America’s “best” hospitals still underperform on equity

The 2022-23 ranking of “America’s Best Hospitals” from US News & World Report was just published, showcasing the 20 hospitals with the best outcomes across 15 specialties. This year, the US News ranking also incorporates overuse metrics on spinal fusion/laminectomy, carotid endarterectomy, and knee arthroscopy from the Lown Institute.

We usually see a lot of prestigious hospitals at the top of the US News rankings that take pride in their quality of care and high-tech capabilities. But how do these top-ranked hospitals do on the Lown Hospitals Index for Social Responsibility? Here are our key takeaways.

Equity is the missing piece

Most of the US News honor roll hospitals perform moderately well on outcomes and value, with all receiving either A or B grades. However they don’t do as well as one might expect given their prestige; only one hospital ranked in the top 100 for outcomes (Mayo Clinic Rochester) and four in the top 100 for value.

None of these hospitals rank in the top 100 for the overall Social Responsibility metric, mostly because of their poor rankings on equity. Only three hospitals received equity grades higher than a C, and all but four hospitals ranked in the bottom third of all hospitals on equity. (See Table 1 for rankings and Table 2 for grades.)

Table 1: US News Honor Roll rankings on Lown Index

US News rankingHospitalCity, StateSocial responsibility (n=3606)Outcomes (n=3606)Value (n=3606)Equity (n=3764)
1Mayo Clinic Hospital RochesterRochester, MN409262519
2Cedars-Sinai Medical CenterLos Angeles, CA249415644443661
3NYU Langone HospitalsNew York, NY8331945163384
4Cleveland ClinicCleveland, OH562665482895
5 (tie)Johns Hopkins HospitalBaltimore, MD97119332031591
5 (tie)Ronald Reagan UCLA Medical CenterLos Angeles, CA8326252473362
7New York-Presbyterian HospitalNew York, NY8199952073381
8Massachusetts General HospitalBoston, MA6397311252890
9Northwestern Memorial HospitalChicago, IL14089671883657
10Stanford Health CareStanford, CA12934631843626
11Barnes Jewish HospitalSt. Louis1615262411292144
12UCSF Medical CenterSan Francisco, CA2067121231694
13Hospitals of University of PennsylvaniaPhiladelphia, PA6256452303165
14Brigham & Women’s HospitalBoston, MA222511371873603
15Houston Methodist HospitalHouston, TX215712313503724
16Mount Sinai HospitalNew York, NY5527972452925
17Michigan MedicineAnn Arbor, MI615569953418
18Mayo Clinic Hospital Phoenix, AZ1292454803727
19Vanderbilt University Medical CenterNashville, TN6646279643198
20Rush University Medical CenterChicago, IL1152272421577

Table 2: US News Honor Roll hospital grades on Lown Index

US News rankingHospitalCity, StateSocial responsibilityOutcomesValueEquity
1Mayo Clinic Hospital RochesterRochester, MNAAAC
2Cedars-Sinai Medical CenterLos Angeles, CABBAD
3NYU Langone HospitalsNew York, NYAAAC
4Cleveland ClinicCleveland, OHAAAC
5 (tie)Johns Hopkins HospitalBaltimore, MDABAB
5 (tie)Ronald Reagan UCLA Medical CenterLos Angeles, CAAAAC
7New York-Presbyterian HospitalNew York, NYAAAC
8Massachusetts General HospitalBoston, MAAAAC
9Northwestern Memorial HospitalChicago, ILBAAD
10Stanford Health CareStanford, CAAAAD
11Barnes-Jewish HospitalSt. Louis, MOBBAC
12UCSF Medical CenterSan Francisco, CAAAAB
13Hospitals of University of PennsylvaniaPhiladelphia, PAAAAC
14Brigham & Women’s HospitalBoston, MABBAD
15Houston Methodist HospitalHouston, TXBABD
16Mount Sinai HospitalNew York, NYAAAC
17Michigan MedicineAnn Arbor, MIAAAC
18Mayo Clinic Hospital Phoenix, AZBAAD
19Vanderbilt University Medical CenterNashville, TNAAAC
20Rush University Medical CenterChicago, ILAAAB

Academic medical centers

Compared to other academic medical centers, the pattern holds; the US News top hospitals perform well on outcomes and value, but poorly on equity. Ten hospitals rank within the top 50 on outcomes and three within the top 10, among all academic medical centers. But on equity, only four (Johns Hopkins, UCSF, Barnes, Rush) rank in the top half of academic medical centers

