Updated Leapfrog Hospital Safety Scores: Not Much Improvement

The Leapfrog Group has issued its Fall 2013 update of hospital safety scores, which shows small gains at best since the last update in May.  “On average, there was no improvement in hospitals’ reported performance on the measures included in the score, with the exception of hospital adoption for computerized physician order entry,” the organization contends. “The expansion in adoption of this life-saving technology suggests that federal policy efforts to improve hospital technology have shown some success.”

In the new update, 813 of 2,539 hospitals that issued a Hospital Safety Score earned a grade of A, a rate of 32 percent compared with 31 percent in May. In the fall survey, 661 hospitals received a B grade, 893 got a C, 150 had a D and 22 flunked. Only 3.5 percent of the surveyed hospitals improved by two or more grade levels.

New Study On Disconnect Between Cost and Quality Outcomes

Modern Healthcare has analyzed data for hospitals in 12 different cities and found that for a common cardiology procedure, the hospitals with the lowest costs sometimes had the best quality outcomes. While limited in scope, the analysis suggests there is no consistent relationship between hospitals spending more to perform a procedure and their achieving better patient outcomes. A hospital's internal costs for delivering a service matter because those costs typically are reflected in what the hospital charges private insurers and patients.

The disconnect Modern Healthcare found between cost and quality for one procedure in 12 markets suggests that the transparency movement, if it gains critical mass across the country, could put pressure on hospitals to become more cost-efficient and improve their outcomes. That pressure could be especially great on higher-cost facilities that can't demonstrate better quality. Otherwise, payers and patients may take their business elsewhere.

New RWJF Resource on Hospital Quality Data

The Robert Wood Johnson Foundation has created a national directory designed to enable the public to access reliable hospital quality data through a centralized database. Consumers can search by state and browse reports. The purpose of creating the tool is to allow the public to have easy access to reliable information on quality of care in their communities. The database currently houses 182 state and local public reports and 26 national reports.

Hospital CEO Pay Not Tied to Quality Outcomes

A new study published in JAMA Internal Medicine finds that hospital CEOs' pay isn't linked to their hospital's benefit to the community. Nor is it linked to the quality of care the hospital provides. Instead, the CEOs tended to earn more at hospitals with high patient satisfaction ratings and advanced technology. They looked at CEO paychecks in 2009 alongside hospital size, quality and other data from 2008, figuring salaries and bonuses might be tied to the prior year's figures. The study included 1,877 CEOs from 2,681 private, non-profit hospitals across the country. The average executive earned about $596,000.

Executive paychecks at hospitals varied widely. The CEOs with salaries and bonuses in the lowest 10 percent earned $118,000 a year, on average. They mostly worked at small, non-teaching hospitals in rural areas. On the other end of the spectrum, executives in the highest 10 percent earned almost $1.7 million. They tended to head up large teaching hospitals in cities. CEOs at hospitals that had more beds and more advanced medical technology made more money than those at other hospitals, the researchers found.

And executives tended to earn more when more of their hospitals' patients reported being very satisfied with their care. However, the hospital's own bottom line, including how often its beds were occupied, was not linked to a CEO's pay. Neither were commonly used measures of a hospital's quality, such as mortality rates and readmissions.

New Leapfrog Group Tool Helps Purchasers Calculate Cost of Hospital Errors

Slightly more than a year after the Leapfrog Group unveiled its letter grades for hospital safety, the employer-driven not-for-profit organization has introduced an online tool to help purchasers calculate the annual costs of hospital errors, accidents and infections. The hidden surcharge calculator, developed by a team of experts in patient safety, hospital finance, and policy, is designed to allow employers to determine how much they pay each year in unnecessary medical-related costs.

By inputting claims data and local hospital safety rankings, purchasers are able to calculate both the total surcharge for hospital errors and the average amount spent on errors per patient admission each year. Leapfrog estimates that a purchaser pays, on average, $7,780 in hidden surcharges when a patient is admitted to a hospital with a safety score of “C,” “D” or “F.” The calculator includes an example of an employer with 1,000 annual hospital admissions that would pay a $7.7 million surcharge for the year.

