MGB's continuing expansion raises questions about the underlying values of nonprofit hospitals. If you’re a hospital with tax-exempt status, “you could be asking, ‘what are you doing locally for the community?‘ ” Saini told me. “Or, you can figure out where there are paying customers and build a clinic.”
On one hand, MGB simply embodies the market-driven spirit of American health care: “They have to find revenue, and the revenue is fragmented in terms of geography and social class,” said Saini.
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Brigham is among the worst of more than 3,000 US hospitals in providing community benefits like health education and clinics, according to the Lown Institute, a Needham-based health care think tank.
Nonprofit hospitals like the Brigham, with tax-exempt status, should not be trying to “suck up wealth in other countries to subsidize unaffordable health care here,” said Dr. Vikas Saini, Lown’s president.
Brigham’s Evergrande project, he said, “would probably be the most egregious example of what we have been talking about.”
“This is catering to elites, and the elites didn’t show up,” he said.
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A group of Alzheimer’s experts and health advocates called on the Food and Drug Administration to pull Aduhelm off the market and said they were supporting an effort to file a formal petition with the agency to withdraw it.
“The F.D.A.’s decision to approve Aduhelm is indefensible in both scientific and clinical terms,” said a statement signed by 18 scientists, most of them doctors. “This drug should be withdrawn from the market immediately.”
The doctors and scientists who signed the statement also agreed to provide their expertise to support the filing of a citizen petition, a formal process to seek reversal of the F.D.A.’s decision. The petition will be filed by the Right Care Alliance, a coalition of clinicians, patients and community members, which is also circulating a pledge for physicians who promise not to prescribe Aduhelm and for patients and family members who say they will not request it.
Dr. Vikas Saini, chairman of the Right Care Alliance and president of the Lown Institute, a health care think tank, said that while the citizen petition process can take months or years, it can prompt F.D.A. action.
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“The financial realities for hospitals are at odds with other things we might want hospitals to do,” study co-creator Shannon Brownlee said during the release of the Lown Institute Index for Social Responsibility. “The real goal is to start seeing hospitals in a different light.”
Dr. Vikas Saini, the Lown Institute president, said the rankings are not designed for consumers to decide where to schedule their next elective procedure, but rather for informed citizens to think about the public good hospitals ought to provide in exchange for the tax benefits and privileged status they receive in the community.
“We want them to think about these rankings more like: ‘What kind of health care system do we have, and is that the one I want for myself, my community and my country?’” Dr. Saini said. “I don’t think we want a system that has no soul, even if we live forever.”
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When examining 3,641 private nonprofit hospitals for its rankings, Lown looked beyond the usual metrics used to evaluate hospitals. It sought to encourage these organizations to be more responsible and accountable to the communities they serve, said Dr. Vikas Saini, president of Lown Institute.
“The reason our rankings matter is because, as citizens, all of us have a huge stake in how high quality, how affordable and how just our health care system is,” Saini said. “We’re reporting measures that do all of that.”
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In Modern Healthcare, Lisa Gillespie reviews the evidence and incentives that drive some hospitals to overuse spinal fusion procedures.
She cites research from the Lown Institute in collaboration with Australian academics published this year, which shows that spinal fusions for stenosis and other conditions not backed by strong evidence of effectiveness are associated with poor outcomes. Out of seven low-value procedures, inpatient spinal fusions were affiliated the most with hospital-acquired conditions, adverse patient safety indicators and unplanned hospital admissions after outpatient procedures, their review of Medicare claims from 2016 to 2018 found.
“If, on average, this thing doesn’t work, the burden is on you to tell me why for this particular patient, it’s going to work, beyond just a faith-based argument,” said Dr. Vikas Saini, president of the Lown Institute.
“The public expects their doctors to make care decisions, but I will also say the public expects doctors to make their medical decisions on the basis of the best interest of the patient,” Saini said. “It is now going to become more relevant for hospital administrators to do their homework on appropriateness and inappropriateness.”
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Only 75 hospitals achieved an “A” grade across all three categories used to determine social responsibility: equity, value and outcomes. None of the top 20 U.S. News & World Report hospitals made the honor roll, despite scoring well for value and outcomes.
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Only one California hospital ranked among the 10 most socially responsible hospitals in the United States: Tiny Oroville Hospital, which landed at No. 4 this year on the Lown Institute Hospitals Index.
The hospital serves a large number of Medi-Cal beneficiaries and patients with low education levels, according to the report released Tuesday by the Lown Institute, while also excelling at preventing patient errors and re-admissions, keeping mortality rates low and quality clinical outcomes and running an efficient operation.
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The Cleveland Clinic, the second-best hospital in the nation as ranked by U.S. News and World Report, ranks so poorly in equity metrics that it failed to crack the United States' top 500 hospitals when "social responsibility" was taken into account.
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The second annual most socially responsible hospitals rankings are out from the Lown Institute.
The not-for-profit think tank takes into account readmissions and mortality, along with top executive compensation, charity care, community investments, cost efficiency and value of care.
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