This spring’s Leapfrog ratings came with a caveat

Hospital safety watchdog the Leapfrog Group left 450 hospitals ungraded on May 6 in its most recent round of biannual hospital safety grades.

These hospitals escaped judgement because they didn’t participate in Leapfrog’s 2024 or 2025 hospital surveys, which it uses alongside federal data to dole out “A” through “F” grades for patient safety on up to 32 measures, such as handwashing or rates of dangerous objects left in patients’ bodies.

In past years, Leapfrog would still estimate grades for nonparticipating hospitals using outside data or, when outside data didn’t exist, using mean scores from similar hospitals.

In fall 2024, it switched to a method that assigned a score for missing measures based on the lowest score of a participating hospital. In April 2025, five South Florida hospitals owned by multinational health services chain Tenet Healthcare Corporation sued over the change. A judge ruled March 6 that Leapfrog’s methodology “unfairly penaliz[ed]” nonparticipating hospitals like those five with low scores. Leapfrog appealed the ruling and is working on a new methodology, CEO Leah Binder told us, but for now it has left the grades out.

This is a big deal because Leapfrog is one of just a few public sources of information on hospital safety, Martin Nowak, president of Alabama-based hospital, health, and business consulting firm Nowak and Associates, told Healthcare Brew. He thinks this change in methodology could inspire more hospitals not to participate.

“Here’s the real question: Can Leapfrog survive the pushback from hospitals?” he said. “If more hospitals just drop out from self reporting, they don’t get a bad score, and then they can also use their local pulpit…to tell their patients, ‘Don’t worry about [Leapfrog ratings].’”

No change yet. Binder told us the nonprofit is seeing “strong” participation so far in its 2026 survey, which opened April 1 and closes June 30. The group also grades ambulatory surgical centers and has seen a “significant increase” in participation from those facilities.

“We have always worried that hospitals that are performing poorly might choose not to voluntarily report…To the credit of the hospital industry, I think they hold themselves to a high level of transparency and accountability,” Binder said.

Leapfrog also saw an improvement in patient safety grades this year, which Binder said “was not impacted by the removal of hospitals not assigned a letter grade.”

Everybody’s a critic. As they do every year, many hospitals proudly displayed their “A” report cards on their parents’ fridge on their websites.

The grades affect more than just bragging rights, too. Patients care about what Leapfrog has to say.

In the Tenet lawsuit, Florida’s Delray Medical Center CEO Heather Havericak and West Boca Medical Center CEO Jerad Hanlon both testified that a patient had specifically brought up the hospital’s poor safety grade when refusing care. Both got “F’s” in fall 2024.

Hospitals and some researchers have criticized these ranking systems and their methodologies in the past. Leapfrog was sued by other hospitals in 2018 and 2019 but was not ordered to take down any scores, per a May 2025 statement from the company.

Another ranking body, US News & World Report, also faced backlash in 2023 when several hospitals decided not to participate in its annual “best hospitals” list, citing perceived issues with its methodology.

A July 2024 study compared Leapfrog to other ranking systems Healthgrades, Hospital Compare, and US News & World Report and found the ratings significantly differed largely due to methodological reasons that “may create significant confusion for patients and consumers.”