Ballad CEO: No single data point can accurately measure hospital care

JOHNSON CITY — Letter grades issued to Ballad Health hospitals during a recent national survey do not accurately reflect quality of care, according to the healthcare system's president and CEO.The Leapfrog Hospital Survey Fall 2023 Report gave Johnson City Medical Center a letter grade of D. The same survey gave other Ballad hospitals a letter grade of C. The survey came out this month."The Leapfrog score is not a good indicator," said Alan Levine, Ballad's president and CEO. "I tell people that if you have a heart problem, look at a hospital that has the best cardiac care. That gives you more relevant information for yourself."An independent nonprofit, the Leapfrog Group distributes the grades of more than 2,000 hospitals as a public service, with the majority of determining data pulled from the Centers for Medicare and Medicaid Services.In contrast to the Leapfrog rating, Johnson City Medical Center placed in the top 10% of hospitals in the nation for patient safety in overall medical care. An acquisition of Healthcare Bluebook, the quality analytics software Quantros made that distinction about JCMC in its 2023 CareChex® Awards.Additionally, JCMC received similar honors for patient safety in trauma care, medical excellence in hip fracture care and for patient safety in both heart failure treatment and stroke care. For each of these clinical categories, the JCMC ranked in the top 10% of hospitals throughout the United States in Quantros' awards.With two conflicting reports surrounding one facility, which one should you trust?For Ballad's Levine, the nuanced nature of healthcare means there is no singular data point that can properly answer that question.Since the Leapfrog Health Survey is voluntary, many hospitals, including Ballad, choose not to participate. If a hospital does not participate, Leapfrog defaults to Medicare Fee-for-Service Data from the Centers for Medicare and Medicaid Services to calculate a grade.Currently, Ballad has one of the highest penetrations for Medicare Advantage in the United States. Of the 55% of patients on Medicare, 20% are in the Medicare FFS program, which is where a healthcare provider is paid separately for each service they perform."The Medicare Advantage population tends to be healthier," Levine said. "People who tend to be admitted to the hospital more tend to stay in the Medicare FFS program. So, Leapfrog is using a small sliver of our population that is the sickest and comparing us to everyone else."The following Ballad locations received a C from Leapfrog:• Bristol Regional Medical Center• Indian Path Community Hospital in Kingsport• Holston Valley Medical Center in Kingsport• Sycamore Shoals Hospital in Elizabethton• Johnston Memorial Hospital in Abingdon• Lonesome Pine Hospital in Big Stone Gap, Va.JCMC and otherBallad hospitals ranked better in reports from other agencies.U.S. News' annual "Best Hospital Study" named Holston Valley Medical Center as the ninth-ranked hospital in the state of Tennessee.U.S. News recognizedBristol Regional, Holston Valley and JCMC for their "high-performing" care for stroke patients."Leapfrog was actually given one of the lowest ratings by the raters," Levine said, referring to an article from the New England Journal of Medicine. "U.S. News received the highest."Something else to be considered when navigating Leapfrog's survey is the structure of Ballad's 21-hospital system, Levine said.As a Level 1 trauma center, JCMC receives cases of a different caliber than those at Franklin Woods Community Hospital in Johnson City, which received a B grade from Leapfrog."We send all of the sickest patients to JCMC and Holston Valley," Levine said. "You can look at our other hospitals whose grades are better, but that's because they're sending the sickest patients to JCMC. JCMC has the burden of taking care of the sickest patients and, since we don't submit the data, they're taking only the Medicare FFS Data — which is the sickest of the elderly patients — and using that to give us a grade."With these logistics, Levin said he does not consider Leapfrog's hospital survey to be as valid a report as U.S. News or, perhaps even more importantly, Blue Cross Blue Shield.Providing coverage to over 115 million people, BCBS reports remain positive toward Ballad. Four hospitals in Tennessee have been named Blue Centers of Distinction for quality and cost in cardiology by BCBS.Two are Ballad hospitals: Holston Valley Medical Center and Bristol Regional Medical Center.Other Ballad hospitals have received distinctions from BCBS for maternity care, hip/knee replacement surgery and overall quality as well."They are our largest commercial payer," Levine said. "They participate in Medicare Advantage, they're commercial and they're also in Medicaid. So, they have all the data, you can't fool them."Levine said he hopes people in the region navigate the reports for themselves to determine what is most appropriate to their needs."Take it with a grain of salt," Levine said. "Never ever consider a single data point that tries to broadly grade a hospital. You can't look at just a simplified score and draw a valid conclusion about a hospital, particularly when you have all the other rating agencies agreeing, and Leapfrog is the outlier."For future reports, Ballad is not opposed to submitting its data for Leapfrog's Health Grade Survey."We don't submit our data, we never have," Levine said. "Maybe in the future we can because we don't want people to be confused."