The Leapfrog Hospital Safety Grade assigns letter grades to hospitals based on their record of patient safety. Saint Anthony Hospital in Chicago was so upset that its patient safety grade was going to drop from an A to a C that it sued the ratings group for defamation, alleging that Leapfrog used inaccurate information when lowering the hospital's score.

Saint Anthony confronted Leapfrog when it learned of the impending C grade in the fall ratings. Leapfrog said the hospital lost points because it only electronically prescribed medications between 50% and 74% of the time. Saint Anthony disagreed, alleging that it uses electronic prescribing at least 95% of the time and that it provided corroborating data to Leapfrog. (Electronic prescribing accounts for about 14% of a hospital's final rating, according to the complaint.)

The hospital says the drop in grade would damage its reputation. "Saint Anthony competes with other hospitals in the immediate area, including one down the street," says the complaint. "One of the most important ways Saint Anthony recently has been able to distinguish itself is the high safety grades it receives from Leapfrog."

Leapfrog issues more than 1,800 hospitals spring and fall grades on 27 measures of hospital safety, including hand hygiene, bedsores and falls.

"The safety grade does get a lot of attention in local communities," says Erica Mobley, Leapfrog's director of operations. "What's making an impact is local and regional publications writing about hospitals in their communities. When they publish these articles, people are looking."

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Henry Ford Wyandotte (Mich.) Hospital spent $250,000 to improve its lobby in January 2016 with the hopes of improving its patient experience. The hospital was shocked when it received a 68 on its next OAS CAHPS score from Press Ganey. Patients gave the hospital lower scores in 2 areas: discharge instructions and the facility experience, including how the facility cared for patients' families.

DISCHARGE Patients will be sure to tell surveyors how well you prepared them for discharge.

In the lobby, the hospital noticed that relatives waiting for patients to come out of surgery wanted to plug in their phones, get something to eat and have access to Wi-Fi. So the hospital installed a phone charging bank and started handing out pamphlets with all the information family members might need while they wait, including the Wi-Fi password and locations of all the bathrooms and cafeterias. The charging bank cost the hospital $600, and the paper for the pamphlets only cost them $250.

"For less than $850, I have them centered for success the moment they come in," says Tiffany Tscherne, RN, MSN, CNL, CSSM, TCRN, director of surgical services at Henry Ford Wyandotte.

The hospital also changed the way it gave discharge instructions to patients and their families by giving them bedside during pre-op, before medications were administered.

Within 11 months, the hospital's Press Ganey score rose from a 68 to a 94. Plus, within the first 2 months of receiving that 68 score, they moved from an 80 to a 93.3 on communication, and from a 77 to a 90 on discharge instructions.

Ms. Tscherne's advice? "Manage your message," she says. "From the moment a surgery is booked, manage the message about the process," she says. "That will set a high expectation for once patients arrive at the facility."

How will you be affected?
There are several types of surveys and evaluators. One of the biggest is a series of patient surveys called CAHPS — HCAHPS for hospitals and OAS CAHPS for ASCs and HOPDs — that CMS oversees.

In both ASCs and hospitals, the CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey process works similarly: Facilities choose a CMS-approved vendor and then send their list of patients for the month to that vendor each month. The vendor randomly chooses patients that they'll contact with CMS-certified questions about their stay at the facility. Those can include anything from the quality of communication with their doctors and nurses to the cleanliness of the hospital or center, says Sandy Baker, senior director of business for Research and Marketing Strategies (RMS), a CMS-certified vendor. Hospitals have the option to administer the surveys themselves, but ASCs do not. CMS is looking for hospitals and surgery centers to have completed surveys from 300 patients a year — or 25 a month.

It's not yet mandatory for outpatient facilities to participate in CAHPS. That's expected to happen in 2019, says Ken Fields of Fields Research, a CMS-approved CAHPS vendor.

CMS calculates a score and then posts it on hospital compare or outpatient compare websites for patients' reference. If a facility doesn't participate, Medicare will withhold 2% of its reimbursement.

