Leapfrog names the ABCs of hospital-acquired conditions

Since the 2012 establishment of the Leapfrog Group’s Hospital Safety Grade health care rating system, patient safety has improved across the country, including a 21 percent reduction in hospital-acquired conditions (HACs). However, significant patient safety problems persist. For example, over 1000 people are estimated to die each day from preventable errors—the third leading cause of death in the country.


The Leapfrog Hospital Safety Grade is the only national health care rating focused on errors, accidents, and infections. The program has assigned letter grades—A, B, C, D, F—to general acute-care hospitals in the U.S. since 2012 based upon national performance measures from CMS, the Leapfrog Hospital Survey, the Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), and the American Hospital Association’s Annual Survey and Health Information Technology Supplement.


A significant area of improvement is the 21 percent reduction in HACs between 2010 and 2015. The positive stride is attributable, in part, to Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) provisions designed to reduce HACs (see By any measure, national effort to increase health care safety succeeded, Health Law Daily, December 13, 2016). However, the HAC progress is not without its caveats. Estimates of hospital related patient harms put the number of hospital deaths related to preventable errors at over 400,000 per year.

The Leapfrog Group identified other areas of progress, regarding the reduction of medication errors through increased adoption and functionality of computerized physician order entry systems, as well the development of public and private partnerships to reduce HACs.


Five years into the Leapfrog Hospital Safety Grade scoring, 63 out of over 2,600 hospitals have achieved an “A” in every national scoring update. In the most recent rating of 2,369 hospitals, 823 earned an “A,” 706 earned a “B,” 933 earned a “C,” 167 earned a “D” and 10 earned an “F”. The five states with the highest percentage of “A” hospitals were Maine, Hawaii, Oregon, Wisconsin and Idaho.

Thousands of lives, billions of dollars saved by Affordable Care Act

The Affordable Care Act’s provisions to reduce hospital-acquired conditions (HACs) saved 87,000 lives and almost $20 billion in health care costs from 2010 to 2014, according to a report from HHS’ Agency for Healthcare Research and Quality (AHRQ). The report, Saving Lives & Saving Money: Hospital-Acquired Conditions Update, found that the four-year period saw 2.1 million fewer HACs—such as infections associated with catheters, central lines, and surgical sites—or a 17 percent decline. “Patients in America’s hospitals are safer today,” said HHS Secretary Sylvia Burwell.


Thousands of Americans die each year from preventable medical errors. HACs are conditions individuals acquire during the course of treatment for a different condition in a health care setting. Due to the high number of preventable deaths and injuries attributable to HACs, the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) included a number of provisions to reduce such problems. Under Section 3008, Medicare payments will be reduced by 1 percent to hospitals scoring in the top quartile of the national average for HACs. Section 3025 of the ACA also seeks to reduce hospital readmissions, which are associated with HACs, by reducing the base diagnosis-related group (DRG) payment to hospitals based on the ratio of actual to expected readmissions.

To implement the HAC reduction program, HHS created strong, diverse public-private partnerships and sought active engagement by patients and families. These efforts include the federal Partnership for Patients initiative, Hospital Engagement Networks, Quality Improvement Organizations, and many other public and private partners. According to HHS, public and private partners, including hospitals and other health care providers, are collaborating to identify and spread best practices and apply these solutions to reduce HACs and hospital readmissions.


The new AHRQ report shows that the HAC reduction program is accomplishing its goals of encouraging better care, smarter spending, and healthier people. An earlier report for 2010 through 2013 showed 50,000 fewer patients dying in hospitals and $12 billion in health care cost savings. After adding data from 2014, those numbers increased by 37,000 fewer deaths and $8 billion. HHS says that the updated data shows that the ACA’s patient safety improvements are holding steady, while showing an accumulation of impact over time.

To create the report, the AHRQ analyzed the incidence of a number of avoidable HACs compared to 2010 rates, using as a baseline estimates of deaths and excess health care costs that were developed when the Partnership for Patients was launched. CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer Patrick Conway, M.D., said, “These results demonstrate that it’s possible to improve national patient safety performance resulting in millions of people avoiding infections and adverse events.” To assist providers in preventing HACs, the AHRQ produced a variety of tools and resources.