#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.

Dr. Saini on the decision to measure stent overuse:

“The issue with stents illustrates some of the deep problems in American medicine, which has to do with how do you decide when something works and when it doesn’t? How do you decide if it works, how much to pay for it? When something is discovered not to work and you’re already paying for it, how do you turn that down? These are all difficult questions, and they’re not new.”

Dr. Saini on treating healthcare like a market:

“I don’t want to walk into my doctor’s office thinking I’m at a McDonald’s. I want to be listened to. I want to be known. I want my background, my family to be known. I want the clinician to hear me and to give me advice. And I want the dollars and cents in the background.”

Dr. Saini on the feasibility of transformative healthcare change:

“If people had an opportunity to work together, crowdsourcing the design of the health care system they want for themselves, their families, and others, I think it’s doable. It’s a big project. But when did we stop trying big projects? Moonshots are what we should try to do, and this is one of the biggest moonshots there is really: fixing American health care.”

Dr. Saini on what a uniquely American healthcare system could look like:

My own view is that we can do a lot better than Medicare or Medicare For All. We can do better in a way that would be different from Canada, different from Europe, different from any other country. If very American, it would be decentralized. It would have a lot of local and regional autonomy and control. It would have elements that were tuned to the local culture…America could have the best health care system in the world.

The post LISTEN: The “biggest moonshot” is fixing American healthcare appeared first on Lown Institute.

While coronary stents can be lifesaving for an acute heart attack, decades of research shows that they are not beneficial for patients with stable heart disease. Yet hospitals perform hundreds of thousands of these procedures unnecessarily, exposing patients to needless risk and wasting billions.

Why do doctors continue to do procedures without evidence they benefit patients? At a panel discussion hosted by the Lown Institute, overuse experts David Brown, Thomas Power, Betty Rambur, and Vikas Saini discussed the implications of stent overuse, what causes overuse, and what we need to change. Watch the full video recording of the event below:

How prevalent is stent overuse?

The Lown Institute report found that more than one in five stents that hospitals performed from 2019-2021 for Medicare patients met criteria for overuse. Stents were defined as meeting overuse criteria for patients with a diagnosis of ischemic heart disease at least six months prior to the procedure, excluding patients with a diagnosis of unstable angina or heart attack within the past two weeks, and excluding patients who visited the emergency department over the past two weeks.

The rate of overuse varied widely among hospitals; at some hospitals, more than 40 percent of all stents were overuse, while at others, fewer than 10 percent were overuse.

The panelists found these numbers illuminating, but not shocking. In fact, Dr. Brown found the hospitals on the low end the most surprising, expecting even the low outliers to have much higher overuse rates.

“[These results are] the logical consequence of unbridled overuse of services.”

Betty Rambur, Professor of Nursing at the University of Rhode Island

What’s driving stent overuse?

Our panelists pointed out many reasons why a clinician might perform an unnecessary stent. The narrative of an artery being a “clogged pipe” that just needs to be opened is very convincing both for doctors and patients. In reality, a clogged artery is indicative of systemic heart disease that requires medication and lifestyle changes; simply opening one artery won’t prevent future cardiovascular events, said Brown.

“When a patient is shown a coronary angiogram showing right narrowing of an artery… there is an intuitive desire to make it go away.”

Dr. David L. Brown, Clinical Professor of Medicine, Keck Medicine of USC

Another reason is that guidelines are far behind the evidence, making change a slow process. Medicare’s coverage guidelines allow doctors to be paid for stents that we now know do not benefit patients — as long as Medicare will still pay for them, our health system will deliver them. Specialty guidelines also have not kept up with evidence. For example, the American Heart Association’s latest chest pain guidelines are “full of recommendations for procedural overuse…modeled on the clogged pipe paradigm of coronary disease” said Brown. “They’ve been missing in action, to say the least.”

And of course, financial incentives play a role. Our fee-for-service payment system incentivizes hospitals to do more elective procedures, and gives less to hospitals spending more time with patients or pursuing preventive measures. The $2.4 billion in waste from overused stents could be put to a much better use.

“There are harms to other patients by using healthcare dollars on low-value services, thereby depriving other patients of services that are higher value.”

