#1 Review financial assistance and collection policies

Does your hospital allow patients to be sued for medical debt? What about denying nonemergency care for patients with outstanding debt? Knowing your hospital’s financial assistance and collection policies can go a long way toward improving social responsibility.

All nonprofit hospitals are required to have a policy around financial assistance outlining who is eligible for free and discounted care and how they can get it. Most also have a collections policy that shows what “extraordinary collection actions” the hospital is allowed to take if patients don’t pay (like garnishing wages, suing patients, or sending debt to collections).

However, the extent to which hospitals provide free and discounted care varies widely across the country. In most states, there aren’t strict rules about who should be eligible for assistance, so it’s up to hospitals to create their own policy. Hospitals also differ in the collections actions their policy allows them to take, with some allowing for legal action, reporting debt to collection agencies, and denying nonemergency care for patients with debt.

For hospitals looking to boost their financial assistance ranking on the Lown Hospitals Index, there may be room for improvement in their policies. Hospitals should examine their policies with the following questions in mind:

• Are the eligibility requirements broad and generous?
• Are patients being adequately screened for eligibility?
• Is the application short and easy to understand?
• Are there additional asset tests or residency requirements?
• Are aggressive collection actions allowed?

Reviewing these policies can help hospitals understand where they could expand eligibility or streamline the process to get aid to more needy patients.

#2 Invest in the social drivers that affect upstream health 

Clinicians know that most of what determines their patients’ health happens before patients even step foot in the hospital. Things like environment, education, neighborhood safety, housing, and nutrition make up the social drivers of health. Hospitals and healthcare systems can make a huge impact on community health by investing in these factors, even if they’re outside the hospital walls.

Some hospitals have been incredibly innovative in their programming around social drivers of health, including:

• Helping patients pay their utility bills
• Offering free food from food pantries 
• Investing in affordable housing
• Supporting the local economy through local contracting and hiring

On the Lown Index, we measure hospital spending on community investments like these. (See which hospitals are already at the top in your state!)

#3 Become champions for high-value care 

Overuse of medical services with no or little clinical benefit is unfortunately prevalent at U.S. hospitals. A recent report from the Lown Index found that hospitals delivered nearly 230,000 unnecessary coronary stents to Medicare patients from 2019-2021.

There are many things that hospitals can do to protect their patients from exposure to harm and unnecessary cost. For example, when Children’s Hospital of Colorado found out they had a very high rate of CT scan for abdominal pain (which is not recommended by pediatric specialty organizations), they created a plan of action. They implemented a new protocol to get surgeon consultation in the ER before a CT scan is ordered, to decide whether or not patients were at high risk of appendicitis. Within two years, the hospital cut its rate of these CT scans from 45% to 10%.

Hospitals will soon be able to evaluate their CT radiation dose compared to their peers, using CMS’ new metric on radiation quality. For hospitals that are using too high of a dose, they can undertake initiatives to educate clinicians about reducing their dose to avoid exposing patients to unnecessary harm. 

#4 Evaluate new AI tools with an eye toward equity and overuse

Artificial intelligence (AI) tools are taking off in health care, and hospitals are no exception. AI tools have the potential to improve patient outcomes, reduce administrative burden, and even improve health equity. For example, a recent study found that a new AI algorithm has the potential to identify knee pain in Black patients with osteoarthritis more accurate than radiologists. 

However, experts are also sounding the call about the potential for AI tools to exacerbate existing patterns of racial inequity and overuse in health care. For example, a study of AI diagnostic algorithms for chest radiography found that underserved populations (which are less represented in the data used to train the AI) were less likely to be diagnosed using the AI tool. And a Lancet study testing AI breast cancer screening found that AI-supported screening detected nearly double the number of (DCIS) low-grade cases than standard screening. 

Given these concerns, hospitals should take steps to ensure that their implementation of AI tools is socially responsible. Here’s how some hospitals are already doing this:

• NorthShore – Edward-Elmhurst Health and AVIA are working together to develop a generative AI plan for healthcare systems that focuses on the risks and opportunities of AI as well as guidelines to monitor their usage and effects.
• Hospital systems like CommonSpirit and Penn Medicine are collaborating with health systems and other organizations to screen for, identify, and eliminate biases within EHRs. 
• Houston Methodist Hospital created iBRISK, a breast cancer risk assessment tool supported by AI. iBRISK takes into account patients’ demographics and medical history before recommending future diagnostic testing. By targeting screening toward patients with the highest risk, we improve the chance of benefit from screening.

