US News' hospital equity measures: A first look at what they'll cover

When developing a methodology for its hospital rankings, U.S. News & World Report always sets a research question it's trying to answer. 

"With our existing rankings, we have a very simple research question: Which hospitals take care of the sickest, most challenging patients and produce the best outcomes?" Ben Harder, managing editor and chief of health analysis, told Becker's.

Later this month, U.S. News is set to release new healthcare equity measures that build toward a complementary and equally important question: Which hospitals take care of the most disadvantaged, historically underserved populations and produce the best outcomes?

Becker's spoke with Mr. Harder July 9 to learn more about the new equity measures and what the U.S. News analysis revealed. 

Hospitals have a mission to serve their communities 

Most hospitals have a social mission to serve and benefit the people who live around them, Mr. Harder said. This applies to the patients who come for care, but also community members who haven't historically visited the hospital, but need healthcare.

Over the last decade, many hospitals have strengthened their mission statements and set their sights on tackling broader health challenges in their communities, including population health, environmental issues and structural racism. 

"When we talk about equity, a good part of what we're talking about is related to how hospitals serve that social mission and the communities that they're embedded in," Mr. Harder said. "It's important that they are not discriminating among patients who they treat or staff, but that's only part of it. We're looking at this much more broadly."

U.S. News' new emphasis on equity acknowledges hospitals' growing focus on this social mission and comes after several years of discussions with healthcare leaders who shared one overarching piece of advice: Don't let the perfect be the enemy of the good. Rather than setting out to develop "an all-encompassing index of health equity on day one," Mr. Harder said, U.S. News plans to study different facets of health equity and publish relevant information along the way.

What measures will be included this year?

The initial set of health equity measures are set to come out July 27 alongside U.S. News' 2021-22 best hospitals rankings.

The new measures look at the representation of patients who are treated at Medicare-accredited hospitals, relative to the demographics of the surrounding community. Mr. Harder said it's crucial for U.S. News — and other stakeholders — to have a basic understanding of which hospitals are serving which patient populations before they can develop and add more nuanced equity measures. 

"So we're looking at, at hospital A, what are the racial and ethnic demographics of the patients they choose to treat or choose them for treatment, and how does that compare to the community in which that hospital was located?" Mr. Harder said. 

For the analysis, Mr. Harder and his team focused on Medicare patients who received elective care at hospitals in their own communities. These parameters allowed the team to eliminate variables that could influence results, such as insurance coverage status or travel limitations for those outside the hospital's service area.

The team looked at each hospital's patient representation, relative to the surrounding community, for four racial and ethnic groups: Black, Native American, Hispanic. and Asian American and Pacific Islander. These four measures will be reported at the hospital level. 

There will also be a fifth measure that includes data for these four groups, along with a small number of patients with an "unspecified" demographic category in the Medicare data.

Mr. Harder underscored that the measures, which will not factor into the best hospital ratings, are descriptive data only — not judgments.

"We are not saying that every hospital should have exactly the same proportion of patients in their hospital as their community," he said of the analysis. "There are various reasons it might be different, and there may not be anything wrong with it, and there may not be anything possible to do about it."

U.S. News also plans to add more equity measures in the coming years. 

A snapshot of U.S. News' findings

"Not surprisingly, we have found that there are many hospitals that treat a very different population than the community in which they are embedded, whether that population is more white or less white than their community," Mr. Harder said. 

For about 80 percent of hospitals included in the analysis, patients from minority backgrounds received less elective care than expected given their representation in the community. At the remainder of hospitals, many of which have large charity care expenditures, this trend skewed in the opposite direction. 

While the analysis simply describes these trends, and not why they are occurring, Mr. Harder pointed to a well-established body of research showing that where patients go for care matters. 

"Not all hospitals are equal in quality," he said, and research shows patients from minority backgrounds tend to be treated at lower quality hospitals. If patients are being segregated to different hospitals or care, hospital leaders can't expect to achieve equitable outcomes, according to Mr. Harder. 

"It's just descriptive, but it does paint a very informative picture about the patchwork of how different populations are cared for in this country and where they are cared for," he said. "That is critical information for us and healthcare leaders to have as we try to understand how we can address disparities in this country."

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