Number of Top-Scoring Hospitals in Patient Safety Increases

In New Jersey, the wide participation of hospitals in a state-based learning collaborative was credited as a factor in the state’s ability to garner strong collective patient safety results.

Nov. 12—The share of hospitals earning the highest patient safety grades increased in the latest scorecard from a national organization.

The Leapfrog Group, which was launched in 2000 by large employers and other purchasers, reported that among 2,600 acute-care hospitals assessed, 32 percent earned an “A” rating in safety based on the incidence of errors, accidents, injuries, and infections. That was an increase from 30 percent in the spring assessment, which included 2,500 hospitals.

“In general, we have seen increased adoption and use of technology to improve safety,” said Leah Binder, president and CEO of The Leapfrog Group.

Among the latest safety grades:

• 24 percent of hospitals earned a B, compared with 28 percent in the spring
• 37 percent received a C, compared with 35 percent in the spring
• 6 percent received a D and 1 percent an F, which were identical to findings in the spring

Leapfrog safety grades, which are peer-reviewed, transparent, and free to the public, are updated every six months and have been issued since the spring of 2012.

The scorecard’s finding echo the trend seen in the latest patient safety data from the Agency for Healthcare Research and Quality (AHRQ). AHRQ’s National Scorecard on Rates of Hospital-Acquired Conditions, 2014 to 2016, its most recent report, found that from 2014 to 2016, hospital-acquired conditions decreased by 8 percent, which saved about 8,000 lives and about $2.9 billion.

Collaboration a Factor

Leapfrog credited at least some of the topline improvement was credited to the growing number of collaboratives among hospitals in various states. These collaboratives disseminate and coordinate hospital safety improvement efforts.

“It’s important for hospitals to join with each other rather than trying to solve all the problems of patient safety at your own facility,” Binder said in an interview. “It’s reinventing the wheel a thousand times over, as opposed to working with others, learning together, benchmarking with each other, and encouraging each other.

Binder cited the experience of New Jersey, which was among the states with the highest percentage of A-rated hospitals—38 hospitals out of 67 graded by Leapfrog.

Among the statewide initiatives that the New Jersey Hospital Association (NJHA) identified as key to improving safety outcomes was the Hospital Improvement Innovation Network (HIIN), in which all 71 acute-care hospitals in the state participate to varying extents.

“There was a time, not so many years ago, when we were in the middle of the pack in Leapfrog; we weren’t happy with that,” said Kathryn Collins, RN, clinical quality improvement manager for NJHA. “And so we along with our members have worked very, very hard.”

NJHA has operated the HIIN for two years with funding from the Centers for Medicare & Medicaid Services (CMS) and believes the initiative is fueling the recent findings of improved safety results.

The HIIN and other collaboratives gave New Jersey hospitals a chance to learn about effective approaches locally and nationally and ways to improve results with similar populations, and allowed them to share resources. For instance, the collaboratives funded visits and instruction from nationally recognized patient safety leaders, which the individual hospitals could not afford.

The collaboratives work as mutual learning environments, giving hospital officials a chance to share best practices with each other through live and web-based training events, an email listserv, and data sharing.

“It takes the competitive edge off health care and allows providers to take it in but push it out at the same time,” Collins said, referring to best practices and other insights.

Different Forms of ROI

Mary Ditri, director of professional practice at NJHA, said the safety-related ROI for hospitals in the state has depended on their individual focus.

For instance, those that have focused on reducing high rates of readmissions have found an ROI in lives saved, efficiencies derived from improved processes, and avoidance of Medicare penalties.

“The patient experience measures from the HCAHPS [Hospital Consumer Assessment of Healthcare Providers and Systems] survey are tied to CMS payment programs, so to the extent that we are seeing that improvement, that will show up on the bottom line of hospitals directly from CMS,” Binder said.

The most common patient safety errors in hospitals stem from medication errors, which lead to excessive lengths of stay and readmissions, Binder said.

She suggested hospital executives look closely at the performance of any processes they have in place to reduce medication errors, especially related to computerized physician order entry systems and bar code medication administration (BCMA).

Many hospitals have such technology, but its impact depends on whether it works well, Binder said.

Hospitals can test for free the effectiveness of their administration support functions through the Leapfrog survey or aim to meet or surpass the Leapfrog standard for use of bar coding to reduce medication errors.

“That kind of implementation of technology to reduce medication errors is something we would look for and any health system would be wise to look for because of the major expense of the consequences of medication errors,” Binder said.

Leapfrog expanded its rating this year to assess hospital use of BCMA, noting that harm from medication errors affects as many as one in four patients.

Other safety-related cost drivers include so-called never events and infections.

Binder also has seen an increased focus by hospitals on patient communication and engagement, with more organizations introducing chief experience officers.

Payer Focus

Payers are increasingly focused on patient safety because safety-related issues result in so much waste, Binder said.

“So many direct contracts and other kinds of new payment reforms we’re seeing out in the marketplace are looking closely at the hospital grades as part of the contract provisions,” Binder said.

Leapfrog offers purchasers a calculator—which is very popular with payers—to estimate the impact on costs and mortality when their employees or members use hospitals that receive different Leapfrog grades.

“There’s a lot of interest in the fact that there are quite a lot of dollars lost to purchasers when [their enrollees are] at a hospital where there is a high rate of errors, accidents, and injuries,” Binder said.

Payers have reported estimating that about $8,000 per admission goes toward the cost of safety problems. Added costs estimated by researchers with AHRQ varied from $32,000 for a surgical site infection to $9,000 for a hospital-acquired urinary tract infection.

“So as we look to the future of value-based purchasing, bundled payments, direct contracting, and narrow networks, there is no question that patient safety is a top priority for purchasers in those negotiations,” Binder said.

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Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare