When it’s Raining Down Changes, Be Aware of Your Surroundings

Let’s start today with a report that five Florida hospitals are suing Leapfrog Group over their receiving poor ratings. The hospitals, all part of Tenet, claim that because they would not elect to report safety measures to Leapfrog voluntarily, they were given lower patient safety scores, damaging their reputation.

As I have discussed before, Leapfrog makes its money by charging hospitals to advertise their ratings and the lawsuit reports that such payments also allow some hospitals to participate in Leapfrog’s advisory board and to sponsor Leapfrog’s awards ceremonies. Of course, Leapfrog claims that these hospital’s poor ratings were calculated based on publicly reported measures from Medicare and are accurate.

So I took a look at one of the hospital’s ratings. Leapfrog gave that hospital a grade of F. But that same hospital received Healthgrades awards for being in the top 5 percent of all hospitals for patient safety along with awards for pulmonary care, stroke care and critical care. Sure does not sound like a failing hospital. Now I am sure the lawsuit will sort everything out as lawsuits always do. I will update everyone if we hear any more.

Moving on to another topic I have discussed before— there are continued efforts by ambulatory surgery centers (ASCs) to get site neutral payments, meaning they want to get paid the same for doing a surgery as does a hospital.

And a paper published in the very exciting medical journal Arthroplasty Today , a group of researchers at the University of Rochester Medical Center, provides data that supports the contention by hospitals that hospitals actually deserve a higher payment. In this study, the researchers compared patient characteristics having total joint replacement in New York and the numbers are startling.

It should come as no surprise that compared to hospitals, ASCs had significantly fewer patients whose insurance paid less.

For example, hospital patients were about 35 percent private insurance, 50 percent Medicare, 7 percent Medicaid, and 6 percent workers compensation.

ASCs had almost 70 percent of patients with private insurance, 27 percent Medicare, 4 percent workers compensation and less than 1 percent Medicaid. There is also a significant difference in the comorbidity scores with 93 percent of patients having surgery at an ASC experiencing no comorbidities whereas more than 50 percent of patients having surgery at hospitals having at least one significant comorbidity.

Now once again I want to stress that I expect any of you not to do anything with this information but be informed in case this comes up in conversations with surgeons. And if it does come up, my best advice is to just be a good listener.

Finally, I think every Monitor Monday listener knows the significant influence of the social determinants of health in everything we do and everything that is measured, from length of stay to readmissions to total cost of care. And there has been much more attention given to them by regulators and payer.

But it appears that things are changing. In the 2026 Inpatient Prospective Payment System (IPPS) Proposed Rule, the Centers for Medicare & Medicaid Services (CMS) proposes to eliminate the collection of social determinant and health equity data from the new TEAM bundled payment program.

In addition, CMS announced that effective immediately it is eliminating all physician practice improvement activities from the Merit-Based Incentive Payment System (MIPS) that are related to racism, health equity, and social determinants.

Not measuring these social determinants and health inequity will not make them go away and it won’t be long before access to quality healthcare for all patients is adversely affected when hospitals and physicians who care for patients facing such issues can no longer make ends meet and close down.