Facilities can also face scrutiny from such non-governmental organizations as Leapfrog. With private companies, you don't face any monetary penalties for not participating, but the results of the survey are still made public. And although a poor grade from Leapfrog doesn't have the power to force you to close down your facility, a low rating from the company can still prove detrimental.

How to do well
The best way to prepare for a CAHPS survey is to familiarize yourself with the questions, says Ms. Baker. In an outpatient survey, for example, there are 37 questions that patients will consider when evaluating your facility, including their preparation for the procedure, the check-in and pre-op processes, and how well they're prepared for at-home recovery.

The survey can be found on the outpatient CAHPS website (osmag.net/eXU5bJ) or on the hospital CAHPS website (osmag.net/PngJ2S). "Know what the language is, and use that language," says Ms. Baker. For example, if nurses use "pills" when describing post-op pain management drugs to patients, but surveyors ask patients if their nurses explained "pain medication" to them, patients could say, "No," because the nurses didn't specifically use the words "pain medication." It seems insignificant, but that subtle disparity in language could result in docked points for your center, says Mr. Fields.

For facilities that have not already started being evaluated by CAHPS — mostly ASCs and HOPDs — start preparing now because the program is expected to become mandatory in about a year, say Ms. Baker and Mr. Fields.

"They want you to ace the test," says Mr. Fields of the CMS surveys and his suggestion that ASCs start familiarizing themselves with the survey now, which about 1,400 HOPDs and 1,000 ASCs are already doing.

Mr. Fields has another tip for facilities looking to score well: "Make sure your survey is conducted only via phone," he says. "It stands to reason that people who are upset will fill out the mail survey at a higher rate than those who are content."

Doing poorly in a single area isn't enough to drop your Leapfrog grade from a 'D' to an 'F,' says Ms. Mobley. "That's the benefit of being able to look at a wide variety of errors," she explains. "Even 'A' hospitals make mistakes."

FAMILY AFFAIR It's important to make the patient's family's experience positive.

If you get a poor score
In the direct aftermath of receiving a poor score, make sure you come out to the public to address the score and your facility's intentions and plans to improve it. "Set into place an improvement plan," says Ms. Mobley. "Prove to stakeholders that you intend to be a safe place to get care. We've seen hospitals hold press conferences to respond to bad grades and say, 'Here's what we want to do.'"

Once you set that improvement plan, start putting it into action. In Ms. Tscherne's case, it came down to evaluating the patient experience and making simple adjustments to make things easier for both the patients and their families. They evaluated everything they were doing down to the documents they were giving out to patients for discharge instructions. "There's an evidence-based article that if you highlight 3 things on a document, you increase engagement," she says. "So we highlight at least 3 things on our papers."

Another way to raise your scores is by closely examining any bad results.

"It's very easy to look at the data and see areas they're scoring poorly and areas that carry the most weight and get the biggest bang for their buck in terms of improvement," says Ms. Mobley.

While you're at it, look at other facilities' scores as well. All OAS CAHPS scores will be posted to compare starting with the voluntary OAS CAHPS scores in 2018, says Courtney Jenkins, a spokesperson for CMS. The HCAHPS scores are already available on the "hospital compare" section of the Medicare website (medicare.gov/hospitalcompare).

"If you have a declining area, compare your score with other facilities to see if the problem is common," says Mr. Fields.

Many facilities do well with patient care management, attentiveness to patient comfort, and preparing patients for what to expect during recovery, say Mark Dengler, president of RMS and Susan Maxween, senior director of RMS. However, they often fall short when thoroughly explaining to patients what they should do in cases of bleeding, nausea or infection, and in fully explaining the side effects of anesthesia, say Mr. Dengler and Ms. Maxween.

They suggest correcting this by focusing on better communication with patients about what they can expect post-op and following up with patients in the 24 to 48 hours following their procedures by providing more printed and online materials. OSM