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April 5, 2017

Can hospitals game Leapfrog's safety grading system? This study says they could

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Hospitals may be able to influence their scores on the Leapfrog Group's Hospital Safety Grade system by declining to submit certain patient safety data, according to a study recently published in Medical Care.

About Leapfrog patient safety grades

Leapfrog twice annually gives patient safety grades to about 2,600 general acute-care hospitals throughout the United States. The grades are based on 30 metrics, including some that hospitals self-report on Leapfrog's voluntary hospital survey. According to the researchers, the self-reported data can count for almost 25 percent of a hospital's grade.

If a hospital does not participate in the survey, Leapfrog basis the facility's grade solely on outcomes and process data that are publicly reported, such as hospitals' performance on National Quality Forum-endorsed Safe Practices (NQFSP).

Study details

For the study, Jennifer Meddings of the University of Michigan and colleagues conducted simulations based on 2013 hospital data to see how hospitals' safety grades could change if they did not participate in Leapfrog's hospital survey and instead reported less-than-perfect or perfect performance on NQFSP.


The researchers found that hospitals in their simulations that reported patient safety data through Leapfrog's survey were more likely to receive lower safety grades than hospitals that did not participate in the survey.

Shawna Smith, the study's lead author, said, "Hospitals that have less-than-perfect performance on Leapfrog's list of protocols get a big hit to their grade, but those with most or all protocols in place are rewarded very little," adding, "Our simulations show that some hospitals would have had better grades when they didn't report than when they reported imperfect compliance."

Overall, the researchers suggested that Leapfrog should base hospital safety grades more heavily on safety measures reported by objective sources and not hospitals, themselves. Meddings said, "It's time to have a new discussion about how to measure new metrics and use them in innovative ways to evaluate hospitals."

Leapfrog's response

Leah Binder, president and CEO of the Leapfrog Group, said she was "flabbergasted" by the study and questioned why researchers would look at "how hospitals can 'game' the safety grade."

Binder said the safety grade is "too complicated" for hospitals to manipulate. Leapfrog in a statement said the number of measures on which the grade is based, and that hospitals are graded on a curve, help to ensure hospitals cannot influence the system.

Binder also pushed back against the notions that hospitals might get better scores if they abstain from reporting patient safety data to Leapfrog. "Hospitals that provide Leapfrog with as much data as possible tend to do better over time," she said (Punke, Becker's Infection Control & Clinical Quality, 3/29; Minemyer, FierceHealthcare, 3/30; Gavin, "Rounds," University of Michigan, 3/28).

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