Several NBCH coalition members are Leapfrog Regional Rollout Leaders and active in publishing hospital safety data for use in their markets.

New RWJF/Urban Institute Study on Performance Measurement

To improve performance, health care leaders need to understand the strengths and weaknesses of performance measures, according to a Robert Wood Johnson Foundation-funded report from the Urban Institute, "Achieving the Potential of Health Care Performance Measures: Timely Analysis of Immediate Health Policy Issues."

The authors offer seven policy recommendations for reaching the full potential of performance measurement in health care:

1. Decisively move from measuring processes to outcomes.
2. Use quality measures strategically, adopting other quality improvement approaches where measures fall short.
3. Measure quality at the level of the organization, not the clinician.
4. Measure patient experience with care and patient-reported outcomes as ends in themselves.
5. Use measurement to promote the concept of the rapid-learning healthcare system.
6. Invest in the "basic science" of measurement development.
7. Task a single entity with defining standards for measuring and reporting quality and cost data, similar to the role the Securities and Exchange Commission serves for the reporting of corporate financial data, to improve the validity, comparability and transparency of publicly reported healthcare quality data.

Guide Designed to Help Hospitals Assess Value-Based Care

The Health Research & Educational Trust and Hospitals in Pursuit of Excellence, both research affiliates of the American Hospital Association, have issued the "Second Curve Road Map for Health Care" guide meant to help hospitals assess their performance on value-based metrics as they shift to new payment models.  The report suggests 19 metrics to meet four value-based strategies prioritized in a previously released AHA report, "Hospitals and Care Systems of the Future," as health care transitions from fee-for-service to pay-for-performance.

Strategy 1: Aligning hospitals, physicians and other clinical providers across the continuum of care
1. Percentage of aligned and engaged physicians.
2. Percentage of physician and other clinical provider contracts containing performance and efficiency incentives aligned with accountable care organization-type incentives.
3. Availability of non-acute services.
4. Distribution of shared savings and performance bonuses or gains to aligned physicians and clinicians.
5. Number of covered lives accountable for population health (e.g., ACOs or patient-centered medical homes).
6. Percentage of clinicians in leadership.

Strategy 2: Utilizing evidence-based practices to improve quality and patient safety
7. Effective measurement and management of care transitions.
8. Management of utilization variation.
9. Reducing preventable admissions, readmissions, emergency department visits, complications and mortality.
10. Active patient engagement in design and improvement.

Strategy 3: Improving efficiency through productivity and financial management
11. Expense per episode of care.
12. Shared savings, financial gains or risk-bearing arrangements from performance-based contracts.
13. Targeted cost-reduction and risk-management goals.
14. Management to Medicare payment levels.

Strategy 4: Developing integrated information systems
15. Integrated data warehouse.
16. Lag time between analysis and availability of results.
17. Understanding of population disease patterns.
18. Use of electronic health information across the continuum of care and community.
19. Real-time information exchange.

The report breaks down these metrics further to measure progress on value-based care.

Study: Patient Satisfaction May Not Be A Good Indicator Of Surgical Quality

A new study in the current issue of JAMA Surgery finds little relationship between a hospital’s patient satisfaction scores and most quality ratings. The study, led by researchers at the Johns Hopkins University medical and public health schools, looked at patient satisfaction and surgical quality measures at 31 urban hospitals in 10 states. Patient satisfaction was determined by the results of standard Medicare surveys given to patients after they left the hospital. Quality was judged by how consistently surgeons and nurses followed recommended standards of care, such as giving antibiotics at the right time and taking precautionary steps to avert blood clots. The researchers also looked at how hospital employees evaluated safety attitudes at their hospital.

Previous studies of the relationship between patient views and the quality of care also have found that they are not necessarily correlated, but Medicare views them as useful. The patient assessments account for 30 percent of bonuses and penalties given to hospitals in the first year of Medicare’s “value-based purchasing” program, which was created by the Affordable Care Act.

Some of the surgical measures are also included in the calculations that make up the other 70 percent of the bonuses and penalties this year. Hospitals can gain or lose 1 percent of their regular Medicare payments under the quality program. All those individual scores are available to the public on Medicare’s Hospital Compare.

