Maryland hospitals rank near the bottom nationwide when it comes to avoiding medical errors, accidents, injuries and infections, according to a new assessment by the Leapfrog Group.
The assessment generally drew a reserved response from area hospital administrators, who say safety is a top priority and they are always working to do better.
“We all want to improve quality,” said David Simon, a spokesman for the Maryland Hospital Association. “You just have to look at how it’s all measured.”
Hospital officials noted there are many such assessments available to patients — all using different criteria — and cautioned that the rankings confuse consumers.
Leapfrog assigned Maryland hospitals letter grades based on a range of patient safety measures.
Only one of the state’s 44 hospitals, Howard County General Hospital, earned an A, while seven received a B. The majority earned a C, while eight got a D and one — Bon Secours Hospital in West Baltimore — received an F.
“Errors and infections in hospitals are the third leading cause of death in America, and Maryland residents deserve to know which of their hospitals are best at preventing them,” said Leah Binder, president and CEO of Leapfrog.
The nonprofit group, which was formed by large employers of all kinds, collects data on 2,600 hospitals nationwide.
Leapfrog included Maryland for the first time in its safety rankings, setting aside the fact that the state’s hospitals operate under a unique federal agreement that emphasizes patient outcomes based on a wider array of measures.
As a result, Simon said, Maryland may not look as good in a side-by-side comparison when only a small number of criteria are considered.
From 2013 to 2016, the overall rate of medical complications at Maryland hospitals dropped 43 percent and readmissions went down 6 percent, Simon said.
Binder said it’s admirable that Maryland hospitals are seeking broader declines in medical errors and other problems, but Leapfrog looks at basics every hospital should be focused on.
The report looked at 27 individual measures in several categories, such as infection rates and so-called “never events” that include objects left in patients after surgery. Leapfrog also looked at whether there are proper systems in place to prevent and address errors and accidents. A panel of experts collects and assesses the data, Binder said.
She said she wanted patients to use the data to begin conversations with their providers or to choose hospitals, and hospitals to use the data to improve.
“Transparency has a really strong galvanizing effect,” she said. “I have strong optimism that we will see sustained improvement in Maryland and it will happen very quickly.”
In the five years since Leapfrog began the assessments, others states have made major gains. Hawaii, Idaho, Oregon and Rhode Island showed the most improvement. Rhode Island went from 50th to 1st.
Some outside observers take issue with certain aspects of the rating process.
Researchers at the University of Michigan raised questions about how Leapfrog incorporates into its rankings information that hospitals voluntarily provide. So many hospitals reported high performance that a facility that reports “reasonable but less-than-perfect” results could be penalized because of the way Leapfrog calculates its scores. The researchers, Dr. Jennifer Meddings and Shawna N. Smith, concluded that might deter some hospitals from sharing the data in the first place.
Despite that concern, the researchers said overall they supported the work Leapfrog does.
The hospitals in Maryland, which ranked 48th with three states tied for 49th in the country in the Leapfrog ranking, agreed that patients should be able to access measures about their hospitals.
Pat Ercolano, vice president for quality management for the University of Maryland Medical System, said hospital administrators will study the report and try to learn from it. But she advised patients to look at the data and then discuss it with a doctor or nurse.
She said large urban hospitals, and those like the University of Maryland Medical Center, face complex cases such as gunshot wounds and transplants that will always have higher rates of infections, for example, than suburban hospitals than don’t treat such cases. Even when the data are “risk adjusted” they don’t always fully take those cases into account.
Officials at other hospitals, including those within the MedStar health system, also noted that the data may not necessarily be the most current.
“Leapfrog Group is one of many that use publicly reported data to ascribe levels of performance to hospitals,” said Debra Schindler, a MedStar spokeswoman. “MedStar does not participate in the voluntary Leapfrog survey process, therefore the data used for the Leapfrog safety grades for MedStar hospitals come from a variety of sources and lag current performance. The October Leapfrog safety grades do not reflect the continuous improvement we are seeing in all of our hospitals.” ”
Cynthia Gutierrez-White, a spokeswoman for Johns Hopkins Medicine, added, “We strive every day to provide the highest quality and safest care to all of our patients. As such, we review and analyze hospital ratings with interest, such as those recently released by Leapfrog. We appreciate hospital ratings as a tool to help inform patients’ decisions about their health care and believe they play an important role in holding hospitals accountable to patients and the communities we serve.”
Judith Carmichael, a spokeswoman for Bon Secours, shared a bulletin the hospital issued responding to the grade from Leapfrog.
"We believe this grade does not accurately reflect the level of care we provide to our patients or the essential role we play within the West Baltimore community," the document reads in part.
"We believe that in the case of LeapFrog’s ratings, their methodology makes it more difficult for smaller hospitals like ours that serve a limited number of patients to achieve better grades. For example, the effect of relatively rare occurrences, such as a patient experiencing complications from surgery, is more dramatic when it is one of 200 cases than when it is one of 2,000 cases."
The bulletin says the hospital's staff are focused on patient safety and said the hospital's leaders are committed to addressing any problems they face.
Leapfrog’s Grades for Baltimore area hospitals
Anne Arundel Medical Center, C
Bon Secours Baltimore Health System, F
Carroll Hospital Center, C
Greater Baltimore Medical Center, C
Howard County General Hospital, A
Johns Hopkins Bayview Medical Center, C
MedStar Franklin Square Medical Center, C
MedStar Good Samaritan Hospital, C
MedStar Harbor Hospital, C
MedStar Union Memorial Hospital, B
Mercy Medical Center, B
Northwest Hospital, B
Sinai Hospital of Baltimore, C
St. Agnes Hospital, D
Johns Hopkins Hospital, B
The Morning Sun
UM Baltimore Washington Medical Center, C
University of Maryland Harford Memorial Hospital, C
University of Maryland Medical Center, C
University of Maryland Medical Center Midtown Campus, D
University of Maryland St. Joseph Medical Center, B
University of Maryland Upper Chesapeake Medical Center, C
Baltimore Sun reporter Ian Duncan contributed to this article.