Measuring what matters: How hospital rankings are evolving

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Hospital rankings serve as indicators of how organizations are performing compared to their peers, and they have historically been focused on outcomes and patient safety.

However, the thought process around ratings is evolving.

Last year, the Lown Institute, a Brookline, Mass.-based nonpartisan healthcare think tank, broke new ground with the release of the Lown Hospitals Index that includes metrics such as racial inclusivity, pay equity and community benefit spending. The institute is now releasing updated 2021 results for the full index starting with the May 4 announcement of the top hospitals in the U.S. for avoiding overuse of low-value tests and procedures.

Looking at the best hospitals to avoid overuse of low-value services "was a natural" choice, Lown President Vikas Saini, MD, told Becker's.

"We had been looking at the question of low-value care ever since a groundbreaking conference we organized nine years ago," he said. "Even prior to that, my colleague Shannon Brownlee had published a book called Overtreated, and my mentor, [the late Lown founder] Bernard Lown, MD, had been talking about too much intervention in cardiology for 40 years. That was kind of part of our background."

Amid Lown's work, other discussions around rankings have persisted. For example, when U.S. News & World Report released its best hospitals rankings for 2020-21 last July, it said it plans to have a methodology for evaluating hospitals' performance in health equity as well.

"Right now, it is all about outcomes and quality of patient care across 26 specialties and procedures and conditions. With the additions of measures of health equity and other aspects of care, that [will one day give] us yet another lens to add into that broader picture of which hospitals are the best," Ben Harder, who oversees methodology and data analysis for U.S. News' best hospitals honor roll, said at the time.

U.S. News hosted a webinar in January on measuring equity. And IBM Watson Health released its 2021 rankings of the top hospitals and health systems in April, in partnership with Fortune and with a new evaluation dimension: how hospitals improved the well-being of their surrounding communities.  

Later this month, the Lown institute is issuing the 2021 release of best hospitals for racial and economic inclusivity. Lown examined 3,000 U.S. hospitals for the list, specifically assessing the racial, income and educational profile of the patients that hospitals are taking care of.

"The issue around racial and economic inclusivity is clearly coming from lots of factors outside of healthcare. But I think what we're trying to say and what we're trying to show is that factors outside healthcare do shape and influence healthcare's structure, and to the extent that we within healthcare are able to recognize that and measure it, we do have the power to begin to alter some of those, especially things that are not inclusive, things like racial or class segregation," said Dr. Saini.

He said Lown looked at the demographic profiles of patients and identified how far those patients traveled to the hospital and what area they traveled from. That helped define the hospital's catching area/perimeter, and Lown then looked at the demographics of everyone who isn't coming to the hospital, even though they're within that same hospital's perimeter or service area. Then researchers compared the two to determine an inclusivity measure.

"If a hospital is exactly serving everybody demographically (in regards to income and education) as in their catchment area, then they represent a group that's actually fair or inclusive, and they receive an average score," explained Dr. Saini. "Hospitals that are doing less or taking care of fewer people of lower income, lower education or from minority backgrounds than are in their catchment area had a lower-than-average score, while hospitals serving those communities even more received an above-average score."

Overall, Dr. Saini sees Lown's rankings as an effort to measure what matters. He also sees them as a way to show that there are a number of hospitals achieving greater community engagement, cost effectiveness and social responsibility.

"What we're trying to show is the hospitals at the top of our list are showing that it can be done. It is quite possible. So, for us the rationale for doing this is to show by example what can be done and then participate in what needs to be a broader movement to have American healthcare to move in that direction. It's only when we're able to do that will we be able to solve the deeper problems in healthcare, including affordability," he said.

After Lown releases this year's list of best hospitals for racial and economic inclusivity, it will publish its full rankings for a second year in a row in late June. This year, Lown's rankings will add a metric of the cost efficiency of hospitals for the first time.

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