#5 Prioritize equitable pay for employees 

It’s no secret that a happy, healthy staff makes for better patient care. Improving employee satisfaction is easier said than done, but ensuring equitable pay for all employees is a good start. 

Compared to other nonprofits, hospitals are outliers in terms of how much they pay their CEOs. Lown Index data on pay equity found that nonprofit hospital CEOs are paid eight times the rate of hospital workers without advanced medical degrees, on average. Creating incentives for CEO pay based not only on financial performance but patient outcomes, community investment, and other social responsibility metrics, would help align incentives for leadership with those of the community.

Committing to providing a living wage for all hospital workers would be an incredible boost for financial security within the community. The median wage for health care support, service, and direct care jobs was $13.48 an hour in 2019. California took a giant step by raising the minimum wage for healthcare workers to $25 an hour. Because hospitals are often one of the largest employers in a region, raising the minimum wage helps to support local economic development, and could even improve community health. 

We’re envisioning a 2024 full of innovation and collaboration in the hospital space, and these socially responsible hospitals give us hope that this vision will become a reality. We hope you will join us next year as we continue to build the movement for socially responsible healthcare.

The post Five ways hospitals can be more socially responsible in 2024 appeared first on Lown Institute.

Bringing together Dr. Vikas Saini (the Lown Institute), Dr. Katherine Peeler (Boston Children’s Hospital), Dr. Omar Lateef (RUSH University Medical Center), and Dr. Thea James (Boston Medical Center), the discussion focused on the role of hospitals in addressing problems like moral stress and burnout and how a commitment to equity fits into their resolution. Watch the video of the event and read some of the highlights from the discussion.

The dilemmas facing hospitals 

Panelists emphasized the conflicting incentives for health systems between prioritizing equity and keeping the lights on. “The more right you do in health care, the more wrong your operating margin will report at the end of the year,” said Dr. Lateef. 

He shared how RUSH University Medical Center’s strategy during COVID-19 of taking as many patients from safety net hospitals as possible was an energizing force for physicians who saw the difference they were making in their community, but it created financial issues for the hospital. “Because we had lost so much money, we were going to fall below our debt covenant. We couldn’t pay our loans …. We had unprecedented losses through the pandemic,” he said.

Another key challenge for hospitals is making sure that the C-suite and frontline hospital staff are on the same page. “Hospitals often say they have a plan, but physicians who are in the trenches often don’t see this plan,” Dr. Peeler explained. “If hospital’s systems that support equity… aren’t clearly communicated, physicians find themselves in the tough position of not knowing how to actually access the resources in their own hospital to deliver the care their patients deserve,” she said.

And for hospital workers who had been trying to call attention to structural racism for years, it seemed suspect that leaders were vowing to improve equity only after it became popular to do so. “I couldn’t understand that while people don’t recognize inequity when it’s clearly in plain sight all day long, how can all of the sudden people have this commitment to equity?” said Dr. James.

How equity metrics help hospitals “do the right thing”

In order to bolster the contents and actionability of hospitals’ health equity plans, hospitals have to measure what matters and do so in a transparent way. “If we’re going to reframe what it means to be a great hospital, we need new metrics,” said Lown Institute President Dr. Saini. This goal is what drove the creation of the Lown Institute Hospitals Index for Social Responsibility, which evaluates hospitals on equity and value as well as outcomes. 

“Let’s measure things that aren’t currently being measured. Let’s do it in a way that’s transparent, and let’s measure things that would be really hard to game.”

Dr. Vikas Saini

However, it’s not just enough to measure health disparities or community investment – institutions have to be willing to internalize and act upon these results, said Dr. Lateef. That can be tough when the results bring feelings of discomfort and frustration for hospital systems. “We all feel like we’re doing an incredible amount of work and no one wants to hear that they’re not doing enough,” he said.

Equity-related measures in particular can provide a critical opportunity to increase the efficiency and impact of hospitals’ plans in the long-term, but only if hospital leaders take them to heart. “Metrics that look at equity should be discussed in boardrooms and when you’re doing that … you’ll drive change, said Dr. Lateef.

