An employer-driven hospital rating system gains ground

The latest Leapfrog hospital safety grades for 47 Philadelphia-area hospitals awarded top marks — an A — to 15 area hospitals, including four to Jefferson Health and three each to Main Line Health and the University of Pennsylvania Health System.

The Leapfrog Group, founded in 2000 by major national employers, also awarded a C to Lankenau Medical Center. And it gave three D’s — to Brandywine, Phoenixville, and Pottstown, all owned by financially troubled Tower Health.

“These ratings are not an accurate reflection of the high-quality and compassionate care delivered across each of our facilities,” a Tower spokesperson said. No local hospital received the bottom mark of F, which was handed out to only about 1% of hospitals nationwide.

Leapfrog is part of a movement by employers, who sponsor health coverage for nearly half the U.S. population, to get better value out of the more than $700 billion they spend annually on health care for their employees and family members by taking a more active part in the way services are delivered.

Among Leapfrog’s founding members was General Motors Corp. which in the early 2000s was spending about $1,500 per vehicle on health care. Other founding members of Leapfrog, which started as part of the Business Roundtable, were Boeing, General Electric, and Marriott.

The problem of rising health-care spending has continued. The average cost of employer-based family coverage has jumped 55% over the last decade to $21,342, with nearly three-quarters of that amount paid by employers, according to the Kaiser Family Foundation.

Leapfrog, a Washington nonprofit, started with a voluntary survey that tracked hospitals progress in adopting safe medication handling practices, maintaining procedures to prevent infections in the hospital, and having the best-trained staff in intensive-care units.

Since 2012, Leapfrog has been combining the results of its survey with actual results from Medicare data and other sources to create hospital safety grades twice a year. The goal is to give consumers an easy way to gauge how safe their hospital is.

The latest safety grades came out late last month. They showed that 32% of the hospitals in the eight-county Philadelphia region received an A, about the same percentage as nationally. Nine hospitals earned an A the first year. Leapfrog grades hospitals whether or not they participate in the survey, using public data.

Leapfrog’s grading system differs from other hospital ranking systems, such as U.S. News Best Hospitals, the Center for Medicare and Medicaid Services’ star-ratings, Health Grades, and the IBM Watson Health 100 Top Hospitals. IBM Health last month ranked St. Luke’s University Hospital in Bethlehem the nation’s top major teaching hospital, because it focuses on safety rather than overall quality or reputation in particular specialties.

“I think Leapfrog is as good as any, recognizing that each one has its strengths and weaknesses,” said Mike Young, president and chief executive of Temple University Health System. Temple University Hospital has received two Leapfrog A’s in a row after receiving B’s and C’s since the Leapfrog grades started.

“The nice thing about Leapfrog, it allows you to compare yourself to every other hospital, not just academics,” said Young, referring to hospitals connected to medical schools. He also said he likes that Leapfrog focuses on on infection rates and the way patients are cared for.

“It’s horrible for the patient” and costs the hospital $30,000 to $50,000 when a patients gets an infection, Young said. Another financial component to safety is that Aetna uses Temple’s Leapfrog safety grade as an incentive in Temple’s contract, Young said.

In the spring of 2016, CEO Jim Brexler was unhappy to see Doylestown Hospital with a C from Leapfrog, according to a blog post on the Leapfrog web site. Brexler led an effort to improve safety throughout the hospital, including the addition of board-certified intensive care doctors in the ICU. That helped the hospital receive an A that fall, and during every grading period since then. Doylestown officials did not respond to requests for comment.

When hospital officials did not like the latest grade their hospital received, they typically complain that Leapfrog uses old data that doesn’t reflect current conditions in their institutions — though Leapfrog uses the most recent standardized data that are available. Some of the information used for the current ranking cover from July 1, 2017, to June 30, 2019.

