Amanda Melillo, Chief of Staff of the Quality Institute, leads the Quality Institute’s Leapfrog programming. She talked with Take Five about recent changes in the Leapfrog Hospital Safety Grades.
After the spring Leapfrog Hospital Safety Grades came out this year we saw a real shake-up in scoring. One-third of New Jersey hospitals dropped a grade or more. Meanwhile, our state’s overall score dropped to 22nd in the nation — from fifth place the year before. What changed?
Several changes in the grade’s scoring methodology could have affected a hospital’s performance this latest round. Five measures were removed from the methodology. These were Surgical Care Improvement Project (SCIP) measures that no longer had much variation. All hospitals performed well on these measures so it no longer made sense to include them in the safety scores. In addition, the numeric cut-off points that determine whether a hospital receives an A, B, C, D or F score were increased, making it more difficult for hospitals to receive an A or B grade. Leapfrog works to continually raise the bar on safety. That’s the reason new measures also were added.
What new measures were added?
For the first time, the Leapfrog Hospital Safety Grade includes results of patient surveys. Five measures that are part of the HCAHPS, or the Hospital Consumer Assessment of Healthcare Providers and Systems Survey, are now included. Leapfrog counts only the questions that are related to patient safety and quality, such as questions surrounding nurse and physician communication, staff responsiveness, communication around medicines and discharge information. Leapfrog believes that these questions are closely linked to patient quality and safety and it makes sense to now include them in the grading process.
Were there any other changes?
Yes, the new scoring methodology also now includes two additional outcome measurements: rates of MRSA and C. difficile. These are health care associated infections that pose a serious risk to patients.
What are you expecting from the fall Hospital Safety Grade results, which will be made public on Monday.
I am not expecting significant changes in these grades compared to those released in the Spring. This round of grading uses the same scoring methodology as that used in the Spring. However, some of the data used in the 30 measures that make up the grade has been updated, so there might be some variation. As hospitals have more time to make changes in response to the new scoring methodology I expect we will begin to see more New Jersey hospitals getting A and B grades. Remember, New Jersey historically has done very well on Leapfrog Hospital Safety Grades and we traditionally have been among the nation’s top performing states.
We have heard criticism from hospitals nationally that incorporating patient-reported measurements into the Leapfrog Hospital Safety Grade is not fair to safety net hospitals, which have more lower income patients.
I can respond to the story in New Jersey, where we do not see the new measurements — specifically the five HCAHPS measures focused on provider communication, staff responsiveness, communication around medication and discharge information — disproportionately hurting safety net hospitals versus other New Jersey hospitals. Of the safety net hospitals scored in Spring 2016 and Fall 2015, about 31% saw a decrease in their grade under the new methodology. Non-safety net hospitals saw similar declines during that same time period. This is a rough calculation. We are sensitive to the concerns of our state’s safety net hospitals so we will continue to follow these grades closely going forward.