New hospital rankings show ‘elite’ facilities struggle with health equity, inclusivity

Dive Brief:

  • A new ranking of U.S. hospitals found many renowned institutions with good clinical outcomes struggle to address health inequities in their communities.
  • The Lown Institute, a Massachusetts-based think tank, compared 3,300 U.S. hospitals on 42 performance indicators under three categories: care value, care quality and “civic leadership,” or a commitment to equity and inclusion measured by pay equity, community benefit and inclusivity.
  • It found an inverse relationship between inclusivity and patient outcomes that could be due to differences in resources or patient mix, with Lown researchers noting smaller, lesser-known hospitals are more inclusive than their well-known, well-funded peers in many cities. Though “elite” hospitals did well on some measures, few appeared near the top of the list.

Dive Insight:

Hospitals compete fiercely to end up in the top slots of a number of lists from government agencies like CMS and private groups like U.S. News & World Report, Healthgrades and Leapfrog. 

A report last year in the the New England Journal of Medicine found many rating systems misclassify hospital performance, which can mislead consumers. Yet in the opaque U.S. healthcare system, hospitals tout the rankings — which can produce drastically different results — as evidence of their superior medical abilities, nudging consumers to one site or another.

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. The think tank pulled data from a slew of sources, including CMS, the American Hospital Association and publicly available records from the IRS, SEC and Bureau of Labor Statistics.

The rankings are the first to take into account how well hospitals serve minority and low-income communities, according to Lown, partially by measuring the degree to which its patient demographics match those found in its community.

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.

“There are some very fine hospitals that feel forced to focus on profitable elective procedures to stay in business,” Lown Institute President Vikas Saini said in a statement on the index.

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,” Saini said.

The top-performing hospitals in the rankings are various sizes, but all are nonprofits located in urban areas. Larger, teaching hospitals, which the ranking found generally provide better care for common conditions and have lower rates of patient mortality, are overrepresented in the top 100.

However, many small rural facilities and safety net hospitals outrank other big name hospitals by doing slightly better on inclusivity, Lown said.

The top 10 hospitals in the Index are: 

  1. JPS Health Network, in Fort Worth, Texas
  2. Marshall Medical Center, in Placerville, California
  3. UPMC McKeesport, in McKeesport, Pennsylvania
  4. Seton Northwest Hospital, in Austin, Texas
  5. Mercy Health-West Hospital, in Cincinnati
  6. Wellstar Douglas Hospital, in Douglasville, Georgia
  7. Providence Portland Medical Center, in Portland, Oregon
  8. Health Alliance-Clinton Hospital, in Leominster, Massaschusetts
  9. Memorial Hermann Texas Medical Center, in Houston
  10. Parkland Health and Hospital System, in Dallas

UPMC McKeesport is managed by Pittsburgh-based system UPMC, which operates 40 hospitals in the region; Seton Northwest is owned by Catholic system Ascension, one of the largest hospital operators in the country with 150 hospitals across 20 states; Mercy Health-West is owned by 50-hospital operator Bon Secours Mercy Health and Providence Portland is owned by 51-hospital Catholic nonprofit Providence.

Nonprofit hospitals were only slightly more represented in the top 100 list compared to their for-profit peers, and nonprofits and for-profits were very similar in their scores for community benefit and inclusivity.

Lown experts called the result “unexpected” given that nonprofits have a mission to invest in community health — and have to do so, per IRS regulations, to justify their tax-exempt status. Nonprofits have faced rising scrutiny from regulators on this very issue.

Four of the top 10 performing hospitals are located in Texas, but hospitals in Connecticut, Delaware, Hawaii, Massachusetts, Maryland, Ohio, and Rhode Island have the best Lown Index rankings on average.

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