For Dr. James at BMC, to make strides on equity it was important to “look inside our own house,” she said. Their “Health Equity Accelerator” program started with hospital leaders meeting monthly in working groups to identify the biggest health disparities in their own patient population. Using this model, BMC has been able to reframe their approach to medicine by putting the identification and resolution of the root causes of ill-health at the forefront of their operations.

It’s not easy to remove health inequities that are baked into the system, but having health systems, researchers, and policymakers working together is a start. “In the same way that multiple forces led us to this moment over many decades, multiple economic, social, and political forces are going to be necessary to get us out of it and that means multiple solutions, different initiatives, multiple domains – all working together if we’re going to pull ourselves out of this tailspin,” said Dr. Vikas Saini.

The post WATCH: Hospitals reveal key challenges to achieving equity, and how they’re overcoming them appeared first on Lown Institute.

Women also face a long-documented “tampon tax” in the form of sales tax on menstrual products, which results in period poverty for many low-income Americans. Advocacy around this issue has resulted in positive policy changes; more than 15 states have exempted menstrual products from sales tax; the CARES Act of 2020 expanded the list of qualified medical expenses to include menstrual care products; and in May, Congresswoman Grace Meng reintroduced a bill to combat period poverty. 

Is there a “pink tax” in healthcare as well? A recent report by Deloitte* finds that women have 18% higher annual out-of-pocket costs on average compared to men. Notably, this estimate excludes pregnancy-related costs, which are typically credited for increased healthcare costs for women.

What explains this difference?

In general, women have more contact with the healthcare system. Women live longer than men and tend to seek out and receive healthcare at higher rates, which is a major contributor to their healthcare costs. Radiology, laboratory work, mental health, emergency room, office visits, physical/occupational therapy, and chiropractic care are all sought out at higher rates by women than men, according to the Deloitte report. The report also found that women tend to surpass their deductible from these encounters, leading to both a lower value in care for each premium dollar spent as well as higher out-of-pocket costs.

Specific checkups like gynecological exams or breast cancer screening do tend to be more expensive than other types of check-ups, though. We’ve written about the benefits and harms of early, widespread breast cancer screening before; this report comes to similar conclusions, advocating for more specific guidelines on who and when to screen.

While increased utilization of healthcare services is certainly not the only factor, it is a contributing one. Part of the problem may not actually be that we’re charging women too much, but that men aren’t receiving the healthcare they need. 

So, is the “pink tax” a problem in healthcare? Maybe. But maybe it’s just a symptom of other dysfunctions like the imbalance between underuse and overuse or general price gouging. 

*Due to the sex and gender data that was available, this report was constricted to the binary of men and women and does not represent gender-diverse people. For consistency, this blog follows those constraints.

The post Healthcare’s “pink tax” is more complicated than it seems appeared first on Lown Institute.

Last week, the American Medical Association (AMA) brought together experts to discuss issues of data and measurement in the latest edition of their National Health Equity Grand Rounds series. 

Event panelists included Lown Institute President Dr. Vikas Saini, Dr. Elena Mendez-Escobar (Boston Medical Center), Linda Villarosa (journalist, educator, and contributing writer to the New York Times Magazine), and Dr. Ryan Petteway (OHSU-PSU School of Public Health). 

“What [data] can do is create additional vehicles for people who want change…to take on the challenge of structural racism in the country.”

-Dr. Vikas Saini

The panelists tackled some of the most pressing questions related to data, metrics, and the path forward for equity in medicine, such as:

• How can we leverage data to better understand the experiences and outcomes of all patients?
• What does it look like to measure what matters?
• How can we move from research to action?
• How do we make sense of data overload in the 21st century?
• What should medical students and young health care professionals know about the future of equity in medicine?

“We view this as a time for a new paradigm [in healthcare]…the key issues are equity, accountability, and the value of care.”

– Dr. Vikas Saini

The post WATCH: The data we need for more equitable care appeared first on Lown Institute.

How have hospital equity officials addressed racism within their institutions and in healthcare, and what challenges have they faced? In Health Affairs, researchers from Brigham and Women’s Hospital, Harvard University, the American Hospitals Association, and the Commonwealth Fund surveyed 340 hospital equity officers from across the country. A smaller subset of 18 officers participated in longer qualitative interviews.

