Additional guidance issued late last month by the Trump administration added to the confusion. Some consumers may find themselves unexpectedly on the hook for the cost of a test.
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What are the top hospitals in the country doing to excel in all three categories on the Lown Hospitals Index? At a recent event hosted by the Lown Institute, Washington Monthly, and Open Markets Institute, the creators of the Lown Index and leaders of some of the winning hospitals discussed how hospitals can go from good to great.
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Prescription drugs have long provided two bad examples of American exceptionalism. They cost three-to-four times more than anywhere else, and we’re one of only two countries in the world that allows consumer advertising of the drugs.
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A growing number of prominent hospitals are using AI-powered tools to advise patient care. But patients often aren't informed, a STAT examination finds.
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Advocacy groups and Democratic senators have complained that Moncef Slaoui's extensive financial interests in drug companies pose a conflict of interest.
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“This is more for all of us to think about hospitals in a different way and begin to imagine what it could be like if all hospitals really hit those stretch goals across the board, and what kind of a health care system we could have if we did that,” Dr. Vikas Saini said. “We didn’t realize how much of a challenge it would be to find hospitals that do well across these measures. But we did. There are hospitals that do that.”
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“There are plenty of lists for people to look at to decide where to get your knee replaced,” said Lown Senior Vice President Shannon Brownlee. “We wanted a list that policymakers and community leaders could look at and could really start to re-think how we judge hospital performance and what we expect from hospitals.”
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"What our ranking shows is that there are really big differences in hospitals in terms of how inclusive they are, how good a job they are doing of bring in people of color and people of lower incomes in their catchment areas. As you can imagine, it's creating a certain amount of controversy in the hospital world," says Shannon Brownlee
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The United States is the only developed nation unable to balance cost, efficacy and social good in setting prices.
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A new ranking of hospitals in the United States measures not just patient outcomes, but also community policies and if the hospital avoids unnecessary care, among other criteria.
Using these metrics means some of the world-renowned hospitals, like Rochester's Mayo Clinic, Massachusetts General Hospital and Johns Hopkins Hospital, are missing from the top spots on the Lown Institute Hospitals Index.
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JPS was joined in the top 10 by Parkland Health and Hospital System, which ranked ninth in the nation. Washington Monthly’s annual report serves as a counter to the U.S. News and World Report rankings, which ranks hospitals without factoring in cost or service to vulnerable communities. “What Americans should be asking is, why can’t more hospitals be like JPS?” Washington Monthly editors wrote. “Shouldn’t every person in this country have access to a hospital that provides high-quality care, welcomes all comers regardless of wealth and insurance status, and contributes to the larger health of the community?”
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Vikas Saini, MD, president of the Lown Institute, told Medscape Medical News that hospitals have always needed to be essential partners in their communities, but that need has been acutely apparent in the COVID-19 crisis and these rankings provide a more comprehensive means of judging hospitals' value.
"Half the ranking is weighted on traditional things like mortality and readmissions," he said. But the combined look at outcomes, value, and civic leadership shows how "to go from being really good hospitals to being great — and that means great for everybody," he explained.
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While COVID-19 is disproportionally striking people of color, a new ranking system is grading hospitals on their commitment to equity, inclusivity and community health.
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“One important metric that has not been measured before for individual hospitals is how often hospitals deliver unnecessary treatments and tests, explains Brownlee. “A patient who comes to the hospital because they have fainted generally does not need an MRI or CT scan. We found that at many hospitals, patients who fainted were getting an unnecessary head imaging test. Unnecessary services put patients at needless risk of harm, but they also waste money and resources.”
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Americans who had coronavirus symptoms in March and April are getting big hospital bills — because they were not sick enough to get then-scarce COVID tests.
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While most ranking methodologies only include metrics for patient outcomes and satisfaction, the new ranking from Lown factors in hospital's community health investments, pay equity and inclusivity, though outcomes are still most heavily weighted.
What resulted is drastically different rankings than other systems. For example, Rochester, Minn.-based center Mayo Clinic won the No. 1 spot on U.S. News' rankings last year for the fourth year in a row, but Mayo's highest rated facility, in Albert Lea, was ranked 81 in Lown's list.
Lown said the differences were because many hospitals rely on a business model that relies on attracting wealthier patients from outside their immediate community, while doubling down on patient satisfaction by offering high-class amenities, like private rooms, and lucrative specialized procedures.
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“Hospitals are members of their communities, and when we think about them and when we try to understand what their performance is like, we wanted to be able to think about ways we might measure their participation or engagement ... in the community,” said Dr. Vikas Saini, Lown’s president and a cardiologist. “With the (coronavirus) pandemic, I think more than ever the idea that hospitals need to be real partners with their communities has become much clearer to a lot of people.”
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It's the ranking and measuring of particular metrics that the Lown Institute uses to differentiate its rankings from other, similar top hospitals lists. Value of care, civic leadership, and patient outcomes including safety and mortality rates are all factored into an aggregate score, with individual scores broken down by each hospital.
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"What we are showing isn't news — there is a certain amount of inequity in healthcare," said Dr. Vikas Saini, president of the Lown Institute. "But what we have tried to do is paint this picture in a way that allows everyone to see it and all of us to think about how to do things better."
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The University of Colorado Hospital Authority, based in Aurora, ranks among the top 20 U.S. hospitals, according to the Lown Institute Hospitals Index.
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