New hospital racial inclusivity ranking doesn't take service areas, outreach into account, critics say

A new ranking assessing which hospitals are best at serving people of color in their communities is drawing some criticism from low-scoring hospitals and the American Hospital Association, who say the Lown Institute's analysis doesn't consider the complexities involved in where patients seek care or the limitations of a hospital's service area. 

For the ranking of more than 3,200 U.S. hospitals, released May 25, nonpartisan healthcare think tank Lown looked at how well the demographics of a hospital's Medicare patients matched the demographics of that facility's surrounding communities. Data in the ranking is based on Medicare claims from 2018 as well as the U.S. Census Bureau's American Community Survey data from 2018. 

Among Lown's list of bottom 10 hospitals for racial inclusivity were Englewood (N.J.) Hospital and Medical Center, a 352-bed acute care teaching hospital, and Gateway Regional Medical Center, a safety-net facility based in Granite City, Ill., about 10 miles from St. Louis. 

Overall, Beth Ann Gailey, a spokesperson for Gateway Regional, said the ranking is not reflective of the service area for Gateway and other facilities that sit on state lines or in suburban areas near large cities, though she said Lown's work to highlight racial inclusivity for Medicare patients in hospitals is commendable.

"For Gateway, the 'community area' as defined by the Lown Institute includes several ZIP codes in the neighboring state of Missouri, including at least one that is densely populated and more than 90 percent non-Caucasian. These residents would need to pass four hospitals and cross the Mississippi River on their way to Gateway," she said. 

"While some of these patients do seek care at Gateway for various reasons, it would probably be unrealistic that the hospital would serve the entire population for such distant cities, especially for the 65+ patient population," Ms. Gailey said.

"Regardless from where patients come, it is Gateway's priority to provide them high quality, compassionate care in a safe and respectful environment," she said. 

Lown said hospitals received a higher ranking if they had higher patient counts from ZIP codes with greater proportions of nonwhite patients compared to their "community area" radius, defined by "the distance from which about 90 percent of the hospital's Medicare patients travel."

In Gateway's case, Lown said it found the community area radius was 16.5 miles, and within that, 84 percent of Gateway's Medicare patients admitted to the hospital resided there. 

"There are several examples of prior work in the literature on market area analyses that use 90 percent of a hospital’s patients as the definition. There are some that use 75 percent," said Lown. "Our method actually only allowed a full weighting of the demographics for the area containing 50 percent of patients. After that, we applied an attenuation function that reduced the weight we gave to race as we moved to the bounds of the community area."

In a statement from Englewood, hospital officials there also applauded the goal of transparent, publicly accessible data on inclusivity, but said they do not agree that their ranking accurately reflects the hospital's work to reach underserved and diverse audiences. 

"Englewood Hospital, our acute care facility, is in a unique location just minutes from the George Washington Bridge. We question how the survey determined the radius of our community. We also question the use of traditional Medicare claims, as this narrow lens is not a true reflection of the patients and communities we serve on an inpatient and outpatient basis over six counties in northern New Jersey and New York," the hospital said. 

Englewood said it has programs and services that specifically target underserved communities, including Asian, Black, and Hispanic members of its community. These include the hospital's population health strategy, its broadening its physician network's presence to include offices in many underserved communities in Bergen, Hudson and Passaic counties, and the community health needs assessment it conducts every three years to identify and measure the needs of the communities it serves. 

Lown responded, "While there are limitations in any study, we believe our methods are sound and can raise important questions for hospitals, including Gateway and Englewood. Clearly, these hospitals want to address the challenge of equity. Our data are here to help them if they are willing to be a little vulnerable in the interest of progress."

The American Hospital Association also expressed concerns about the Lown methodology and limitations of the analysis and said there is complexity involved in where patients seek care. 

The association also cited steps it and other organizations are taking to address health equity: "Among other tactics, hospitals are providing foundational implicit bias training to healthcare teams, analyzing data to identify and track potential disparities and engaging patient and family advisory groups on how to make their care as inclusive as possible." 

Lown Institute said that, "Sadly, there are few metrics such as ours that quantify the disparities in access that are obvious to anyone who looks. We hope those who aspire to leadership in dismantling structural racism and accelerating health equity welcome this new work. It's time for us all to be putting our shoulders to the same wheel."

The full rankings and additional methodology information is available here.  

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