Advancements in equity

The survey results and interviews show where strides have already been taken towards health equity. Here are a few of the key takeaways on the positives:

• Buy-in for health equity work among hospital leadership appears to be high. Eighty-four percent of equity officers reporting that their CEO was very supportive of their efforts, and 64% said that the hospital board was very supportive.
• Data collection on demographic characteristics is widespread. A large majority (88-94%) reported routinely collecting data on patients’ race, ethnicity, language, and social determinants of health.
• Common activities to address racism include collecting information about instances of racism within the hospital (54% of officers reported doing this) and forging community partnerships to improve equity through events like listening sessions (66%).

“I think any executive needs the health equity lens. We should all have it.”

Equity officer interview participant, Health Affairs

Room for improvement

Researchers also identified obstacles to change and room for improvement:

• While support from hospital leadership for equity efforts was high, fewer respondents (52%) said they that clinical leaders were very supportive; some cited pushback from clinicians who saw health equity efforts as an accusation of bias.
• Not all institutions have committed to specific equity goals. Only 68% of survey respondents said that their hospital had specific goals or strategies to reduce inequities in the clinical care by race/ethnicity, and fewer than 50% had strategies for reducing disparities based on sex, gender identity, or sexual orientation.
• The biggest obstacles to change that officers cited were lack of diverse staff (25% reported as a “major obstacle”) and lack of a standardized way to record data on social determinants of health (26%). Some officers noted that the political climate kept them from announcing their equity initiatives publicly for fear of backlash.
• Relatively few respondents (22%) reported that their hospital was reviewing clinical algorithms for potential bias.
• Although almost all respondents said their institution collected data on race and ethnicity, only half said they used this data to stratify performance metrics (more likely in teaching and urban hospitals or systems). Why such a low rate? Officers cited doubt in the validity of this data and lack of systematic collection practices.

“Fuzzy data in, fuzzy results, right? So, we have a lot of fuzzy data.”

Equity officer interview participant, Health Affairs

Where to go next?

Equity officers identified the need for certain tools and guidelines that could help advance equity at their hospital:

• One of the largest barriers to using data has been a lack of standardized practices for collecting data, especially for social determinants of health. Issues of privacy and patient trust are important to consider when asking patients about health-related social needs.
• Equity officers noted the need for more tools and curricula for training hospital staff on DEI issues.

“What are the right clinical settings to collect [social determinants of health] data? How do we collect it in a confidential manner? When should it be collected? How often should it be collected? What do we do with the data once we have it?”

Equity officer interview participant, Health Affairs

Creating DEI positions is not a cure-all for healthcare inequities; it’s just the start. These findings provide a peek into how hospital equity leaders are making change, and how researchers and policymakers can help their work forward.

The post “We should all have an equity lens”: Insights from hospital equity officers appeared first on Lown Institute.

This debacle pushed Michigan’s legislature to revise its Lead and Copper Rule to 1) require water utilities to conduct inventory of existing water service lines in the next two years and 2) replace all the identified lead-containing lines by 2041. Michigan is the first state to require this proactive replacement and will be using funding from the Bipartisan Infrastructure Law of 2021 to complete the replacements.

There is no safe level of lead exposure, especially for young children. Lead exposure is known to impact neurodevelopment, translating to negative health impacts like mental illness and increased mortality down the line. Water through lead service lines is the primary source of exposure for children; it follows that replacing old lead service lines would be an effective preventative measure. But to what degree exactly? Let’s take a look.

The Breakdown

Dr. Hanna-Attisha and colleagues recently co-authored a cost-benefit analysis in Health Affairs, attempting to nail down the quantitative benefits of replacing lead service lines according to the revised Michigan Lead and Copper Rule. 

The analysis estimates 423,479 lead service lines in Michigan that should be replaced. Over a forty-year period (2020-2060), predicted benefits based on 5% per year replacement rate over the next twenty years are:

• A reduction in lead exposure for 420,800 newborns
  • 86% of which live in a household 250% below FPL 
  • 36% of which are non-white
• A net societal program benefit of $1.91 billion
  • $130 million in health cost benefits
  • $43 million in education cost benefits
  • $602.9 million in total benefits to Black households, which have been historically been disproportionately exposed to lead
• A societal return on investment of $2.44 per dollar invested

The estimated break-even year when societal benefits first exceed cost is 2038, meaning the break-even year would come 2 years before the project was even completed.