The researchers found that there was some relationship between how patients rated their experiences and whether hospital workers considered themselves part of a team approach to caring for patients and felt their work environment was not excessively stressful. There was no relationship between patient scores and hospital workers’ overall assessment of the hospital’s safety culture, which also included job satisfaction, working conditions and perception of management.

Hospital Begins Publishing Detailed Patient Safety Information

According to the Boston Globe, Brigham and Women's Hospital has begun an ambitious effort to openly recount patient safety mistakes, and the improvements they led to, in a monthly online newsletter for its 16,000 employees. Brigham leaders started the publication to encourage staff to talk openly about their mistakes and propose solutions, and help make sure errors are not repeated.

While many hospitals post information on their websites about patient infections and falls, they rarely provide details of medical errors or candidly discuss with their entire staff how medical mistakes harmed patients. Executives fear the public will find out, sparking lawsuits and scaring off patients. This reluctance, patient safety advocates warn, may be hampering the push to reduce medical errors because there is not wide discussion of how mistakes happen and can be prevented.

The Brigham doesn’t make the newsletters readily available to the public — but it doesn’t hide them either; it gave the Globe all issues. The Brigham began publishing “Safety Matters” online in January 2011 on its employee intranet and will start distributing paper copies in staff lounges, conference rooms, and other gathering spots later this spring — a move that some hospital administrators initially opposed because they worried about scaring patients. Most issues tell a story of medical care gone awry through interviews with caregivers and often with patients, and describe the hospital’s response. Patients are not named, to protect their privacy. Caregivers also are anonymous because hospital leaders do not want to discourage them from reporting problems.

The Leapfrog Group's Hospital Safety Score Updates

The latest update to the Hospital Safety Score, the A, B, C, D or F scores assigned to U.S. hospitals based on preventable medical errors, injuries, accidents, and infections, shows that hospitals are making some progress, but many still have a long way to go to reliably deliver safe health care. For the first time, the Hospital Safety Score now identifies “D” and “F” hospitals that represent the most hazardous environments for patients in need of care. The Hospital Safety Score - first released in June of 2012 - was compiled under the guidance of the nation’s leading experts on patient safety, and administered by the independent, national nonprofit organization The Leapfrog Group. This Hospital Safety Score update accounts for the data updated over the last six months, most covering hospital performance in 2011, and uses a modified methodology based on research and public comments.

Key Findings

• Of the 2618 general hospitals issued a Hospital Safety Score, 790 earned an “A,” 678 earned a “B,” 1004 earned a “C,” 121 earned a “D” and 25 earned an “F.”
• 58 percent of hospitals maintained the same grade level as they had in the scores issued in June. Another 34 percent of hospitals changed by one grade level (some higher, some lower). About eight percent of hospitals showed more dramatic change, moving two grade levels or more up or down.
• A wide range of hospitals earned “A’s,” with no one class of hospitals (i.e., teaching hospitals, public hospitals, etc.) dominating among those showing the highest safety scores. Hospitals earning an “A” include academic medical centers New York Presbyterian Hospital, Brigham and Women’s Hospital, and Mayo Clinic. Many rural hospitals earned an “A,” including Geisinger Medical Center and Blessing Hospital.
• Hospitals with myriad national accolades, such as Massachusetts General Hospital, Duke University Hospital, and Cleveland Clinic Florida each earned an “A.”
• “A” scores were also earned by hospitals serving highly vulnerable, impoverished, and/or health-challenged populations, such as Bellevue Hospital Center and Detroit Receiving Hospital.

While there are several other hospital ratings in the market – many of which use Leapfrog data for their calculations – the Hospital Safety Score is unique in that it is offered free to the public, along with a full analysis of the data and methodology used to calculate each individual hospital’s Hospital Safety Score. The Hospital Safety Score relies on the advice of the nation’s foremost patient safety experts, whose participation is a voluntary contribution to Leapfrog’s nonprofit mission.

NBCH member coalitions make up the majority of the Regional Roll-Out Leaders for Leapfrog.  These coalitions use the Hospital Safety Score in their communities to work with employers and other purchaser members on contracting, value-based purchasing, benefits design, and employee educational programs to spur safety improvements in our hospitals.

