Hospitals are usually judged on their quality of care, but a new ranking aims to also look at how much they contribute to their community with metrics like charity care and pay equity.
Using these standards, some hospitals known for providing exemplary care fared worse than normal in rankings, and others that don’t have a national reputation rose to the top.
That was the point, said Dr. Vikas Saini, president of the Lown Institute, a nonpartisan healthcare think tank that compiled the nationwide ranking of 3,282 hospitals.
“There are a lot of unsung heroes,” Saini said. “What we’re trying to do is create a new narrative and for all of us to think differently about hospitals — what they are doing and what they could do.”
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The institute rated every hospital in three areas: civic responsibility, patient outcomes and value of care, including what the institute considers "unnecessary" care.
The results were different than other well-known rankings based solely on patient care.
In the U.S. News and World Report’s hospital rankings, for instance, the Mayo Clinic of Rochester, Minnesota, ranked first, followed by Massachusetts General Hospital in Boston and Johns Hopkins University Hospital in Baltimore.
But in the Lown Hospitals Index, Mayo Clinic fell to 956 — almost out of the top third — because of its low rate of charity care, less than .5% of all care, and high level of unnecessary procedures. Massachusetts General ranked No. 394, mostly because of what the ranking deemed its lack of civic leadership, and Hopkins was No. 61.
By contrast, the top-ranking hospitals included many lesser known hospitals including JPS Health Network in Fort Worth, Texas; Marshall Medical Center in Placerville, California; UPMC McKeesport in McKeesport, Pennsylania; Seton Northwest Hospital in Austin, Texas; and Mercy Health-West Hospital in Cincinnati.
“At JPS, we never lose sight of why we are here: to deliver the very best care to every person who walks through our doors, regardless of circumstances, background, ability to pay," said Robert Earley, president and CEO of the study's No. 1-ranked hospital.
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In a statement, Erin Sexton, the Mayo Clinic's director of enterprise community engagement, defended her institution's long-term commitment to charity care and the partnership it has formed with the communities where it has facilities, including Rochester, Scottsdale and Phoenix, Arizona, and Jacksonville, Florida.
“Whether it is leading COVID-19 research, paving the way for more affordable housing, staffing school-based care clinics or investing in a mental health crisis center, we are committed to a comprehensive approach to improving lives every day,” according to the statement.
Mayo Clinic’s activities have been estimated to have more than $28 billion in positive economic impact on our communities each year and the institution paid nearly $171 million in taxes in 2019, Sexton wrote.
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Mayo’s leadership wants to learn more about the report’s methodology, Sexton added. “As an organization equally committed to the practice of medicine, medical education and medical research, evaluation of only a small portion of that work will likely fail to accurately reflect the unique value of Mayo Clinic,” she wrote.
Saini agreed that the rankings will be refined in future years.
For "value of care," the Lown index considered estimates of a hospital's use of care that isn't life-saving or won't make people healthier, including hysterectomies for harmless disease, head imaging for simple headaches and 11 other procedures and tests. For-profit hospitals and those in the South were more likely to overuse these low-value, high-returnservices, the institute found.
For quality, the Lown Institute used an algorithm called the Risk Stratification Index (RSI), which is based on insurance claims.
And for the new concept of "civic leadership," the institute measured inclusivity, or the degree to which a hospital is caring for patients of color and of lower income or education. It also compared executive compensation to that of employees without advanced degrees. On average, hospital CEO's earned about eight times as much as their employees, Saini said, but some earned as much as 20-, 30- or even 80-times more, even at nonprofit hospitals.
There's no right figure for a CEO salary, Saini said, "But what is a fair compensation has never been answered."
Boston Medical Center ranked 11th on the list, a position that’s rewarding but also frustrating, admitted Kate Walsh, president and CEO of the private nonprofit health system, which has an annual operating revenue of $4 billion.
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“We’re very honored by the recognition,” she said, but “11 is a tough number.” She said she wasn’t sure the health system would change any of its activities to rise into the top 10, but hoped that as the Lown Institute refined its measurements in future years, Boston Medical Center would naturally climb.
“It really reflects the wonderful commitment and diversity and energy on our campus,” said Walsh, whose system includes a 514-bed academic medical center, a network affiliation of 14 community health centers and a Managed Care Organization with more than 450,000 members.
The new rankings are not intended for patients to use when deciding their care, Saini said, but rather for communities to understand whether their hospital is a good member of the community, in addition to treating patients well.
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