The authors note several limitations with their cost-benefit analysis. Lead exposure has numerous impacts on human health, such as its impact on aggression and violence, and this article was unable to capture the full scope of those health effects. This resulted in a conservative estimate of the total societal benefits of lead service line replacement, as not all the potential improvements could be captured in statistically significant ways. 

The state has four potential plans it could take to replace the lines on both a 10- and 20-year timeline. This analysis found that the expedited replacement timeline has the potential to benefit an additional 68,700 children and increase the estimated total net societal program benefits to $2.48 billion, up from $1.91 billion. 

Implications of these findings

Preventative care is often overlooked and devalued as not profitable, but this cost-benefit analysis calls that assumption into question. 

This data suggests that an effective way to follow through would be to invest in widespread, community-based preventative care. Rather than treating individual patients after lead exposure damage is done, it would be far more efficient and cost-effective to simply remove that exposure in the first place. 

Hospitals often include health equity as one of their core missions. Factors like income and insurance status are closely linked with health and can be difficult for hospitals to address. These findings suggest hospitals could make a significant positive societal impact by applying their community investment funds to public health interventions like de-leading water lines.

“By taking on a life in medicine, we have places ourselves on the front lines of some of the most important battlegrounds of society…sometimes that means being on guard for a city that’s being poisoned.”

-Dr. Mona Hanna-Attisha receiving the 2022 Bernard Lown Award for Social Responsibility

While this study only looked at Michigan, other states should take note. The country as a whole has a $14.2 billion “Fair Share” deficit, meaning most nonprofit hospitals spent less on charity care and community investment than the value of their tax breaks. What if we applied even a portion of those funds toward tangible, effective public health interventions? 

The research is certainly promising. A 1987 EPA cost-benefit analysis estimated the benefits to outweigh the costs by about 4 to 1. The Environmental Defense Fund estimates that lead service line replacement could prevent up to 6,150 deaths from cardiovascular disease alone and deliver societal benefits of up to $51 billion across the country. 

To be a strong, productive nation, we need to be healthy. Perhaps our best return on investment would be prioritizing preventative care, rather than attempting to whack-a-mole problems as they come up.

The post The estimated benefits of reducing lead exposure: cost-effective preventative care appeared first on Lown Institute.

Guest panelists were: 

• Dr. Uché Blackstock, ​​founder of Advancing Health Equity, which partners with healthcare organizations. Her forthcoming book, Legacy: A Black Physician Reckons with Racism in Medicine, will be released in January 2024.
• Dr. Selwyn Rogers, acclaimed surgeon and founding director of the University of Chicago Trauma Center. He was recently named an associate editor for the New England Journal of Medicine and serves as a member of the Lown Institute Board.
• Dr. Elena Mendez-Escobar, Co-Director at the Health Equity Accelerator at Boston Medical Center, responsible for strategy.

Why hospital segregation happens

The Lown Institute’s racial inclusivity metric shows how well hospitals serve patients from communities of color in their surrounding area. We consistently find that some of the most and least racially inclusive hospitals are in the same metro areas, demonstrating patterns of segregation in American cities. (See the cities with the most segregated hospital markets on the Lown Hospitals Index website.)

More than fifty years after segregation was outlawed, we still see segregation in healthcare in similar ways that we see in education and housing. In racially diverse urban areas, some hospitals are disproportionately serving communities of color while others disproportionately serve patients from whiter and wealthier areas.  

Why does this happen? Redlining and other forms of residential segregation; inequities in reimbursement rates for patients based on insurance status, which correlates with race; differences in hospital culture and staff diversity; and many other factors play a role. 

“What we’re really looking at are the long-term effects of structural racism and classism.”

Dr. Vikas Saini

However, just because hospital segregation is long-standing doesn’t mean we should tolerate or normalize it, panelists said. “People expect these differences to exist, and sometimes that can paralyze us. It shouldn’t be this way,” said Dr. Mendez-Escobar. 