Dr. Thomas Power, Senior Medical Director of Cardiology and Sleep Programs at Carelon Medical Benefits Management

Despite being the wealthiest country in the world, we have a “resource-constrained system” because not everyone can access the care they need. Imagine what the billions we spend on low-value care each year could do to change that.

The post The prevalence and harm of unnecessary stents appeared first on Lown Institute.

How often are these procedures happening, and where? How much are we wasting on these low-value services? And what can we do to prevent unnecessary care?

Join us Tuesday, October 31 as we discuss the impact of unnecessary stents with leading health experts and policymakers.

Meet the panelists

David L. Brown, MD

David L. Brown, MD is a general cardiologist and Clinical Professor of Medicine in the Division of Cardiovascular Medicine at Keck Medicine of USC. Dr. Brown received his undergraduate degree from the University of Texas and his medical degree at Baylor College of Medicine where he also trained in internal medicine and served as a chief medical resident. He trained in cardiology and hematology at University of California, San Francisco and interventional cardiology at the Cleveland Clinic. During his career he has practiced and taught interventional cardiology, critical care cardiology, consultative cardiology, and outpatient cardiology. He has published more than 300 abstracts, manuscripts and book chapters. His work has been cited more than 8500 times resulting in an h-index of 37. His primary research focus has been on outcomes research in cardiovascular disease with most of his research projects attempting to fill gaps in the knowledge base that come to light during direct patient care. He currently serves on the editorial board of JAMA Internal Medicine. 

Thomas Power, MD, MBA, FACC, MRCPI

Thomas Power is the Senior Medical Director of Cardiology and Sleep Programs at Carelon Medical Benefits Management and is responsible for the clinical components of those programs. Before coming to Carelon MBM, Dr. Power had three years of experience in cardiac imaging utilization management. He attended medical school at the University of Dublin (Trinity College) and completed residency and fellowship in cardiovascular diseases at Allegheny General Hospital in Pittsburgh, Pennsylvania. 

Dr. Power is board certified in cardiovascular diseases and is a Fellow of the American College of Cardiology (FACC). In addition, he holds a certificate from the Certification Council for Nuclear Cardiology, and he is a Professional of the Academy of Healthcare Management. He has been the recipient of several awards for excellence in clinical teaching and a research grant from the American Heart Association (AHA).

Betty Rambur, PhD, RN, FAAN

Betty Rambur, PhD, RN, FAAN is the Routhier Endowed Chair for Practice, Professor of Nursing, and Interim Dean of the College of Nursing at the University of Rhode Island.  She serves on the state’s Cost Trends Steering Committee, the Technical Advisory Panel for Reimagining Nursing Initiative “Reducing Barriers to Value-based Care Payments in NP-led Primary Care,” and as a member of the Medicare Payment Advisory Commission (MEDPAC).

Vikas Saini, MD

Vikas Saini, MD, president of the Lown Institute, is a clinical cardiologist trained by Dr. Bernard Lown at Harvard. He also serves as co-chair of the Right Care Alliance, a grassroots network of clinicians, patient activists, and community leaders organizing to put patients, not profits, at the heart of health care. Dr. Saini is an expert on the optimal medical management of cardiologic conditions, medical overuse, hospital performance and evaluation, and health equity. He has spoken and presented research at professional meetings around the world, and has been quoted in numerous print media, radio, and television.

The post REGISTER: How unnecessary stents harm patients and waste billions of dollars 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.

Join us on September 19 for a candid discussion with hospital leaders, policymakers, and Lown experts.

Meet the guests

Uché Blackstock, MD

CEO of Advancing Health Equity; Author of “Legacy: A Black Physician Reckons with Racism in Medicine”

Dr. Uché Blackstock is a physician and thought leader on bias and racism in health care. She is the founder of Advancing Health Equity, which partners with healthcare organizations to dismantle racism and to close the gap in racial health equity. Dr. Blackstock is a frequent contributor to major media outlets like MSNBC and NBC News. Her forthcoming book, Legacy: A Black Physician Reckons with Racism in Medicine, will be released in January 2024.