Main Line Health received A’s at Bryn Mawr, Paoli, and Riddle Hospitals, but has had C’s at Lankenau Medical Center six times in a row. Main Line officials said the grade doesn’t reflect the current state at the hospital in Wynnewood. “The Lankenau team has proactively implemented changes that have resulted in significant improvements in key areas such as infection prevention and patient experience,” Lankenau president Phil Robinson said in a statement.

Similarly, Tower said it had made significant changes to improve care: “Since Tower Health was founded in September of 2017, we have invested more than $275 million across our footprint in clinical and patient experience upgrades. During that time frame, our award-winning care teams have been recognized by countless organizations for quality outcomes and patient safety.”

Participation in the Leapfrog survey, which accounts for 50% of the safety grade if hospitals complete it, has been growing.

Ten years ago, only one general hospital in Southeastern Pennsylvania participated in the Leapfrog Group’s national survey of quality and safety practices. That was the now-closed Hahnemann University Hospital in Center City.

Last year, 28 hospitals in Southeastern Pennsylvania participated in the survey while nine did not.

That’s a big shift for Southeastern Pennsylvania. Every hospital in New Jersey and Delaware participated in the most recent survey.

“In Southeastern Pennsylvania, we still have some work to do,” said Neil Goldfarb, chief executive of the Greater Philadelphia Business Coalition on Health, a group that advocates for hospital participation with Leapfrog.

Among hospitals for adults, the holdouts include Crozer Health, Tower Health at five of its hospitals, and the University of Pennsylvania Health System, which responded partially to the survey. Children’s Hospital of Philadelphia also did not participate in the survey

Crozer said it might participate this year.

New Jersey hospitals have historically had a higher participation rate in the Leapfrog survey because for a long time they were eligible for Horizon Blue Cross Blue Shield’s bonus payments only if they did, said Linda Schwimmer, CEO of the New Jersey Health Care Quality Institute.

Horizon, the largest health insurer in New Jersey, stopped using Leapfrog participation as a requirement for incentive payments in 2016. That was after the survey became “widely adopted and accepted by New Jersey’s health systems, which now make quality and patient safety a central part of their operations and assessments,” a Horizon spokesperson said. Horizon still includes Leapfrog safety grades in its online tool to help members pick hospitals.

Independence Blue Cross, the dominant health insurer in Southeastern Pennsylvania, has looked at Leapfrog, but doesn’t use it, a spokesperson said.

One of the knocks against Leapfrog is that its survey lacks on-site auditing of the results with the exception — pre-pandemic — of a very small number of hospitals. Leapfrog has systems in place to ensure accuracy, including checks for potential data entry errors and inconsistencies, said Erica Mobley, the organization’s vice president of administration.

The usefulness of Leapfrog grades is also limited by its focus on hospital-level data, even advocates say. Consumers and employers, which pay for much of the health care in this country, want to be more specific and know the best place to get a new hip, for example.

That’s why the Greater Philadelphia Business Coalition on Health, which started in 2012, the same year Leapfrog introduced safety grades, published a report last year for members on joint replacement.

“What we showed was there are better and worse hospitals, but within the better hospitals, there were better and worse physicians,” said Goldfarb, the group’s CEO. “In some of the problem hospitals, there were some good doctors.”

Goldfarb and others said a combination of quality and costs is needed to get good results.

That’s the tack of the Health Transformation Alliance, a cooperative of 58 large employers that participated in a letter campaign this year urging hospitals nationwide to participate in the Leapfrog survey. The Alliance, whose Philadelphia-area members include Lincoln Financial Corp., Drexel University, and DuPont Co., is led by former South Jersey congressman Rob Andrews.

The group, founded in 2016, has compiled a depersonalized database of health expenses for more than three million people and uses that information to negotiate better deals with doctors, hospitals, and drug companies to provide better care at a lower cost. Leapfrog is part of that mix, Andrews said.

“We think combining our cost data — Leapfrog’s first-rate, platinum-plated institutional data, and then what we can figure out about different providers — is a really powerful combination.”