Policy solutions for more inclusive hospitals  

How do we begin to solve such a complex and entrenched problem? One of the big structural elements that perpetuate segregation is the way we pay hospitals–giving them more to care for patients with private insurance, and more to perform elective procedures rather than preventive care. 

“We pay [hospitals] for doing stuff…there’s not a lot of pay in not doing stuff, and there’s even less pay in preventative things that for the most part fall into the public health realm.”

Dr. Selwyn Rogers

We’ve created a “two-tiered system,” said Dr. Mendez-Escobar. It’s not only a segregated system but it’s also unequal, as the hospitals serving more patients of color tend to have the least amount of funding, she said.

In many ways, segregated hospital markets reflect a “segregated insurance market,” said Dr. Saini. “It seems pretty obvious that if all patients meant the same revenue opportunity for everybody all the time…we’d go a huge way toward removing some of the structural impediments,” said Saini.  

This can have a large impact on who can access care or feels welcome at certain hospitals. For example, Dr. Blackstock recalled working at an academic medical center where EMTs did not bring certain patients to the hospital because they were worried about getting in trouble for doing so.

But that’s just one piece of the puzzle, panelists said. Even a single-payer system wouldn’t solve the issues of structural racism that impact health access. Dr. Blackstock noted that communities that have high levels of interaction with police have greater mistrust in the health system, and therefore may not seek treatment for unmet health needs even if they have insurance. “We really have to understand the myriad of ways that systemic racism plays out,” she said. 

What hospitals can do

Larger policy changes are undoubtedly needed to close racial health gaps, but there are still many things hospitals can do on an individual level to improve inclusivity and reduce disparities. 

“Hospitals can’t change the past, we can’t change the present, but we can influence the future. We have to be intentional.”

Dr. Selwyn Rogers

One way to tackle upstream health outcomes is through equitable hiring decisions and investing more into communities of color. Income is one of the key social drivers of health and hospitals are often some of the largest employers in their community; the decisions hospitals make about who to hire, who they promote, and how they procure resources can have a large impact in financial security of their communities. BMC offers financial coaching to patients as one way to improve financial security as well, said Mendez-Escobar. “If you’re the economic engine, buy local,” Rogers added. 

To make a difference in health disparities, hospitals have to see equity as a quality issue, panelists said. That means tracking outcomes metrics across racial, ethnic, and socioeconomic groups, identifying disparities, and evaluating the impact of interventions. For example, at BMC there was a large racial disparity in how long it took patients to undergo a cesarean section after they had decided to have the surgery. A longer time before surgery creates more opportunity for complications. By standardizing a goal of 60 minutes or less for all patients, outcomes improved for patients of all races, but especially helped Black patients. 

“This is not rocket science. This is really about centering the communities that your hospital has a mission to serve.”

Dr. Uché Blackstock

Additionally, involving community members directly in hospital decision-making is key. At UChicago, they have a community action council, of about 20 representatives from the community, who provide guidance and advice to hospital leaders. Dr. Blackstock agreed that hospitals can “look more at community governance models where community members, employees, even patients are involved in helping develop health equity metrics to ensure transparency.”  

For much more on this topic, watch the full video of the event and see the racial inclusivity results from the Lown Hospitals Index.

The post WATCH: How hospitals can improve racial inclusivity appeared first on Lown Institute.

Many of the most and least inclusive hospitals are in the same cities, analysis finds

BOSTON, MA – Most hospitals say advancing health equity in their communities is a priority, and a new report examines just how well they’re doing. The Lown Institute, an independent healthcare think tank, ranked over 3,000 U.S. hospitals on how well they served patients of color, using Medicare data from 2021.

Disparities in healthcare outcomes and access are well-documented in communities of color, including higher rates of chronic conditions, lower life expectancy, and lower rates of private insurance. Lown examined the racial and ethnic demographics of patients to gauge how effectively hospitals target care to those populations. Racially inclusive hospitals served more patients of color than expected based on the demographics of their service area.

“It’s refreshing to see that some hospitals make caring for those most in need their top priority,” said Vikas Saini, MD, president of the Lown Institute. “Inclusive hospitals show that it’s possible to serve everyone, even when it may be against their financial interest.”

