Methodology

Leapfrog evaluates almost 3,000 general acute care hospitals across the United States twice yearly. A panel of patient safety experts selects appropriate measures and develops a scoring methodology.

The expert panel selected 22 evidence-based measures of patient safety, including CMS Medicare PSI 90 Patient Safety and Adverse Events composite. The weight of each measure was based on evidence, opportunity for improvement, and impact.

The Leapfrog Hospital Safety Grade placed each measure into one of two domains:

1. Process/structural measures, which represent how often a hospital gives a patient a recommended treatment for a given medical condition or procedure and the environment in which they receive care.
2. Outcome measures, which represent what happens to a patient while they receive care.

Each domain accounts for 50% of a hospital's overall score, and a hospital must have enough safety data available for Leapfrog's experts to issue them a letter grade. Currently, Department of Veteran's Affairs hospitals, critical access hospitals, some specialty hospitals, children's hospitals, and outpatient surgery centers are not included in the safety grades.

How hospitals performed

In the latest report, of the nearly 3,000 general acute care hospitals graded:

• 32% earned an "A"
• 26% earned a "B"
• 33% earned a "C"
• 8% earned a "D"
• 1% earned an "F"

Leapfrog found that the 10 health systems with the highest total number of "A" hospitals and Straight A hospitals are:

• HCA Healthcare
• CommonSpirit Health
• AdventHealth
• Kaiser Permanente
• AdvocateHealth
• Prime Healthcare Services
• Defense Health Agency
• Lifepoint Health
• Northwell Health
• Sutter Health

Commentary

"The Leapfrog Group was founded 25 years ago to improve American health care through transparency, and the Safety Grade has been a cornerstone of that effort," said Leah Binder, president and CEO of Leapfrog. "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."

Bender added that some health systems "are doing an excellent job with safety. They have a plan. They have a strategy at the system level for how they are going to drive better and safer outcomes for their patients."

Michael Ramsay, CEO of the Patient Safety Movement Foundation, said that hospital safety has generally improved in recent years with an increased focus on patient safety. He added that a Medicare proposal to analyze hospital data within weeks after patients are discharged for surgeries or other procedures will drive more improvements, as hospitals and doctors won't be able to argue that regulators are using out-of-state data.

"Once you get real numbers in real time, people change," he said. "They change dramatically because there's no avoiding it."