Consumers Use Rankings, But Experts Disagree on "Best Hospitals"

According to the USA Today, nearly 40% of consumers surveyed last year said they use hospital ratings to choose a health care facility, but there's little agreement among the lists, raising questions about their value. Consumers pore over reviews and ratings of everything from cars to washing machines, but it's doctor and hospital rankings that may be the most confusing and controversial. At least 15 different groups, ranging from news publications such as U.S. News & World Report to the federal government through its "Compare" websites, rank health care organizations, but no two judge them the same way, which leads to widely divergent results.

A survey of consumers' views on hospitals conducted last year by the Robert Wood Johnson Foundation and Harvard School of Public Health, found Americans evenly split on whether they think there are big or small differences in the quality of care among their local hospitals. And while 38% said they rely on rankings to choose a hospital, 57% said they'd more likely go to a hospital they were familiar with than they would go to one because it had a high ranking.

Some rankings focus more in a particular area, such as patient safety, and other ranking organizations think that is too narrow a focus and try to capture a broader set of information. One thing that all sides seem to agree on is that there is a larger benefit to society if hospitals work to improve their rankings on the myriad lists.

Modest Payment Redistribution Means That Hospital Quality Program Is Working, Not Failing

In this Health Affairs blog post, Blair Childs, Senior VP for Public Affairs at Premier, Inc., argues that CMS' Hospital Value Based Purchasing program is working as CMS intended, despite an article by Rachel Werner and R. Adams Dudley’s on Medicare’s hospital value-based purchasing (VBP) program in the September Health Affairs concluding that the program is likely to have only a small impact on hospital payments. While it is true that relatively little money is likely to be redistributed from bottom-performing hospitals to those at the top, this is no reason to conclude that the program is not working as intended. Quite the contrary, it’s performing exactly as intended so far.

This should come as no surprise. After all, the Centers for Medicare & Medicaid Services (CMS) has said all along it did not expect any hospital to attain or lose more than 1 percent of its net Medicare revenues when the program goes into effect on October 1, 2012.

But the limited dollars at risk for any individual hospital for both payment incentives and penalties is no reason to conclude that the program won’t achieve its desired goal. Hospital VBP was designed by lawmakers not as a penalty program but as a means to drive faster performance improvement by tying performance to payment.

The program measures hospitals on 12 processes of care, and their patients’ experience of care. CMS sets targets based on a very high performance level in a baseline period. If hospitals are able to catch up to those levels, then they will avoid a penalty. So, as more hospitals improve the care they provide to patients, less money will be generated by penalties to redistribute to high performers. In other words, if the amount of financial redistribution is small, the program is achieving its goal of driving higher performance on quality and outcomes.

This is exactly what is happening. Premier’s early estimates predicted a significantly greater redistribution than now appears likely. As the program has approached, more hospitals have been meeting the targets.

There are ample incentives to drive continuous improvement. Because the rest of the field is constantly innovating and improving, there will always be an upward pressure on hospitals. Moreover, new domains and measures will be added to the program each year, forcing hospitals to continuously improve across many conditions and facets of care.

Childs goes on to say that the Hospital VBP program with its "carrot and stick" approach is far preferable to CMS' Hospital Readmissions Reduction program, which is a payment penalty only, with no positive incentive or reward for performing well. As employers have known for years, VBP requires more than just penalties; successful VBP programs are those that can balance the interests of all involved to achieve desired outcomes, foremost of which is a healthier population.

Health Leaders Media Compares Three Hospital Ranking Tools

The tools available to hospitals, medical professionals, and consumers for evaluating health care facilities on quality of care, safety, and other measures is growing. The U.S. government posts data on readmissions, mortality, and other measures on its Hospital Compare site. That data may be used by others to build their own ranking systems. In June, the Leapfrog Group introduced "Hospital Safety Score" which assigns letter grades based on safety metrics. (See materials from NBCH's June 19, 2012 All-Member Call.) In July, Consumer Reports' hospital safety ratings were rolled out.