The following hospitals are the most racially inclusive in America:

1. Boston Medical Center (Boston, MA)
2. John H. Stroger Jr. Hospital (Chicago, IL)
3. UChicago Medicine (Chicago, IL)
4. Penn Presbyterian Medical Center (Philadelphia, PA)
5. Metro Nashville General Hospital (Nashville, TN)
6. South Coast Global Medical Center (Santa Ana, CA)
7. St. Charles Madras (Madras, OR)
8. Grady Memorial Hospital (Atlanta, GA)
9. Methodist Hospitals (Gary, IN)
10. Emory University Hospital Midtown (Atlanta, GA)

Segregated healthcare markets

The Institute also found that many of the most and least racially inclusive hospitals are located in the same U.S. cities, reflecting segregated healthcare markets. Of the 11 metro areas identified by the Lown Institute with significant market segregation, New Orleans stands out at the top of the list, with seven of its 14 hospitals (50%) ranking among the most or least inclusive.

The U.S. cities with the most segregated hospital markets are:

1. New Orleans, LA
2. St. Louis, MO
3. Detroit, MI
4. Milwaukee, WI
5. Philadelphia, PA
6. Kansas City, MO
7. Chicago, IL
8. Denver, CO
9. Phoenix, AZ
10. Dallas/Fort Worth, TX
11. Atlanta, GA

The most segregated hospital markets were determined by examining the proportion of hospitals within a metropolitan statistical area receiving either 1 star (lowest score) or 5 stars (highest score) on Lown’s racial inclusivity ranking. All cities included on the list had more than 20% of hospitals at those extremes.

“Hospitals will say their doors are open to everyone and that they don’t turn anyone away, but that can be misleading,” said Saini. “If hospitals really want to undo structural racism’s hold on their communities, they can’t be bystanders. They need to act more systematically and with more intention.”

For additional ranking information, including a full explanation of methods, see the online report.

###

SEE ALSO:
The 50 most racially inclusive hospitals in America
U.S. News Honor Roll hospital racial inclusivity rankings
Each state’s most racially inclusive hospital

About the Lown Institute

Founded in 1973 by Nobel Peace Prize winner Bernard Lown, MD, developer of the defibrillator and cardioverter, the Lown Institute believes that a radically better system of health is possible and generates bold ideas towards that goal. The Lown Institute Hospitals Index for Social Responsibility is a signature project of the Institute and features measures never used before like racial inclusivity, avoidance of overuse, and pay equity.

MEDIA CONTACT: Aaron Toleos, Lown Institute, (978) 821-4620, atoleos@lowninstitute.org

The post PRESS RELEASE: Think tank identifies America’s most inclusive hospitals appeared first on Lown Institute.

Artificial intelligence (AI) has become a key tool for industries to boost productivity and reduce administrative burdens. As health equity has become a central focus for hospitals and other healthcare institutions, how could AI help – or hinder – these efforts?

What is AI?

At its core, AI operates in a similar way as humans. Just as we read and consume information, pick up patterns, learn from experience, and solve problems, computers can mimic these behaviors. If you’ve ever communicated with a chatbot, talked to a Siri or Alexa, or used autocorrect and other text editors, you’ve made use of artificial intelligence.

Some AI programs are programmed to have pre-determined rules and outcomes (traditional, or rule-based AI). For example, a rule-based AI could be a program that flags certain patients, based on pre-prescribed symptoms and risk factors present in their medical record.

Other AI programs are provided with large amounts of data to “train” the computer, allowing it to develop a knowledge base that can evolve and expand as it is introduced to more information. When posed with questions or requests, AI systems comb through their knowledge base to search, synthesize, and report information. These are known as data-based, or machine-learning algorithms. Some programs use both approaches together.

How healthcare systems are using AI

Much of healthcare’s use of AI has focused on record-keeping, clinical research, and patient diagnoses and linkages to care. Leveraging AI has allowed medical providers to create individualized treatment plans, predict and map epidemics, flag certain patients for high risk of COVID-19 complications, and take notes during visits automatically.

For example, Microsoft and Epic – the electronic health record (EHR) platform – have partnered to use AI to streamline clinical summarization and documentation efforts. The Mayo Clinic will utilize a Google cloud generative AI tool to provide staff with immediate and expansive access to clinical information and research. And on the health equity front, companies are popping up to promote AI tools that identify and measure health disparities and track progress on health equity metrics.

