Kentucky gets left out!

A few weeks after the Leapfrog Group released their Hospital Safety Scores, Consumer Reports (CR), the well-respected consumer protection organization, released their own version of a safety score based entirely on publicly available information, including Leapfrog’s data. Both organizations have also prepared more extensive hospital surveys focussing on quality of care. Leapfrog augments its own survey and safety score with information collected directly (and voluntarily) from the hospitals themselves. Otherwise both safety scores are based largely on the same information collected by Medicare with some interesting but minor differences. Consumer Reports’ Safety Scores include elements such as surgical-site infections, readmissions within 30 days for some diagnoses, avoiding unnecessary radiation from certain duplicate CAT scans, and good communication to patients about drug information at discharge. [I must confess though, I am still not altogether clear on what the distinction is between quality and safety measures. Perhaps someone can educate us in the comments.]

Unfortunately the Consumer Reports scores were not released to the general public for free– one must pay to subscribe to their commercial website. (Charging for their evaluation is how they stay independent!)  In contrast, Leapfrog’s Safety Scores and Hospital Survey are both free to all. Nevertheless, I thought it would be instructive to compare the CR safety scores with those of Leapfrog, so for $6.95 per month, I signed up. Continue reading “Consumer Reports Releases a New Set of Hospital Safety Scores.”

Maybe not perfect, but still worthwhile.

It has been an educational experience to examine the Hospital Safety Scores released last month by the well respected Leapfrog Group. Leapfrog was originally organized by large employers and payers in an effort to insure that the large sums they were shelling out for healthcare were in fact buying something worth paying for. Such efforts have been incorporated into our national health policy.

The results for Louisville were not as good as we would all have liked, and for some hospitals worse than they would like to have to defend. Kentucky as a state ranked in the middle. Twenty per cent of scored Kentucky hospitals received an A, and in this regard as a state we ranked 28th. The American Hospital Association wrote a very critical letter in defense of their members and speculated publicly how it could even be possible that Yale-New Haven Hospital, one of the most famous teaching hospitals in the world, only was awarded a C.

For both academic reasons to explore the robustness of the Safety Scores, and because I too was surprised by some of the results in Kentucky, I undertook to analyze in more detail the individual measurements underlying the composite letter scores. I entered the individual scores for all four Louisville hospitals, as well as two of the several hospitals in Kentucky that received a Safety Score of A: the teaching hospital in Madisonville which I hold in high regard, and the Appalachian Regional Hospital in Harlan which has much been in the news lately because of its legal struggles over Medicaid Managed Care. Because the AHA had made an issue about Yale- New Haven, I included both it and St. Raphael, the other major hospital in New Haven. To provide comparison for UofL, I included the University of Kentucky Hospital. Continue reading “Further Details of Louisville’s Hospital Safety Scores.”

Hospitals react to release of Safety Scores.

Earlier this month I commented on the release of a new hospital safety rating system developed by the Leapfrog Group, one of the most respected organizations attempting to promote hospital safety and quality. It gave many of America’s hospitals a letter grade for safety. The results for Kentucky were surprising to me, and perhaps also to the hospitals themselves. Reaction by hospitals to Leapfrog’s Hospital Safety Scores has been largely predictable. Those hospitals getting an ‘A’ were proud to announce it, while hospitals doing less well fell back on the usual excuses rebuttals that the data supporting the scores was too old, unreliable, irrelevant, or otherwise flawed. If those excuses are valid, then we are all in trouble, because 16 of the 26 measures evaluated come directly from information provided by the hospitals themselves to the United States Government and are used in the Centers for Medicare & Medicaid Services (CMS) public Hospital Compare database. If the state-of-the-art of large-scale medical quality measurement is that bad, than we need to start over!

The reaction of the American Hospital Association (AHA), the hospital industry’s major lobbying group, was quite unrestrained. In a letter earlier this week to the Leapfrog Group, AHA’s President Rich Umbdenstock let go with more than both barrels. He declared that the “scorecard’s assessment was neither fair not accurate,” and that “no one should use it to guide their choice of hospitals.” He goes so far as to suggest the methodology and choice of measures do not even meet the Leapfrog Group’s own established standards! Leapfrog’s President replied with a more restrained but very convincing rebuttal that is fun to read. Note that while I am more than willing to give the AHA credit for keeping the welfare of all Americans in mind, their primary job is to protect the interests of its member hospitals. Continue reading “Hospital Safety Scores: The Empire Strikes Back!”

Assessment of Hospital Safety by the Leapfrog Group.

One of the themes presented in this Policy Blog over the last year is that consumers should be careful about uncritical acceptance of unsupported promotional claims of quality by hospitals and other medical providers. After all, how can every hospital be “the best?” As in Lake Woebegone, at least some hospitals have to be average, and unfortunately, some even less than average when compared to their peers.

The Leapfrog Group is one of the very most respected organizations currently measuring and publicizing the safety and quality of care in hospitals. They use publicly available data and information provided voluntary by the hospitals themselves. Earlier this week, that organization made available their Hospital Safety Score derived from 26 different elements. I have not personally seen a more comprehensive panel of items rigorously assessed for this purpose. It includes, but is broader than the “Hospital Compare” scoring system published by Medicare. I would certainly have more confidence in these Hospital Safety Scores than any claims about quality or safety made by the hospitals themselves. In Leapfrog’s words, “The Hospital Safety Score is an A, B, C, D, or F letter grade reflecting how safe hospitals are for patients.” Continue reading “Louisville Hospitals Not As Safe As In Appalachia?”