Local hospitals say the public should not rely solely on a national patient safety scorecard released last week that gave mediocre grades to all included Tucson facilities.
None of the major Tucson acute care community hospitals that were part of the ranking scored higher than a “C” in a letter grade system created by The Leapfrog Group, a national independent, nonprofit organization. Nine Arizona hospitals scored an “A,” but none in Southern Arizona.
The scores are meant to measure how hospitals keep patients safe from preventable harm and medical mistakes, such as adverse drug events and catheter-associated urinary tract infections. Fifty-eight percent of the country’s 2,522 hospitals that were issued a score in the survey had a grade of “B” or higher.
Proponents of the Leapfrog scores say that until hospitals themselves become more open with the public, Leapfrog is the best available measure of hospital safety. Critics say the scoring is imperfect.
Four Tucson hospitals — Tucson Medical Center, Cardondelet St. Joseph’s, Carondelet St. Mary’s and the University of Arizona Medical Center-University Campus — scored a “C” grade.
One local hospital — The University of Arizona Medical Center-South Campus (formerly known as Kino Hospital), scored a “D”.
The Leapfrog survey is voluntary and three Tucson hospitals choose to participate in it: Carondelet St. Mary’s, Carondelet St. Joseph’s and Tucson Medical Center. The others did not.
Two Tucson hospitals — Northwest Medical Center and Oro Valley Hospital — were not included in the rankings because there was not enough publicly available data to grade them, and the hospitals do not voluntarily participate in Leapfrog surveys, Leapfrog officials said.
The UA Health Network does not participate in Leapfrog surveys either, so Leapfrog officials had to rely on publicly available data to determine its hospital scores.
State-by-state rankings of the scores by grade placed Arizona at 29th in the country. Maine ranked Number One, with nearly three-quarters of its hospitals scoring an “A”.
How the hospitals are evaluated
The Leapfrog Group membership represents many of the nation’s largest corporations and public agencies that buy health benefits. The group says it focuses on safety because medical errors are the third leading cause of death in the United States.
The scoring is based on the U.S. Centers for Medicare & Medicaid Services’ Hospital Compare data, information from the American Hospital Association and when available, the Leapfrog Group’s annual hospital survey.
The grades rely on two sets of data — process and outcomes, with each receiving equal weighting. Among the evidence-based measures are physician staffing; hospital-acquired conditions; patient safety indicators such as readmissions, complications and deaths; and safe practices such as hand hygiene and administering the correct antibiotics prior to surgery.
A panel of volunteer experts in patient safety provides guidance, among them Dr. Arnold Milstein of Stanford University, Dr. Ashish Jha of Harvard and Dr. Peter Pronovost of Johns Hopkins School of Medicine.
‘Tucsonans should be concerned’
“This is a piece that will eventually allow us as individuals to make more informed choices,” said Larry Aldrich, executive director of the Employers Health Alliance of Arizona and former chief executive officer of University Physicians Healthcare in Tucson, which is now part of the UA Health Network.
Aldrich’s local alliance is involved in the local rollout of the Leapfrog scores but he does not receive any money from Leapfrog, he emphasized. While other surveys consider reputation, Leapfrog does not, he said. “It’s all about the data,” he said.
People in Tucson should be concerned about the scores because, among other things, they are used by businesses deciding where to locate, Aldrich said.
“If you say ‘they just know how to play the game better in Phoenix, that doesn’t help,’” he said. “If you say ‘the data is wrong’, that doesn’t help. Let’s instead work together to make this better.”
The Leapfrog Group began releasing its hospital data twice yearly in 2012 and Aldrich said he’s been hopeful that Tucson hospital scores would improve, but they have not changed much over two years.
Hospitals say they’ve improved since data collected
Some hospitals have improved in the time between the Leapfrog data collection and publication, local and national hospital officials note.
“It does not really reflect the care that is being given today at any one hospital,” said Dr. Donald Denmark, chief medical officer for the Cardondelet Health Network, which includes St. Mary’s and St. Joseph’s.
He said both hospitals have significantly improved on safety and quality measures.
“I’ve been here for about three and a half years now and I know that in that time we have made significant changes and I can show you data from the last three months that is far superior to the data that was submitted for 2011, 2012. You won’t see that reported in Leapfrog until 2016.”
Among the positive safety and process changes at Carondelet hospitals, Denmark cites innovations in reducing readmissions through a transitional care program that works with the Pima Council on Aging and other community partners.
“You won’t see that in the Leapfrog benchmark,” Denmark said. “But where you’ll see it is when you talk to the patient in the community who says, ‘I didn’t get readmitted to the hospital because people came to my home or resources were made available to me through Cardondelet that made a difference in my health.’ That is quality.”
Denmark also says of Leapfrog, “There’s a lot of opportunity for error in the data that gets submitted to the score calculation.”
The survey appears to have inspired self-reflection at Tucson Medical Center, where officials say they are “committed to tracking our progress against that (Leapfrog) criteria.”
Hospital spokeswoman Alicia Moura wrote in an email that Tucson Medical Center has “learned a lot” about Leapfrog over the past two years. And like Denmark, she says the hospital has taken positive steps that are not reflected in the current score.
“Using more current data, we have seen significant improvement in the areas measured by Leapfrog and we are confident that this will be reflected in our future grades,” she wrote.
Check other measures, hospitals say
Leapfrog scores should be only one tool that members of the public use to assess the quality of their local hospitals, hospital officials say. Numerous hospital rankings and scorecards exist in addition to the Leapfrog scores, including U.S. News & World Report, Consumer Reports and HealthGrades.
“I really don’t want to specifically critique Leapfrog, but from our standpoint, though, as an academic medical center, we use the University Healthsystem Consortium (UHC) as our patient quality and safety organization,” said Dr. Andreas Theodorou, chief medical officer of the hospital division for the University of Arizona Health Network.
“We use them to collect the data and make comparisons because it’s comparing like institutions, academic medical centers. I think every institution needs to choose somebody to help them with patient safety and quality.”
Theodorou said that the federal government’s medicare.gov/hospitalcompare website, which uses Medicare data, is another tool, but he warned that most of the data is not current.
American Hospital Association officials recommend using such other tools, as well as consulting with friends, family, doctors, nurses and other health providers to determine what facility best meets their individual need and treatment plan.
Financial aspects of scoring
One aspect of hospital scores that the public may not know is that many come with fees if hospitals want to tell others about their results. The terms of such fees vary depending on the organization doing the ranking.
Under Leapfrog’s terms, hospitals are able to tout their Leapfrog score on their website, in a news release, announce it to their board and staff or on social media.
But hospitals must pay “licensing fees” to use a Leapfrog score in paid advertising. Leapfrog recently adjusted their licensing fees, so hospitals now pay between $5,000 and $16,000, officials said.