Methodology

For the grades, Leapfrog used up to 32 evidence-based measures of patient safety, including CMS Medicare PSI 90 Patient Safety and Adverse Events composite, which includes 10 component measures.

Those measures are used to produce a single letter grade representing Leapfrog's perspective on a hospital's overall performance in keeping patients safe from preventable harm and medical errors.

The ratings, which are updated twice a year, do not cover facilities such as military or VA hospitals, critical access hospitals, specialty hospitals, children's hospitals, or outpatient surgery centers.

For the spring 2026 grades, Leapfrog did not assign grades to 450 hospitals that didn't participate in the 2024 or 2025 Leapfrog Hospital Survey due to a ruling from a federal court in Florida.

In the lawsuit, five hospitals in Florida's Palm Beach County alleged deception in the way Leapfrog calculated its grades and stopped submitting data to the survey. As a result, the plaintiffs claimed that Leapfrog assigned them lower scores because of their refusal to participate, "resulting in artificially deflated overall grades with no basis in fact and no correlation to a hospital's actual safety performance."

A U.S. District Court Judge for the Southern District of Florida agreed, saying that Leapfrog's method is "unfair and deceptive" and "in violation of the Florida Deceptive and Unfair Trade Practices Act."

Leapfrog is appealing the decision but removed scores for the five hospitals in the lawsuit as well as an additional 445 hospitals that didn't submit metrics to Leapfrog's previous surveys because the company "does not apply programmatic changes to individual hospitals because the Hospital Safety Grade is a national program," Leapfrog said.

This year marks the first time Montana has been in the top five for highest percentage of "A" hospitals.

Meanwhile, Leapfrog found there were no "A" hospitals in:

• North Dakota
• South Dakota
• Vermont
• Wyoming

Leapfrog also noted that in fall 2022, the company reported that several healthcare-associated infections (HAIs) had hit their highest peak since 2016. Since then, average HAI scores have dropped significantly for four measures:

• Central line-associated bloodstream infections dropped 50%
• Catheter-associated urinary tract infections dropped 45%
• Methicillin-resistant Staphylococcus aureus dropped 42%
• Clostridium difficile dropped 30%

"The good news is that hospitals across the country are making meaningful strides in patient safety and helping save countless lives," said Leah Binder, president and CEO of Leapfrog. "But not all hospitals are the same. That's why it's so important for people to consult Safety Grades and do their research when choosing a hospital."