To see how top hospitals measured up across three ratings systems, Health Leaders Media compares hospital safety scores from the Leapfrog Group and Consumer Reports alongside the overall rankings of U.S. News & World Report's 17 top-rated hospitals. As health care data transparency becomes more and more important for all stakeholders in the market, including regional coalitions, employers, and employees, being able to make the data actionable will be a key component to using it successfully to achieve better population health and lower costs.  Regional coalitions have an important role to play in navigating these different tools and topics to help put useful information into the hands of those who make decisions.

New initiative from Partnership for Patients aimed at improving hospital care

HHS announced a new program focused on providing hospitals across the country will new resources and support to make health care safer and less costly by targeting and reducing the millions of preventable injuries and complications from health care acquired conditions.

An initiative of the Partnership for Patients, a nationwide public-private collaboration to improve the quality, safety, and affordability of health care for all Americans, $218 million will go to 26 state, regional, national, or hospital system organizations. As Hospital Engagement Networks, these organizations will help identify solutions already working to reduce healthcare acquired conditions, and work to spread them to other hospitals and health care providers.

The 26 organizations receiving awards are:

Calif. Hospital Report Cards Likely To Go Away

On the Cal Hospital Compare website, conscientious consumers in California can look up scorecards for their local hospitals. How well does the hospital control infections? How often do patients die from complications that can be treated? How satisfied are most patients with their experience? Read the full article...

Leapfrog Group Announces Top Hospitals

Sixty-five hospitals earned The Leapfrog Group’s annual “Top Hospital” designation, equaling 2010’s record-setting total. The “Top Hospital” designation, which is the most competitive national hospital quality award in the country, recognizes hospitals that deliver the highest quality care by preventing medical errors, reducing mortality for high-risk procedures like heart bypass surgery, and reducing hospital readmissions for patients being treated for conditions like pneumonia and heart attack.

The hospitals were honored at the Leapfrog Group’s 2011 annual meeting in Washington on December 6, where several NBCH-member coalitions that serve as Leapfrog Regional-Roll Out Leaders including the Memphis Business Group on Health and the Midwest Business Group on Health were in attendance.

The 2011 Top Hospital list is culled from a field of nearly 1,200 hospitals that voluntarily and publicly report their performance by participating in the Leapfrog Hospital Survey.

A complete list of 2011 Leapfrog Top Hospitals and the survey results for all participating hospitals are posted on a website at www.leapfroggroup.org. The site is open to patients and families, the public, and employers and other purchasers of healthcare.

Hospital safety practices may not be as effective as hoped

Whether or not trauma centers meet national safety standards says little about a patient's risk of dying or getting an infection while there, according to new research.The findings add to evidence that quality measures meant to improve hospital outcomes may not be as effective as hoped.

Earlier this month, for instance, another study found that hospitals scoring high for their treatment of children with asthma aren't better at preventing those kids from ending up in the emergency room with asthma attacks.

The latest results, published in the Archives of Surgery, show that hospital scores on the so-called Leapfrog Safe Practices Survey weren't linked to either death rates or hospital-associated infections. Read the full article...

Comparing Hospital Characteristics Related to Improving Quality and Reducing Health Care Disparities

This summary provides a description of hospital characteristics and activities that are associated with improving quality of care and reducing health care disparities. Hospitals in AF4Q communities are compared with hospitals in the rest of the country on such factors as demographic characteristics; level of community orientation; safety net status; collection of race, ethnicity, and language data; and adoption of electronic health record systems. Download the summary here...

Report Finds Improved Performance by Hospitals

“It’s only highlighting the best performers and they should be highlighting the poorest performers because evidence shows that when you publicly report, it’s the poorest performers that improve the most. And the public wants to know which are the poorest performing hospitals so they can avoid them.”
-- Lisa McGiffert, Director of Consumer Union’s Safe Patient Project

In the latest advance for health care accountability, the country’s leading hospital accreditation board, the Joint Commission, released a list on Tuesday of 405 medical centers that have been the most diligent in following protocols to treat conditions like heart attack and pneumonia. Almost without exception, most highly regarded hospitals in the United States, from Johns Hopkins in Baltimore to the Mayo Clinic in Rochester, Minn., did not make the list. Read the full article...