Selwyn O. Rogers, Jr., MD, MPH

Senior Fellow, Lown Institute

Dr. Selwyn O. Rogers Jr. is a surgeon and founding director of the University of Chicago Medicine Trauma Center. He previously served as vice president and chief medical officer for the University of Texas Medical Branch at Galveston. Dr. Rogers has also served as the chairman of surgery at Temple University School of Medicine and as the division chief of Trauma, Burn and Surgical Critical Care at Harvard Medical School. While at Brigham and Women’s Hospital (BWH), he helped launch the Center for Surgery and Public Health to understand the nature, quality, and utilization of surgical care nationally and internationally.

---

Elena Mendez-Escobar, PhD, MBD

Co-Director and Executive Director of Strategy, The Health Equity Accelerator at Boston Medical Center

Elena Mendez-Escobar is the co-director and Executive Director of Strategy at the Health Equity Accelerator at Boston Medical Center. Prior to this role, she co-founded McKinsey’s Center for Societal Benefit through Healthcare. She holds a PhD in Theoretical Physics from the University of Edinburgh and an MBA from MIT Sloan, and was named 40 under 40 by the Boston Business Journal earlier this year.

The post REGISTER: America’s Most Racially Inclusive Hospitals, 2023 appeared first on Lown Institute.

What do we get for paying hospital CEOs so much? The Lown Institute Hospitals Index, which evaluates hospital social responsibility, shows that CEOs don’t have to be paid excessively to garner good performance. Among the highest-performing hospitals on the Lown Index, most paid their CEO below average for hospitals of a similar size. On the other hand, some of the most prestigious hospitals with the highest CEO pay still fall short on equity metrics like inclusivity and community benefit spending.

“When we have too much of a compensation gap, when people around the country are saying ‘this seems outrageous,’ it subtracts from the moral energy of staff.”

Read Pearce, Chief Quality Officer, Denver Health at Lown Institute launch event

One union in Los Angeles is trying to address this issue by putting a ceiling on CEO pay for certain hospital executives. The ballot question, proposed by Service Employees International Union-United Healthcare Workers West, would cap Los Angeles hospital CEO pay at the level of the US President’s salary ($450,000).

Using Lown Institute data from fiscal year ending 2020, an analysis in KFF Health News shows how some Los Angeles hospital CEOs would be affected. The following are some of the highest-paid nonprofit hospital CEOs in Los Angeles from that year:

• Thomas Priselac, CEO of Cedars-Sinai Medical Center: $5.7 million
• Scott Reiner, former CEO of Adventist Health system: $2.4 million
• Rodney Hanners, CEO of USC’s Keck Medicine: $1.4 million
• John Raffoul, president of Adventist Health White Memorial: $867k
• Andrew Leeka, former CEO of PIH Health Good Samaritan: $735k

The ballot question has the potential to draw needed attention to the issue of nonprofit CEO salaries. These high salaries are a symptom of a bigger problem — the industrialization of healthcare. As nonprofit hospitals have become big businesses, their boards have taken on a corporate feel, there is more of an emphasis on revenue and growth, and executive pay packages have grown closer those in the for-profit hospital world.

The average nonprofit hospital CEO makes eight times what hospital workers without advanced medical degrees make, but some make as much as 60 times the rate of other workers. Putting the issue of pay equity in the hands of community members (who subsidize nonprofit hospitals with their taxes) is a worthy goal.

However, there are practical issues with the salary cap, as health policy experts pointed out in the KFF Health News article. There will likely be legal challenges from hospitals that have existing payment contracts with executives. There are also ambiguities around how benefits like healthcare factor into the cap. Only CEOs of privately-run hospitals would be subject to the rule, even though there are CEOs making more than $1 million at public hospitals. It’s unclear how the rule applies to hospitals of health systems, or CEOs that run more than one hospital.

There is also no guarantee that the money saved by paying executives less would go toward the salaries of other staff, so wages on the lower end would not necessarily improve –although the union is also pursuing an initiative to raise the minimum wage for healthcare workers to $25/hr, which would create a pay floor to complement the potential CEO pay ceiling.

“A lack of economic resources leads to stress and impacts health down the line. Workers need to be able to support their families, we need to lift them out of poverty.”

