New index assesses outcomes, value, and civic leadership of U.S. hospitals.
Findings show many renowned hospitals struggle to advance equity within their region.
Brookline, Mass.—A new ranking of U.S. hospitals shows that those with good clinical outcomes tend to score poorly in addressing inequities that affect the health of their communities.
The Lown Institute, a Brookline, Mass.-based nonpartisan think tank used never-before-considered measures for its Lown Institute Hospitals Index to help hospitals better serve and support their communities. The Index shows how nearly 3,300 U.S. hospitals compare on 42 performance indicators. The measures fall under three categories:
- Civic Leadership, which assesses a commitment to equity, inclusion and community health;
- Value of Care, which measures use of unnecessary services; and
- Patient Outcomes, which evaluates patient safety, satisfaction, and clinical outcomes.
“At a time when communities are relying on them like never before, hospitals must rethink what it means to be great,” said Vikas Saini, M.D., president of the Lown Institute. “COVID-19 highlights how hospitals are essential community partners for anyone in need. To be great, however, a hospital cannot only provide care that’s high in quality. It must also deliver value and advance equality. Our index is designed to help them do just that.”
Across all measures, four of the Index’s top 10 hospitals are located in Texas. While nationally known hospitals perform well on specific measures, few appear near the top of the rankings. The nation’s top 10 hospitals are:
- JPS Health Network — Fort Worth, Texas
- Marshall Medical Center — Placerville, Calif.
- UPMC McKeesport — McKeesport, Penn.
- Seton Northwest Hospital — Austin, Texas
- Mercy Health-West Hospital — Cincinnati, Ohio
- Wellstar Douglas Hospital — Douglasville, Ga.
- Providence Portland Medical Center — Portland, Ore.
- Health Alliance-Clinton Hospital — Leominster, Mass.
- Memorial Hermann Texas Medical Center — Houston, Texas
- Parkland Health and Hospital System — Dallas, Texas
“There are some very fine hospitals that feel forced to focus on profitable elective procedures to stay in business,” said Saini. “This can lead to business decisions that make them look good on outcomes like mortality, but at the expense of equity. The data show that gaps between a hospital’s clinical results and its performance in the community are sometimes very wide, which can contribute to disparities in care and put certain communities at risk.”
The Lown Index results are available at LownHospitalsIndex.org where people can compare hospitals based on location, hospital type, and metric. It is also the data source for the Washington Monthly’s “Best Hospitals for America” issue, released simultaneously.
Civic Leadership
Under “civic leadership,” the Index measures often-overlooked indicators that are essential to understanding how hospitals behave in their communities, both where they succeed and where improvement is needed. It’s different from other hospital rankings because it is the first to address how much hospitals spend on meaningful community benefits, as well as the proportion of low-income patients they serve. Nonprofit hospitals get billions of dollars in tax breaks every year but vary widely in how much they actually give in community benefits. For example, the Mayo Clinic Hospital in Rochester, Minn., benefits from tens of millions in tax breaks each year, but spent less than 0.05 percent of its total expenses on charity care in 2016, landing them near the bottom of the Lown community benefit ranking.
The Index is the first hospital ranking to measure inclusivity, or the degree to which a hospital is caring for patients of color and of lower income or education. It is also the first to measure the ratio of executive compensation to that of employees without advanced degrees. Many of the hospitals that perform best in civic leadership are not names most have heard before. For example, Lallie Kemp Medical Center is a critical access hospital in Independence, La., with 24 beds. It ranks in the top 20 nationally for Civic Leadership.
Value
To determine hospitals’ value of care, the Lown Institute assessed hospitals based on estimates of their rates of overuse, including hysterectomy for benign disease, head imaging for simple headaches, and 11 other procedures and tests. The Lown Institute is the first hospital ranking to use such a metric. The research found that for-profit hospitals and those in certain states, particularly in the South, were more likely to overuse low-value services measured. For example, three of the 20 lowest-ranked hospitals in terms of avoiding overuse are for-profit hospitals and four are located in Florida.
Outcomes
To determine hospitals’ patient outcomes, the Lown Institute used an algorithm called the Risk Stratification Index (RSI) that has been validated on multiple national, state-based and hospital-based datasets using billions of insurance claims. RSI has been shown to predict outcomes such as mortality with greater discriminatory accuracy compared with other publicly available risk adjustment tools.
“No other hospital ranking provides a 360-degree view of hospital performance,” said Shannon Brownlee, senior vice president at the Lown Institute. “Many of the best-known hospitals score highly on patient outcomes but poorly on civic leadership and value of care. Our data show that it’s possible to do well in all three categories, because some hospitals are doing it. That means all the people in their communities are being served effectively and fairly.”
The Index uses data from a wide variety of sources, including the 100 percent Medicare claims datasets (MEDPAR and outpatient); Internal Revenue Service pulled from Community Benefit Insight database; Healthcare Cost Report Information System administered by the Centers for Medicare and Medicaid Services;Securities and Exchange Commission filings; public records; Bureau of Labor Statistics; and other databases.
Founded in 1973 by Nobel Peace Prize winner Bernard Lown, MD, developer of the defibrillator and cardioverter, the Lown Institute focuses on health care issues such as medical overuse and underuse, health equity, and cost of care. The Institute believes a radically better system of health is possible and advances bold ideas to achieve this. Learn more at www.lowninstitute.org.
CONTACT
Aaron Toleos, Lown Institute, USA, (978) 821-4620, atoleos@lowninstitute.org
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