Four Rhode Island hospitals — Newport, Miriam, South County and Westerly — received top marks in the fall report from Leapfrog Group, a nonprofit that grades hospitals on safety. 

The Washington, D.C.-based Leapfrog assigns hospitals letter grades based on data from the Centers for Medicare & Medicaid Services (CMS) as well as Leapfrog’s own surveys. Rhode Island’s hospitals didn’t perform much differently than they did in spring 2024 (The Miriam and Newport have consistently earned A’s the past two years), with two notable exceptions. Westerly’s A is its first since 2022. Landmark Medical Center in Woonsocket, which has received nine consecutive A grades, dropped to a B.

Kent Hospital and Rhode Island Hospital also received B grades. The embattled Our Lady of Fatima Hospital and Roger Williams Medical Center both earned C grades. 

Rhode Island’s hospitals collectively ranked seventh nationwide.

South County Hospital’s good report card was a boon to Dr. Kevin Charpentier, the vice president and chief medical officer at South County Health, the hospital’s parent company.  

“It’s more than a score — it’s a promise to our community of prioritizing the highest level of patient care,” Charpentier wrote in an email.

The score was also a bit of good news amid an ongoing dispute between the hospital’s administration and its staff. A September letter sent by doctors and nurses to the South County Health’s board of trustees detailed escalating tensions between providers and management, with doctor resignations, service cuts and growing patient backlogs among the signatories’ concerns.       

 Landmark’s B left its CEO Mike Souza disappointed.

“We take quality very seriously and our team has already put plans in place to address the areas needing improvement,” Souza said in an emailed response to Rhode Island Current. “Our community will continue to receive great care and our expectation is that we will return to an ‘A’ grade in the near future.”

Leapfrog aggregates 30 metrics to assess how well hospitals care for patients as well as prevent bad outcomes, like infections and falls. The grades are given to roughly 3,000 hospitals, not including VA hospitals or children’s hospitals. Hospitals that lack enough data for multiple metrics are also excluded.

Lisa P. Tomasso, senior vice president of the Hospital Association of Rhode Island, said via email that the trade group was pleased with the state’s performance. But she added that the grades, while insightful, are “not comprehensive, as they exclude factors like social determinants of health, community-level health challenges, and systemic issues like Medicaid reimbursement rates.”

But grades still hold value. Robert Hackey, a professor of health sciences at Providence College, said that “hospitals that don’t do well tend to poke holes in whatever rating methodology that’s used.”  

“If you look at the hospitals in Rhode Island, for the most part, we’re performing very well,” Hackey said. “Yeah, we obviously have two low performers. It’s Fatima and Roger Williams. And there’s a common thread there. They’re both owned by Prospect and they’re both for-profit institutions, yeah. And they both struggle.”

A representative for CharterCARE Health Partners, the Rhode Island subsidiary for Prospect Medical Holdings, which owns Roger Williams Medical Center and Our Lady of Fatima Hospital, did not respond to requests for comment. Facing growing debt, Prospect has sought to unload many of the hospitals in its portfolio, including the two safety net hospitals in Rhode Island. A proposal to sell Roger Williams and Fatima to a new, nonprofit owner, received conditional approval from state regulators in June, but the status of financing required to complete the transaction is unclear. 

Hackey said it’s a bad sign when hospitals ignore questions on Leapfrog’s survey — something both Fatima and Roger Williams Medical Center did when it came to inquiries about nursing and leadership.   

Meanwhile hospitals owned by the state’s largest health care system — Brown University Health, formerly Lifespan Corporation — all performed well. Rhode Island Hospital, the state’s flagship hospital, received a B grade despite demonstrating below-average prevention rates of blood and urinary tract infections and falls causing broken hips, as well as less-than-stellar marks for hospital leadership and communication about medicines with patients. 

Since 2021, Rhode Island Hospital has received C grades more often than not. The B is evidence that things are improving, said Dr. Dean Roye, senior vice president for medical affairs and chief medical officer at the hospital. The Leapfrog grades “help us pinpoint areas” to work on, Roye said. He added that a reorganization of quality and safety departments across Brown Health’s properties was another factor in Rhode Island Hospital’s improved grade. 

But Hackey is eyeing another Brown property, the A-graded Miriam, for a surgery he has scheduled for December. He explained with a laugh that checking the Leapfrog ratings was one of the first things he did when deciding where to have his surgery.  

“The goal of this is to have a more educated healthcare consumer,” he said.

Above average results

Leapfrog uses the percentage of A grade hospitals in a state to determine a state’s national ranking. Almost 61% of Utah’s hospitals received A grades, giving it the top slot nationwide. The top 10 states all sported at least 40% A grade hospitals.

An A grade indicates hospitals that prioritize safety, said Alex Campione, program analyst for the Leapfrog Group, who noted that about 32% of hospitals nationwide achieved this grade. Rhode Island was over the national average with 44% of its hospitals receiving an A grade.  

“Each year more than 250,000 people will die in hospitals due to preventable errors, injuries, accidents, and infections,” Campione said. “We estimate that, at the very least, 50,000 of those lives could be saved if all hospitals performed like A hospitals.”

Rhode Island placed fourth nationwide in Leapfrog’s spring 2024 scores, also with 44% at an A grade, but it was pushed out of the top five this time around by three states that rose with higher grades: California, North Carolina and Connecticut. Connecticut was the only other New England state to crack the top 10. Vermont fared worst of all, and was ranked 48th nationwide, tying for last place with North Dakota, South Dakota and Iowa. There was not a single A grade hospital in any of these states.

Grading the graders

But a bad report card might not be the final word on a hospital’s quality. A 2019 article in New England Journal of Medicine Catalyst graded the graders, and gave Leapfrog a C-, the second lowest of the four systems reviewed. The study noted that Leapfrog had a detailed framework for measurement, with a unique focus on the hospitals’ “culture of safety.” But it also relied on its proprietary survey for a good chunk of its data — a problem, the authors thought, since Leapfrog grades hospitals the same regardless of whether they complete the survey.

Dr. Karl Bilimoria of the Indiana University School of Medicine, who chairs the school’s surgery department and leads its Surgical Outcomes and Quality Improvement Center, led the 2019 study. He wrote in an email Tuesday to Rhode Island Current that Leapfrog’s efforts still leave something to be desired.

“Leapfrog has many issues with their methodology and their general approach that persist and they have been the least receptive to improvement suggestions and the least adaptive to changes in the science of quality measurement,” Bilimoria wrote. 

Asked about Bilimoria’s idea that Leapfrog is not responsive to suggestions, spokesperson Lula Hailesilassie said by email that the public is regularly invited to submit feedback on proposed changes to its surveys. Comments on the 2025 survey are open through Dec. 13, 2024.