Veronica Flores, CEO of Rising Communities, at Lown Institute launch event

In a 2022 article in Health Affairs, we suggested that nonprofit hospital boards should take into account more than just hospital size or revenue when creating compensation packages. For example, CEOs could be rewarded for improving community benefit spending, staff diversity, or disparities in clinical outcomes. If it’s true that “you get what you pay for,” we should be rewarding hospital leaders for prioritizing equity, not just profits.

“As institutions dedicated to the public good and the health of their local communities, nonprofit hospitals should be measured by the value they create—both business value and social value.”

Vikas Saini, Judith Garber, and Shannon Brownlee, Health Affairs

The post How much hospital CEO pay is too much? This city is considering a cap on executive compensation 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.

But how do these high-performing hospitals for patient care do on metrics of equity and value? Here are the results from the Lown Hospitals Index.

US News hospitals on the Lown Index

The 22 US News honor roll hospitals perform well on outcomes and value, with all of them receiving “A” or “B” grades on both of these categories. However, none of these hospitals received an “A” grade on equity, and some of these hospitals have especially low rankings on certain equity metrics. For example, UT Southwestern hospital lands in the bottom 10% of all hospitals for community benefit and Cedars-Sinai Medical Center ranks in the bottom 1% for inclusivity.

There is also substantial variation among these hospitals when it comes to equity. For example, Rush University Medical Center received an “A” grade in inclusivity, while Northwestern Memorial Hospital– another Chicago hospital– received a “D.” Several US News hospitals, such as New York Presbyterian and Stanford Hospital received “A” grades in community benefit and had fair share surpluses in 2020, while other US News hospitals like Hospital of the University of Pennsylvania and the Mayo Clinic received “D” grades in community benefit.

These hospitals also differ in their CEO pay. As we wrote in our July 2023 report on social responsibility, some CEOs of US News hospitals were paid over $10 million in 2020. Most made over $1 million, but a few CEOs–including the leaders of Rush University Medical Center and Michigan Medicine– made less than that.

None of the US News hospitals hit the top 100 rank on the Lown Index, but Rush came very close, and several others are in the top 500. To see which hospitals in your state received all “A” grades on the Lown Index, take a look at our website!

The post US News “best” hospitals still falling short on equity appeared first on Lown Institute.

Academic Medical Centers (AMCs) are affiliated with medical schools and tend to be larger, well-resourced institutions. How do they perform on the Index? Let’s take a look…

Strong on outcomes and value

It’s not a secret that AMCs tend to have better patient outcomes compared to non-teaching hospitals, for both common and rare conditions. On the Lown Index, AMCs rank higher than their non-teaching peers on both clinical outcomes, although they perform about the same on patient safety and worse on patient satisfaction, on average (see table below). Only five AMCs received a “C” grade in clinical outcomes, and none received a “D” grade.

Besides clinical outcomes, AMCs also shine on avoiding overuse and cost efficiency, with more than half of AMCs receiving “A” grades on these metrics. AMCs have the advantages of academic affiliation and resources, allowing them to become hubs for clinical trials and physician training. Research from February suggests this may impact their success, as they’re able to recruit talent, share staff with nearby community hospitals, and coordinate care for patients with various needs.

Equity is the missing piece

However, where some AMCs fall short is equity. AMCs still rank slightly better on average in community benefit and inclusivity compared to non-AMCs, but they don’t do as well on these metrics as they do on most of the outcomes and value ones. Around 50 AMCs get “A” grades on community benefit or inclusivity, compared to about 100 that receive “A” grades on clinical outcomes. 

AMCs have especially poor rankings on pay equity, which may reflect the trend of high CEO pay at these hospitals. Given the great performance across other metrics, perhaps the high CEO pay is warranted. Many other hospitals also highly compensate their CEOs and do not deliver on social responsibility.

AMCs that do it all

It’s not easy to perform well on outcomes, value, and equity, but there are AMCs that have proven they can do it all. Four AMCs made our honor roll, meaning they earned A’s across all three of those metrics. Here are the top ten AMCs.

Top 10 Academic Medical Centers, Social Responsibility

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

The post How do academic medical centers perform on the Lown Index? appeared first on Lown Institute.