Many top hospitals score low on equity, keeping them from a high score for social responsibility, a new analysis from the Lown Institute finds.
The healthcare think tank's Hospitals Index, which claims to be the only ranking to include equity as a major category, examined Medicare data from 2016 to 2018 across 3,000 hospitals, including those named in the latest U.S. News & World Report ranking. Criteria in the equity category included inclusivity, pay equity and community benefit. A full explanation of its methodology can be found on its website.
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.
In terms of rankings by state or district, Hawaii topped the list as most socially responsible, followed by Delaware and Washington, D.C. Rounding out the bottom of the list were Alabama, Mississippi and Arkansas. One-third of all hospitals on the honor roll are in California or Ohio. New Jersey, Maryland and Tennessee are also well-represented.
“It’s not enough for hospitals to say they’re committed to social responsibility. They need to put their commitment into action,” said Vikas Saini, M.D., president of the Lown Institute, in a statement. “Doing well on the Lown Index is one way they can demonstrate progress.”
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Here are the top 10 socially responsible hospitals, according to the Lown Institute's methodology:
- Carepoint Health-Christ Hospital, New Jersey
- Saint Michael's Medical Center, New Jersey
- Johns Hopkins Bayview Medical Center, Maryland
- Oroville Hospital, California
- University of Maryland Medical Center Midtown Campus, Maryland
- UNM Sandoval Regional Medical Center, New Mexico
- Mercy Hospital Clermont, Ohio
- Legacy Mount Hood Medical Center, Oregon
- Banner-University Medical Center South Campus, Arizona
- East Liverpool City Hospital, Ohio
The American Hospital Association (AHA) pushed back against the rankings, saying in a statement that the Institute “draws sweeping and arbitrary conclusions about hospitals and health systems using a mix of old and incomplete data and flawed methodologies.”
The AHA noted as an example that while the inclusivity metric only looks at Medicare data, there is a broader population not taken into account. “Lown penalizes hospitals whose patient mix does not match the local Medicare population,” an AHA spokesperson said in a statement. The use of mortality as the only clinical outcome to measure cost efficiency is also not accurate, the AHA argues, and won’t help patients make decisions about hospitals.
Hospital rankings regularly draw criticism from providers and trade groups. Earlier this year, for instance, the AHA argued that the Lown Institute’s report on hospital community benefits fell short. It also opposed federal hospital rankings put out for the first time by the Centers for Medicare and Medicaid in 2016.
Critics have historically suggested that scores do not take into account progress and may discourage hospitals from treating complex and marginalized populations, leaving groups like Leapfrog to defend their methodologies.
Ultimately, prioritizing equity should be all hospitals’ priority. In a session on health equity at the Atlantic Festival on Wednesday, Marcella Nunez-Smith, M.D., the White House COVID-19 Response Team’s senior adviser, noted that while COVID-19 did not create health inequities, it took advantage of them.
And while access to healthcare does play some role in determining health outcomes, other social factors drive the bulk of health inequities, like a lack of access to good nutrition or proper housing. To move forward and help advance equity, she urged local governments to partner with their communities, who best know what their people need. “Without intentionality, you will never achieve equity,” Nunez-Smith said.