Hospitals' charity care spending and other community benefits carry more weight in a new online ranking system that goes beyond traditional quality and safety information.
The not-for-profit Lown Institute developed the ranking system, which launched Tuesday and evaluates charity care spending, the amount of low-value services hospitals provide and their patient demographics compared with the community. Other popular ranking systems such as CMS' star ratings, the Leapfrog Group and U.S. News and World Report largely rely on outcomes measures to help consumers decide where to get care.
While the Lown Institute includes the typical Medicare quality measures in its ranking system, it also uses data from IRS 990 forms, SEC filings, CMS and the Labor Department to demonstrate hospitals' role in their communities. Unlike other ranking systems, it is not intended for patients to shop around for services, but rather for healthcare executives and policymakers to judge competitors and potential partners.
"What we are showing isn't news—there is a certain amount of inequity in healthcare," said Dr. Vikas Saini, president of the Lown Institute. "But what we have tried to do is paint this picture in a way that allows everyone to see it and all of us to think about how to do things better."
The ranking system uses three categories to evaluate hospital performance: patient outcomes, civic leadership and value of care. Each category is weighted at 50%, 30% and 20% respectively. Overall, 42 metrics are used in the rankings.
There are 3,359 hospitals included in the Lown Institute's ranking system, with each receiving an overall letter grade and a separate grade for its performance in each category.
Fort Worth, Texas-based JPS Health Network scored the best ranking on Lown's system. The hospital performed best in the civic leadership category, receiving high marks for its community benefit spending and inclusivity, which evaluates how well the patients served by the hospital reflect the demographics of the community. JPS Health touted the recognition on its social media and issued a press release.
Houston-based United Memorial Medical Center ranked worst overall, receiving a D- in the civic leadership and patient outcomes categories and B- for value of care metrics.
In individual categories, Houston's Harris Health System performed best in civic leadership, NYC Health + Hospitals/Kings County hospital in Brooklyn received the top value of care score, and Jupiter (Fla.) Medical Center scored the best on patient outcomes.
Users can rank hospitals by state as well as by the specific metrics within each category.
Saini said there is a "dilemma" with healthcare ranking systems in general because there are issues with data and quality measures, but it does give the industry a sense of which hospitals are "definitely doing better" than their peers.
The American Hospital Association slammed the Lown Institute's ranking system, saying its definition of community benefit is "too narrow" and doesn't recognize many ways hospitals contribute to medical research and professional training.
"The report uses confusing definitions and makes sweeping conclusions about hospital performance based on an incomplete set of data sources," said Nancy Foster, vice president of quality and patient safety policy at the AHA, in a statement.
The system also doesn't acknowledge that hospitals subsidize care for low-income patients due to lower payment from Medicaid, Foster said.
"The fact is that this report falls far short of criteria the AHA has endorsed for quality report cards and rating systems," she said.
Saini admits the data used in the ranking system is limited but that's a result of the information available at this time. He said CMS offers the most transparent look at claims data that commercial payers still keep hidden.
"There is not enough good national data for us to get a 360-degree view of hospitals in the healthcare system," he said.
In its methodology report, the Lown Institute said it excluded research and professional development training funds spent by hospitals because "these types of community benefit have been criticized in the health policy and health services literature as not directly benefiting community health."
Saini added that the Lown Institute was often limited in the data it could find for hospitals regarding community benefit spending and pay of CEOs as organizations report that information differently and some are more transparent than others. A 2018 Modern Healthcare in-depth report of hospital tax forms also found similar concerns.
Dr. John Mafi, an assistant professor of internal medicine at UCLA who has researched low-value care and quality measurement, took issue with some of the measures used by the Lown Institute. The ranking system evaluates low-value care based on how often a hospital employs 13 services.
The problem is, Mafi said, that many of the measures haven't been rigorously validated to indicate every time that the services turn out to be low value.
"Some of the measures they talk about, they use the terminology 'always overuse' metrics, and I don't agree with that language," he said. "I'm a primary-care physician and an expert on overuse, and I see a lot of gray."
Saini said the ranking system is far from perfect and may even have errors, but he's hopeful it will start a conversation in the industry about how hospitals operate in communities.
"What we have achieved is a first-time effort to gauge performance in a new way," he said. "Many renowned hospitals struggle to advance equity in their region."