Efficiency versus accuracy

Although AI has great potential, these programs have been criticized for exacerbating structural and systemic inequities. AI algorithms are generated within the confines of structural inequities that devalue communities based on aspects of their identities, including race, ethnicity, gender, sex, etc. AI’s knowledge base is then infused with these biases. 

Here’s a real-world example of how that happens: Health systems were using an algorithm to predict which patients had the greatest health needs. The model used healthcare spending as a proxy for illness, under the assumption that patients with the highest healthcare utilization had the greatest need. Researchers later found that there was substantial bias in the model – because Black patients were less likely to be able to access care (even when they needed it), they were deemed to have lower health needs. As a result, these patients were getting overlooked, with only 18% receiving additional help when 47% needed it. 

This is not an isolated incident. AI has proven far more successful in diagnosing cystic fibrosis than sickle cell disease, a health condition that disproportionately affects Black communities and suffers from an overall lack of research, despite the conditions’ similar genetic nature and severity. A study of AI diagnostic algorithms for chest radiography found that underserved populations (which are less represented in the data used to train the AI) were less likely to be diagnosed using the AI tool. Researchers at Emory University also found that AI can detect patient race from medical imaging, which has the “potential for reinforcing race-based disparities in the quality of care patients receive,” according to Emory radiologist Judy Gichoya.

Technology with accountability

Having identified the ways AI can reinforce inequities, we must prioritize the strategic use of AI. Organizations and researchers alike have taken steps to hold technology accountable and ensure AI is used ethically. Here’s what some of our hospital systems and policymakers are doing now:

• Last year, the FDA released guidance stating that certain AI tools should be regulated as medical devices. The FDA is also working on finalizing more rules around the security, quality, and validation of AI models.
• NorthShore – Edward-Elmhurst Health and AVIA are working together to develop a generative AI plan for healthcare systems that focuses on the risks and opportunities of AI as well as guidelines to monitor their usage and effects.
• Hospital systems like CommonSpirit and Penn Medicine are collaborating with health systems and other organizations to screen for, identify, and eliminate biases within EHRs. 
• The National Institutes of Health launched the All of Us Research Program to collect data from at least one million U.S. citizens to generate one of the largest and most diverse medical datasets.

Moving forward, here are some strategies that organizations can use to prevent AI from driving more disparities:

Education

• Educating the public and healthcare professionals on AI in terms of what it is, how it’s used, and its implications on care provision.
• Generating awareness of the data that is being used in terms of who it was collected by, how the information was gathered, and the population in which the data represents.

Regulation

• Creating equity criteria to evaluate and screen algorithms for the presence of inequity.
• Requiring more information from companies developing AI on the demographics of the datasets used
• Forming regulatory bodies and standards for AI generation and usage.

Research

• Collecting and using diverse data to create accurate views of disease and mortality across racial and ethnic groups.
• Accounting for genetic diversity in datasets to ensure effective precision medical treatments.

As we continue to leverage AI as a tool of efficiency and productivity, we must be intentional about its use and anticipate the impact it will have on society. It’s time that the healthcare system at large takes the necessary steps to use the power of AI for good.

The post Leveraging AI to reduce health disparities: A closer look at the possibilities appeared first on Lown Institute.

Critical Access Hospitals

In order to qualify for Medicare’s Critical Access Hospital designation, hospitals must have no more than 25 inpatient beds, be in a rural area at least 35 miles from the nearest hospital or 15 miles by secondary roads, and maintain 24-hour emergency care services 7 days a week. Without these hospitals, patients in these areas would struggle to receive care. The top 4 are amongst only 54 hospitals in the country to earn a spot on the Lown Index Honor Roll by scoring straight A’s.

When comparing Critical Access and acute care hospitals, some differences jump out. Critical Access Hospitals tend to struggle more on clinical outcomes and cost efficiency, but excel on patient satisfaction and pay equity. This may reflect the trends of fewer resources, lower CEO pay, and more personalized care that are common characteristics of small, rural hospitals. Critical Access Hospitals are not ranked on patient safety or avoiding overuse because of their extremely low patient volume.

Top 10 Critical Access Hospitals, Social Responsibility 2023

Learn more about the Index and see how your hospital performed by visiting our website.

The post How do Critical Access Hospitals perform on the Lown Index? appeared first on Lown Institute.