Table 3: US News Honor Roll rankings on Lown Index, academic medical centers (n=211)

US News rankingHospitalCity, StateOutcomesValueEquity
1Mayo Clinic Hospital RochesterRochester, MN23130
2Cedars-Sinai Medical CenterLos Angeles, CA9970208
3NYU Langone HospitalsNew York, NY1077192
4Cleveland ClinicCleveland, OH4615148
5 (tie)Johns Hopkins HospitalBaltimore, MD1414175
5 (tie)Ronald Reagan UCLA Medical CenterLos Angeles, CA3651186
7New York-Presbyterian HospitalNew York, NY7343190
8Massachusetts General HospitalBoston, MA5730147
9Northwestern Memorial HospitalChicago, IL7139206
10Stanford Healthcare*Stanford, CAn/an/an/a
11Barnes-Jewish HospitalSt. Louis, MO16515698
12UCSF Medical CenterSan Francisco, CA532987
13Hospitals of University of PennsylvaniaPhiladelphia, PA4445169
14Brigham & Women’s HospitalBoston, MA9538197
15Houston Methodist HospitalHouston, TX4173210
16Mount Sinai HospitalNew York, NY6250149
17Michigan MedicineAnn Arbor, MI3224193
18Mayo Clinic Hospital Phoenix, AZ2420211
19Vanderbilt University Medical CenterNashville, TN38116173
20Rush University Medical CenterChicago, IL134973
*Stanford Healthcare is not categorized as an AMC

Behind the equity metrics

Where do these elite hospitals need to improve most on equity? There is a lot of room for improvement on pay equity in particular. On average, CEOs at the US News hospitals get paid $3.6 million, 25 times more than hospital workers without advanced degrees. The average pay for academic medical centers in the Lown Index is $2.1 million, 18 times what other hospital workers are paid.

The US News best hospitals also fall behind on charity care spending. Except for Barnes Jewish Hospital, all of these hospitals spend less than the average AMC on charity care, as a share of expenses. And all but two (Barnes and Houston Methodist) have a “fair share deficit,” meaning they spend less on charity care and community investment than the estimated value of their tax break.

Table 4: US News Honor Roll hospitals, equity metrics

US News rankingHospitalCity, StateAdjusted CEO payPay equity ratioCharity care, share of total expensesFair share spending
1Mayo Clinic Hospital RochesterRochester, MN$1.3 M12:11.2%-$106 M*
2Cedars-Sinai Medical CenterLos Angeles, CA$6.4 M25:10.8%-$130 M
3NYU Langone HospitalsNew York, NY$6.0 M32:11.2%-$177 M
4Cleveland ClinicCleveland, OH$3.3 M 34:10.7%-$257 M*
5 (tie)The Johns Hopkins HospitalBaltimore, MD$1.9 M15:11.2%-$57 M
5 (tie)Ronald Reagan UCLA Medical CenterLos Angeles, CA$1.7 M12:10.4%n/a^
7New York-Presbyterian HospitalNew York, NY$12.4 M69:10.7%-$244 M
8Massachusetts General HospitalBoston, MA$4.1 M28:10.6%-$270 M*
9 Northwestern Memorial HospitalChicago, IL$5.1 M46:12.2%-$166 M*
10Stanford HealthcareStanford, CA$3.2 M17:10.4%-$143 M
11Barnes Jewish HospitalSt Louis, MO$2.9 M30:14.0%$10 M*
12UCSF Medical CenterSan Francisco, CA$2.3 M14:10.7%n/a^
13Hospital of University of PennsylvaniaPhiladelphia, PA$2.2 M12:10.8%-$408 M
14Brigham & Women’s HospitalBoston, MA$3.7 M25:10.3%-$204 M*
15Houston Methodist HospitalHouston, TX$3.3 M30:12.3%$6 M
16Mount Sinai HospitalNew York, NY$4.5 M23:10.9%-$46 M
17Michigan MedicineAnn Arbor, MI$509 K5:10.9%n/a^
18Mayo Clinic Hospital Phoenix, AZ$1.6 M19:10.5%-$65 M*
19Vanderbilt University Medical CenterNashville, TN$5.1 M46:12.1%-$159 M*
20Rush University Medical CenterChicago, IL$2.3 M18:11.2%-$7 M
Hospital CEO is also system CEO. *Community benefit spending reported at system level and prorated to create a hospital-level estimate of spending. ^ Hospital classified as public, does not file IRS form 990.