Hospital Board Discusses Grade Change by the Leapfrog Group

“We have made positive steps forward with the Leapfrog Group, and they have changed our hospital’s grade,” Wes Murray, chief executive officer at Texas County Memorial Hospital, told board members at their monthly meeting on Tuesday.

Hospital administration, board members and members of the TCMH medical staff spent a large portion of the monthly board meeting discussing a scorecard report by the Leapfrog Group.

When first made public, the scorecard gave TCMH a score of “F”, including them with 25 hospitals across the nation that did not participate in The Leapfrog Group’s independent survey of 2,620 hospitals.   After TCMH contacted the Leapfrog Group about the score, the “F” was dropped for further review by the group.

“We were graded by a group on a survey that we did not participate in,” Murray explained.

Murray “fully supports” providing quality data to places like the Center for Medicare Services (CMS) which TCMH reports to regularly.  TCMH does not supply any data to the Leapfrog Group.

The Leapfrog Group is a firm with members that participate with Leapfrog by paying for services provided and data collected by Leapfrog.  Hospitals that utilize data from the Leapfrog Group are required to pay $5,000 to $12,000 for its use.

TCMH does not utilize Leapfrog’s services and voluntarily chose to not participate in the survey.

The Leapfrog Group survey results gained notoriety after Health magazine published the list of 25 hospitals with an “F”—information provided to them by the Leapfrog Group.  Media interest was then spurred across the nation when the spotlight was shown on large hospitals such as the University of California Ronald Reagan UCLA Medical Center in Los Angeles to the 38-bed Richardson Memorial Center in Rayville, LA for receiving “F” scores.

The Springfield television station, KSPR, used the Health magazine information to do a story about the hospital’s score while officials at TCMH were trying to determine how the score was given.

TCMH had to purchase from Leapfrog Group the methodology for the scorecard—a methodology that used incomplete data and partial data from sources to whom TCMH does not submit data.

The “F” score has since been removed by the Leapfrog Group after TCMH made the Leapfrog Group aware of the incorrect data they used to grade the hospital.

“Leapfrog Group used a questionable methodology to give scores to all hospitals,” Murray said, calling the scorecard a “publicity nightmare”.

“We presented the possible conflict of information in the television interview, but we have learned much more information since that time, and we have been able to speak personally with the Leapfrog Group,” Murray said.

TCMH currently has an “SP” score on the Leapfrog site, which stands for “score pending”.  Members of the Leapfrog Group are reviewing data presented by TCMH, and they are waiting for additional data from the Center for Medicare Services to corroborate the data presented by TCMH.

“The Leapfrog Group told us that if the data we gave them over the phone was accurate, there was a discrepancy in the data used by Leapfrog,” Murray said.  “They have agreed to review additional information about TCMH, and it’s our position that they should exempt TCMH from scoring due to our hospital size and patient volumes in the criteria the group has chosen to use.”

Murray explained that TCMH is not ethically bound to verify data from an independent group surveying healthcare facilities.

“I take exception to the Leapfrog Group assuming that data is correct if we don’t validate it,” Murray said.

On October 23^rd TCMH received a letter dated “October 1” from the Leapfrog Group asking TCMH to verify the Leapfrog Group’s survey information by midnight October 24, otherwise, the data was assumed to be correct.

“Our staff didn’t even know where the data from the Leapfrog scorecard came from, so it couldn’t be verified,” Murray said, adding, “It’s not our job to validate data used by Leapfrog.”

Earlier in 2012 TCMH opted not to participate in the Leapfrog Group’s survey when certain hospitals were presented with the option of taking the survey.

The Leapfrog Group survey is over 80 pages in length and must be completed two times annually.  According to the organization, the survey will take four to six days to complete depending upon the number of people working on completing the survey.

“We did not want to utilize our limited hospital manpower and resources to participate in a survey by an independent group that requires money to be a part of their group,” Murray said, adding that he believes TCMH “made a wise decision”.

Murray noted that TCMH staff cannot complete surveys from every group that asks for hospital data.

“We focus our efforts on reporting data to CMS and the Hospital Engagement Network,” Murray said.  “These agencies tabulate our data as well as the data of more than 4,000 other hospitals in the nation.”

Murray explained that he was “very upset” with Leapfrog’s approach to the data in the survey.

“We have a lot going on at our hospital, and we run our operations very lean,” Murray said, adding, “To fill out every survey that comes along just to protect ourselves is wrong.”

