“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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Two Baltimore hospitals — Johns Hopkins Bayview Medical Center and the University of Maryland Medical Center Midtown Campus — have been ranked among the top 10 most “socially responsible” health centers in the U.S. by health care think tank and consulting organization.
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"We think that hospitals represent really kind of probably the central part, certainly the most visible and the most active part, of all of American healthcare," Lown Institute President Vikas Saini said. "And to get a better healthcare system, hospitals absolutely have to be part of the solution."
Saini noted that the individual hospitals on the honor roll were not particularly well-known names. "That was the goal of our whole exercise was to really begin to shine a spotlight on hospitals that might be doing things in a way that hadn't yet been really discovered or recognized," he said.
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Relatively few top healthcare organizations rank high for health equity and social responsibility, a jarring finding considering medicine’s statements committing to health equity over the past year, the Lown Institute reported in a press release sent to journalists.
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