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 ranking	Hospital	City, State	Social responsibility (n=3606)	Outcomes (n=3606)	Value (n=3606)	Equity (n=3764)
1	Mayo Clinic Hospital Rochester	Rochester, MN	409	2	6	2519
2	Cedars-Sinai Medical Center	Los Angeles, CA	2494	1564	444	3661
3	NYU Langone Hospitals	New York, NY	833	194	516	3384
4	Cleveland Clinic	Cleveland, OH	562	665	48	2895
5 (tie)	Johns Hopkins Hospital	Baltimore, MD	971	1933	203	1591
5 (tie)	Ronald Reagan UCLA Medical Center	Los Angeles, CA	832	625	247	3362
7	New York-Presbyterian Hospital	New York, NY	819	995	207	3381
8	Massachusetts General Hospital	Boston, MA	639	731	125	2890
9	Northwestern Memorial Hospital	Chicago, IL	1408	967	188	3657
10	Stanford Health Care	Stanford, CA	1293	463	184	3626
11	Barnes Jewish Hospital	St. Louis	1615	2624	1129	2144
12	UCSF Medical Center	San Francisco, CA	206	712	123	1694
13	Hospitals of University of Pennsylvania	Philadelphia, PA	625	645	230	3165
14	Brigham & Women’s Hospital	Boston, MA	2225	1137	187	3603
15	Houston Methodist Hospital	Houston, TX	2157	123	1350	3724
16	Mount Sinai Hospital	New York, NY	552	797	245	2925
17	Michigan Medicine	Ann Arbor, MI	615	569	95	3418
18	Mayo Clinic Hospital	Phoenix, AZ	1292	454	80	3727
19	Vanderbilt University Medical Center	Nashville, TN	664	627	964	3198
20	Rush University Medical Center	Chicago, IL	115	227	242	1577

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

US News ranking	Hospital	City, State	Social responsibility	Outcomes	Value	Equity
1	Mayo Clinic Hospital Rochester	Rochester, MN	A	A	A	C
2	Cedars-Sinai Medical Center	Los Angeles, CA	B	B	A	D
3	NYU Langone Hospitals	New York, NY	A	A	A	C
4	Cleveland Clinic	Cleveland, OH	A	A	A	C
5 (tie)	Johns Hopkins Hospital	Baltimore, MD	A	B	A	B
5 (tie)	Ronald Reagan UCLA Medical Center	Los Angeles, CA	A	A	A	C
7	New York-Presbyterian Hospital	New York, NY	A	A	A	C
8	Massachusetts General Hospital	Boston, MA	A	A	A	C
9	Northwestern Memorial Hospital	Chicago, IL	B	A	A	D
10	Stanford Health Care	Stanford, CA	A	A	A	D
11	Barnes-Jewish Hospital	St. Louis, MO	B	B	A	C
12	UCSF Medical Center	San Francisco, CA	A	A	A	B
13	Hospitals of University of Pennsylvania	Philadelphia, PA	A	A	A	C
14	Brigham & Women’s Hospital	Boston, MA	B	B	A	D
15	Houston Methodist Hospital	Houston, TX	B	A	B	D
16	Mount Sinai Hospital	New York, NY	A	A	A	C
17	Michigan Medicine	Ann Arbor, MI	A	A	A	C
18	Mayo Clinic Hospital	Phoenix, AZ	B	A	A	D
19	Vanderbilt University Medical Center	Nashville, TN	A	A	A	C
20	Rush University Medical Center	Chicago, IL	A	A	A	B

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 ranking	Hospital	City, State	Outcomes	Value	Equity
1	Mayo Clinic Hospital Rochester	Rochester, MN	2	3	130
2	Cedars-Sinai Medical Center	Los Angeles, CA	99	70	208
3	NYU Langone Hospitals	New York, NY	10	77	192
4	Cleveland Clinic	Cleveland, OH	46	15	148
5 (tie)	Johns Hopkins Hospital	Baltimore, MD	141	41	75
5 (tie)	Ronald Reagan UCLA Medical Center	Los Angeles, CA	36	51	186
7	New York-Presbyterian Hospital	New York, NY	73	43	190
8	Massachusetts General Hospital	Boston, MA	57	30	147
9	Northwestern Memorial Hospital	Chicago, IL	71	39	206
10	Stanford Healthcare*	Stanford, CA	n/a	n/a	n/a
11	Barnes-Jewish Hospital	St. Louis, MO	165	156	98
12	UCSF Medical Center	San Francisco, CA	53	29	87
13	Hospitals of University of Pennsylvania	Philadelphia, PA	44	45	169
14	Brigham & Women’s Hospital	Boston, MA	95	38	197
15	Houston Methodist Hospital	Houston, TX	4	173	210
16	Mount Sinai Hospital	New York, NY	62	50	149
17	Michigan Medicine	Ann Arbor, MI	32	24	193
18	Mayo Clinic Hospital	Phoenix, AZ	24	20	211
19	Vanderbilt University Medical Center	Nashville, TN	38	116	173
20	Rush University Medical Center	Chicago, IL	13	49	73

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 ranking	Hospital	City, State	Adjusted CEO pay	Pay equity ratio	Charity care, share of total expenses	Fair share spending
1	Mayo Clinic Hospital Rochester	Rochester, MN	$1.3 M	12:1	1.2%	-$106 M*
2	Cedars-Sinai Medical Center	Los Angeles, CA	$6.4 M†	25:1	0.8%	-$130 M
3	NYU Langone Hospitals	New York, NY	$6.0 M	32:1	1.2%	-$177 M
4	Cleveland Clinic	Cleveland, OH	$3.3 M †	34:1	0.7%	-$257 M*
5 (tie)	The Johns Hopkins Hospital	Baltimore, MD	$1.9 M	15:1	1.2%	-$57 M
5 (tie)	Ronald Reagan UCLA Medical Center	Los Angeles, CA	$1.7 M	12:1	0.4%	n/a^
7	New York-Presbyterian Hospital	New York, NY	$12.4 M†	69:1	0.7%	-$244 M
8	Massachusetts General Hospital	Boston, MA	$4.1 M	28:1	0.6%	-$270 M*
9	Northwestern Memorial Hospital	Chicago, IL	$5.1 M	46:1	2.2%	-$166 M*
10	Stanford Healthcare	Stanford, CA	$3.2 M†	17:1	0.4%	-$143 M
11	Barnes Jewish Hospital	St Louis, MO	$2.9 M	30:1	4.0%	$10 M*
12	UCSF Medical Center	San Francisco, CA	$2.3 M	14:1	0.7%	n/a^
13	Hospital of University of Pennsylvania	Philadelphia, PA	$2.2 M	12:1	0.8%	-$408 M
14	Brigham & Women’s Hospital	Boston, MA	$3.7 M	25:1	0.3%	-$204 M*
15	Houston Methodist Hospital	Houston, TX	$3.3 M	30:1	2.3%	$6 M
16	Mount Sinai Hospital	New York, NY	$4.5 M	23:1	0.9%	-$46 M
17	Michigan Medicine	Ann Arbor, MI	$509 K	5:1	0.9%	n/a^
18	Mayo Clinic Hospital	Phoenix, AZ	$1.6 M	19:1	0.5%	-$65 M*
19	Vanderbilt University Medical Center	Nashville, TN	$5.1 M	46:1	2.1%	-$159 M*
20	Rush University Medical Center	Chicago, IL	$2.3 M	18:1	1.2%	-$7 M