The Leapfrog Group utilized a portion of data from the Center for Medicare Services, which TCMH reports to regularly, but the Leapfrog Group also used data from sources TCMH does not report to.

Eleven of the 26 measures that make up the Leapfrog Group’s Hospital Safety Score are derived from hospitals’ responses to the 2012 Leapfrog Hospital Survey. To address the gap of hospitals not participating in their survey, The Leapfrog Group developed methods for using secondary data.

The secondary data Leapfrog Group used came from a small portion of information submitted to the American Hospital Association (AHA) by the Missouri Hospital Association (MHA).  The Leapfrog Group then assumed that all hospital data came from “urban” rather than rural hospitals if the designation as a rural hospital was not already indicated in the Leapfrog survey or the AHA survey.

TCMH does not complete the annual AHA survey either, relying on the MHA to submit data about TCMH to the AHA.

Murray noted that several of the hospitals that received “F” scores from the Leapfrog Group are rural hospitals.

“It’s important for our community to know that the Leapfrog Group’s scorecard is based on methodology that is more subjective than other publicly available data,” Murray explained, adding that the data has not been confirmed by the National Quality Forum, nor has it been assessed for reliability and validity by any independent organization.

“The grade the Leapfrog Group awarded to TCMH in no way depicts what is going on inside our hospital,” Murray said, echoing a statement the TCMH medical staff prepared and submitted to the TCMH board of trustees.

“We have to question the validity of a survey in which data was not submitted for analysis,” the TCMH medical staff wrote, “A survey such as this is not representative of our ability to provide competent and safe care for our patients.”

The TCMH medical staff and Murray encouraged those wanting a “true” comparison of TCMH to other hospitals in the area and across the nation to utilize the federal government’s web site, Hospital Compare, which can be found at www.hospitalcompare.hss.gov.

“The data in the Hospital Compare website is an accurate reflection of quantitative information that TCMH and hospitals across the nation must provide to government agencies to give an accurate reflection of the quality of care found behind our doors,” Murray said.

Murray and Doretta Todd-Willis, chief nursing officer at TCMH, presented up to date data for TCMH which shows that the county hospital is above or at the national average or rate for many of the measures used by Hospital Compare.

“The Hospital Compare web site also shows the most up to date information that is publicly reported for all hospitals in the nation,” Murray said.

There are over 5,000 hospitals in the US, and the Leapfrog Group hospital safety score included about half of the hospitals nationwide.  It did not include critical access hospitals, mental health hospitals, specialty hospitals, pediatric hospitals or federal hospitals.

“As the physicians who work at TCMH, we have great confidence in our staff, our administration and our colleagues,” the TCMH medical staff wrote in their statement presented to the TCMH board. “We will continue to utilize and encourage our patients and community members to use websites like Hospital Compare to improve care of patients and make sure we are striving for excellence as we compare ourselves to other hospitals and set new goals for quality.”

In a report also presented to board members, the MHA acknowledged that small and rural hospitals “are challenged” to complete quality reports because the case load volume at smaller hospitals does not adequately reflect the actual quality of care being provided.

“One less than optimal outcome on a small number of patient cases can skew the overall score,” Herb Kuhn, president of the MHA, said.  “Studies show that reported outcomes for rural hospitals tend to be difficult to track because of their lower volumes.”

Kuhn pointed out that hospitals were the first to provide quality data to the public and have been doing so for more than a decade.

“Hospitals believe they should be transparent with their quality and safety information so that communities know the efforts hospitals are making to improve care,” Kuhn said.

Murray explained that in addition to outrage by the TCMH Medical Staff, a large number of hospital employees were upset by the information publicized by the Leapfrog Group.

“TCMH employees and physicians know best the type of work they do and the efforts they make to provide excellent patient care,” Murray said, “They are angered by the information published by Leapfrog Group.”

“We have great support from our community, but it’s misinformation like this scorecard from the Leapfrog Group that could make the difference in someone deciding to use their local hospital,” Murray said.  “Or even worse, it could be the reason a physician might choose a practice opportunity at a different hospital and community over TCMH.”

Murray expressed concern that the Leapfrog information could jeopardize the retention of current physicians working for TCMH.

“If patients stop seeing our physicians because of concern over this inaccurate information–a physician that we need and work hard to retain–could chose to practice in another community,” Murray said.  “We have to set the record straight on behalf of our medical staff and all of our employees.”

Dr. Jim Perry, OD, member of the TCMH board of trustees, agreed, and he shared a personal story of talking with a TCMH employee that was upset about the score from the Leapfrog Group.

