas of patient safety and was ranked No. 1 by BETA Healthcare Group, which provides liability coverage and risk management to hospitals, for obstetrical safety and patient infection rates.
“Our staff and physicians take very seriously the care and well-being of our patients as our data reflects for most indicators, and we achieve excellent outcomes for them,” Gallagher said. “We have numerous internal systems and processes in place to identify and address areas for improvement, and the ongoing changes in the health delivery system.”
She said the Joint Commission on Healthcare Accreditation and the California State Department of Public Health provide regular oversight and review of performance.
“These agencies have consistently over the past several decades been recognized as the most accurate, thorough groups evaluating quality and safety,” Gallagher said.
National concern over study
The American Hospital Association said they were concerned about the methodology used in deriving the scores, such as a bias toward its own survey “over other similarly reliable sources of information.”
The group said in a letter dated June 22 that hospitals that responded directly to Leapfrog about its use of a computerized provider order-entry system and “intensivists” in the intensive care unit could receive up to 100 points, while others whose answers came from secondary data were eligible for just 15 points.
Hazel Hawkins is one of 25 hospitals nationally that received an F grade from Leapfrog, which makes scores available via a smartphone application and a website, hospitalsafetyscore.org, where visitors can type in their zip codes to see the scores of local hospitals or search by name.
The University of California Ronald Reagan UCLA Medical Center, in Los Angeles, which was ranked one of the top five hospitals in the United States in July by U.S. News & World Report, was one of the hospitals to receive an F grade. The hospital has been ranked one of the best hospitals in the Western United States based on patient outcome data for 23 consecutive years.
“UCLA is clearly not an ‘F’ hospital in quality and safety,” said Tom Rosenthal, the hospital’s chief medical officer, in an article posted at HealthLeaders Media, a website that shares news with health officials. “And if UCLA is not an ‘F’ hospital, it seems to me there must be flaws in the Leapfrog methodology.”
Group stands behind scores
Missy Danforth, senior director of hospital ratings for Leapfrog, said the organization stands behind its methodology.
“Leapfrog is not using any condition or procedure-specific measures,” she said. “We are looking at safety measures that all hospitals, regardless of their size, should be focused on – things such as eliminating central-line associated blood stream infections and following best practices known to prevent infections after surgery.”
Cullari reiterated that after the letter from AHA, Leapfrog had a “blue ribbon expert panel” meet to review the methodology of the score.
“They conducted some independent analyses and reached consensus reaffirming the current methodology with two exceptions that affect some hospitals,” she said.
They made changes that give more credit under certain circumstances to hospitals that have ICU coverage and use computerized medication ordering.
Some hospitals also took exception to a licensing fee that hospitals have to pay, depending on bed size, to use the score with a logo on their website, hospital signage, in broadcast and radio advertisements, in paid and online advertisements and through marketing materials. Cullari said hospitals can announce the grade to staff, boards and through internal communications and internal newsletter, or in a press release without paying a fee.
They said they encourage healthcare consumers to use the safety score before choosing a hospital at which to seek care.
“The safety score is not the only piece of information a consumer can rely on – there is other good quality data out there – but we hope consumers consider the safety of a hospital first. We hope that hospitals will use the safety score as an opportunity to identify gaps in their safety efforts and to rapidly begin making improvements.”
In addition to data from its own survey, which Hazel Hawkins did not participate in, Leapfrog used data from the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services. CMS provides a comparison of hospitals at its own site, http://www.hospitalcompare.hhs.gov/.
ON THE WEB
http://www.hospitalcompare.hhs.gov/
http://www.hospitalsafetyscore.org
THE RESULTS
Hazel Hawkins numbers during the time reviewed from July 1, 2009 through June 30, 2011*:
foreign object retained after surgery – 0 patients compared to .02 hospital average
air embolism – 0 patients compared to .0015 hospital average
pressure ulcer in stages 3 and 4 – .553 patients compared to hospital average of .12
falls or trauma .553 patients compared to hospital average of .54
collapsed lung due to medical treatment – .51 compared to .34 hospital average
wound split open after surgery – .82 compared to .96 hospital average.
*Numbers are from the CMS Hospital Compare report.
