Why this hospital is suing The Leapfrog Group

Saint Anthony Hospital in Chicago has filed a lawsuit against The Leapfrog Group to dispute the grade the organization gave the hospital in its fall 2017 review. According to Kaiser Health News, the lawsuit is believed to be the first brought by a hospital against a rating agency over a grade. 

How The Leapfrog Group created this year's list

About the ratings

Leapfrog's Hospital Safety Grades are published twice a year, and assign eligible hospitals "A" to "F" letter grades based on their performance on 12 process and structural measures and 15 outcome measures. The group uses data from CMS, the Leapfrog Hospital Survey, and secondary data sources such as the American Hospital Association's Annual Survey.

Leapfrog calculates hospital safety ratings based on a combination of 27 measures of quality from government data and an independent survey. The survey covers topics such as patient deaths among surgical patients, doctor communication, and infections. About half of hospitals complete Leapfrog's survey, according to KHN, and hospitals often promote a good Leapfrog score—though it is unclear what effect a hospital's score has on patient decisions.

Lawsuit details

Saint Anthony on Oct. 30 filed a complaint in Cook County Circuit Court challenging the "C" grade Leapfrog assigned the hospital in its Fall 2017 Hospital Safety Grades.

Saint Anthony is suing for defamation, claiming that Leapfrog lowered the hospital's grade from an A to a C based on information that Leapfrog knew to be inaccurate.

Saint Anthony contends that the lower grade was primarily the result of inaccurate information about how its physicians order medication. While Leapfrog calculated Saint Anthony's score based on data that showed the hospital's physicians electronically ordered medication 50% to 74% of the time, Saint Anthony claims its actual figure is higher at 95%. Saint Anthony's in the complaint said it tried several times to contact Leapfrog about the error.

The hospital in the suit also argues the lower score could harm the hospital's bottom line.

The complaint states, "If Leapfrog publishes a 'C' grade for Saint Anthony as part of its Fall 2017 Hospital Survey Grades, it will erase years of improvements at the hospital and irreparably degrade the public perception of the hospital."

Saint Anthony's Chief Quality Officer Eden Takhsh said, "We have seen, for better or worse, that people are paying a great deal of attention—not only our patients but also our stakeholders, vendors and politicians." He added the scores are widely shared across local media.

Further, Takhsh said the lower score could threaten potential partnerships. He said after the hospital received an "A" rating, Northwestern University and the University of Chicago had approached it about forming partnerships in neurology and pediatrics. "These organizations don't want to partner with someone with low quality because it hurts them," Takhsh said.

Executives saw the "C" grade in a preview of their score. The score is not currently posted on Leapfrog's website, but according to KHN, the rating agency "will likely repost it pending further investigation."

Leapfrog's response

Leapfrog has temporarily taken Saint Anthony's score down pending further review, but in a response filed last Tuesday the organization disputed Saint Anthony's allegations.

In the filing, Leapfrog calls the lawsuit an "eleventh hour gambit to turn back the clock on a disappointing safety grade based in part on the data that (the hospital) itself provided and certified, and which Leapfrog simply used in accordance with its long-established processes."

Leapfrog CEO and President Leah Binder said Leapfrog's rating methodology "was developed by top experts and uses the very best publicly available data," adding, "Our reviews are scrupulous."

Leapfrog said the electronic order matter is unlikely to explain the "C" grade on its own.

Discussion

In response to news of the lawsuit, experts offered mixed reactions about the value of ratings systems.

Karen Joynt Maddox, an assistant professor at the Washington University School of Medicine in St. Louis, said the dispute shines light on the weaknesses of the ratings information available to patients. "This whole field is way behind where it needs to be," Joynt Maddox said, adding that "there's a vacuum in terms of consumer-friendly information."

Similarly, Karl Bilimoria, a professor at Northwestern University, said, "These ratings systems are overall not very good." He noted that major ratings systems "frequently conflict." For instance, Saint Anthony was rated three out of five starts on Medicare's Hospital Compare website during the same period that Leapfrog gave it an "A."

Meanwhile, Ashish Jha, a professor at the Harvard T.H. Chan School of Public Health who was on a committee that helped set standards when Leapfrog was established, said he was glad to see hospitals reacting to data. "In highly competitive markets, hospitals are likely to see poor grades as a challenge, and I think many will be tempted to sue the rating agencies," Jha noted (Minemeyer, FierceHealthcare, 11/10; Gold, Kaiser Health News, 12/11; Leapfrog complaint, 10/30).

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