“The employee took great pride in their work and their workplace,” Perry said.  “I do believe we need to do something rather than dismiss this information.”

Murray has spoken with leaders at many of the hospitals that made the “25 worst” list, including the chief medical officer at UCLA Medical Center, Dr. Thomas Rosenthal.  Rosenthal considers the Leapfrog scorecard to be “a form of extortion”.

Other hospitals are planning to pursue legal action against the Leapfrog Group.  TCMH is also seeking legal counsel regarding the Leapfrog Group scorecard.

TCMH has contacted KSPR and asked for a correction to the story originally ran by the station.

“We need to take every opportunity to provide correction to the information that is out there,” Omanez Fockler, chairperson of the TCMH board of trustees, said.

“I am proud that we were able to speak with Leapfrog, and they are making an attempt to correct their mistake,” Murray said.

TCMH is anticipating a response from the Leapfrog Group in the upcoming weeks after the organization’s review board looks over information submitted by TCMH.

Also at the board meeting, Linda Pamperien, chief financial officer at TCMH, presented the financial report for the month of November.  TCMH continued to rebound from lost patient days for Medicare patients in the month of November, leading to a negative bottom line of $281,190.51 for the month and a year to date loss of $441,500.61.

Inpatient admissions are up by 146 admissions for the year to date, but inpatient and outpatient revenues were down in November.

Pamperien reported that TCMH was in line to receive $996,000.00 in Medicare funds and $462,000.00 in Medicaid funds for reaching “Stage 2” of “meaningful use” of electronic medical records in the hospital and clinics.  Although the funds have not been received, they will go on the hospital’s bottom line for fiscal year 2012.

Internal audits of the coding for some inpatients are also being done.

“We have asked our physicians to do their part in watching the length of stay for inpatients, so we are doing our part to make sure we’re coding the stays correctly,” Murray said.

Present at the meeting were Murray; Pamperien; Todd-Willis; Joleen Senter Durham, public relations director; Dr. Charlie Rasmussen, chief of staff; Dr. Charles Mueller; Dr. John Duff; Jodie Forbes, and board members, Fockler; Perry; Janet Wiseman, Mark Hampton and Mark Forbes.

The next meeting of the TCMH board of trustees is Tuesday, January 22 at 12 p.m. in the downstairs meeting room of the hospital.

How TCMH Stacks Up On “Outcome Measures” According to the Leapfrog Group

The “outcome measures” portion of the Leapfrog Group survey used data from Hospital Compare.

• On 8 of the 11 measures TCMH had “Perfect/ Best Performing Hospital/Average Performing Hospital” scores

• The 3 remaining measures were “not applicable” to TCMH, but according the Leapfrog Group’s methodology, TCMH received a lesser score for “not applicable” because TCMH did not complete the Leapfrog Group’s survey.

The “process measures” portion of the Leapfrog Group survey used Leapfrog Group Survey data, AHA data and Hospital Compare data with the assumption that TCMH was an urban hospital.

How TCMH Stacks Up Nationally According to CMS Hospital Compare

Timely and Effective Care, January through December 2011:

• 16 Measures for Timely and Effective Care.

• 4 of 16 measures TCMH scores are above or at the national average, or 7 of 16 measures TCMH is above/at/within 5% of the national average.

• 6 of 16 measures TCMH is within 10% of the national average.

Patient Survey Results, January through December 2011:

• 10 Measures on Patient Surveys
• 6 of 10 measures TCMH scores above or at the national average
• Of the remaining 4 measures, TCMH is within 6% of the national average.

Readmissions/Complications/Death, July 2008 through June 2011:

• For 30-day readmissions, serious complications within 30 days, and death within 30 days, there are 11 measures.
• TCMH receives a “No Different from the National Rate” score for each measure.

Hospital Acquired Conditions, July 2008 through June 2011:

• 8 Measures—
  • Objects Accidentally Left in the Body After Surgery
  • Air Bubble in the Bloodstream
  • Mismatched Blood Types
  • Severe Pressure Sores
  • Falls and Injuries
  • Blood Infection from a Catheter in a Large Vein
  • Infection from a Urinary Catheter
  • Signs of Uncontrolled Blood Sugar

• For 7/8 of these measures TCMH scored “0” (the best possible score).  The only measure TCMH is rated on is “Infection from a Urinary Catheter”, and that is less than 1 per 1,000 patient discharges.