The Lown Institute in partnership with Washington Monthly has released a new set of rankings marking the best hospitals and health systems in the United States based on patient outcomes, value of care, and civic responsibility.

Cheat sheet: See how the Lown Institute calculates its hospital index

Methodology

For the rankings, the Lown Institute excluded hospitals with fewer than 50 admissions per year, federal hospitals, hospitals that were not acute care, hospitals where a majority of patients are covered by Medicare Advantage plans, hospitals outside the United States, and hospitals specializing in cancer care and orthopedic or cardiac procedures. The institute also eliminated any hospitals that closed in 2019.

Eligible hospitals were given an overall letter grade based their performance across three categories, as well as separate grades for their performance in each individual category. The categories were:

• Patient outcomes, which accounted for 50% of the final ranking. This category included the sub-components of clinical outcomes, patient safety, and patient satisfaction;
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• Value of care, which accounted for 30% of the final ranking. This measure was based on one sub-component: How well a given hospital avoided "unnecessary care"—care that is neither live-saving nor makes people healthier—such as hysterectomies for harmless diseases or head imaging for headaches; and
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• Civic leadership, which accounted for 20% of the final ranking. This category included sub-components of pay equity, which compares how much a hospital's executives are paid compared with its front-line workers; community benefit; and inclusivity, which refers to "the degree to which a hospital's patient population reflects the demographics of its … area."

The Institute assessed performance across these categories and sub-components by pulling from sources such as CMS' Healthcare Cost Report Information System, the U.S. Bureau of Labor Statistics, IRS 990 forms, the U.S. Census Bureau's American Community Survey, Medicare Provider Analysis and Review administrative claims data, and more.

The top 20 hospitals in the US

In total, the Lown Institute ranked 3,282 hospitals. The top 20 were:

1. JPS Health Network (Fort Worth, Texas)*;
2. Marshall Medical Center (Placerville, California)*;
3. UPMC McKeesport (McKeesport, Pennsylvania)*;
4. Seton Northwest Hospital (Austin, Texas)*;
5. Mercy Health-West Hospital (Cincinnati)*;
6. Wellstar Douglas Hospital (Douglasville, Georgia)*;
7. Providence Portland Medical Center (Portland, Oregon)*
8. Health Alliance-Clinton Hospital (Leominster, Massachusetts)*;
9. Memorial Hermann Texas Medical Center (Houston Dallas)*;
10. Parkland Health and Hospital System (Dallas)*;
11. Boston Medical Center Corp. (Boston)*;
12. Norton Community Hospital (Norton, Virginia)*;
13. Lancaster General Hospital (Lancaster, Pennsylvania)*;
14. St. Luke's Regional Medical Center (Boise, Idaho)*;
15. St. Luke's Hospital-Anderson Campus (Easton, Pennsylvania);
16. St. Luke's Magic Valley RMC (Twin Falls, Idaho)*;
17. Milton S. Hershey Medical Center (Hershey, Pennsylvania)*;
18. University of Colorado Hospital Authority (Aurora, Colorado)*;
19. Mercy Medical Center (Cedar Rapids, Iowa)*; and
20. Sentara Halifax Regional Hospital (South Boston, Virginia)*.

*denotes an Advisory Board member

The Lown Institute also ranked the top health systems in the United States by "roll[ing] up" the scores and rankings of eligible hospitals. The top 20 systems were:

1. Loma Linda University Adventist Health Sciences Center (Loma Linda, California)*;
2. Presbyterian Healthcare Services (Albuquerque, New Mexico)*;
3. Summit Health (Chambersburg, Pennsylvania)*;
4. VCU Health System (Richmond, Virginia)*;
5. Duke University Health System (Durham, North Carolina)*;
6. Carle Foundation (Urbana, Illinois)*;
7. Stanford Health Care (Palo Alto, California)*;
8. Munson Healthcare (Traverse City, Michigan)*;
9. Lifespan Corporation (Providence, Rhode Island)*;
10. Monument Health (formerly known as Regional Health) (Rapid City, South Dakota)*;
11. Ephraim McDowell Health (Danville, Kentucky);
12. Hartford HealthCare (Hartford, Connecticut)*;
13. Fairview Health Services (Minneapolis, Minnesota)*;
14. Hawaii Pacific Health (Honolulu)*;
15. UCHealth (Cincinnati)*;
16. Yale New Haven Health System (New Haven, Connecticut)*;
17. Allina Health (Minneapolis, Minnesota)*;
18. UF Health Shands (Gainesville, Florida)*;
19. Emory Healthcare (Atlanta)*; and
20. University of Kansas Health System (Kansas City, Kansas)*.

*denotes an Advisory Board member

Rankings draw praise, criticism

According to Vikas Saini, president of the Lown Institute, by incorporating civic leadership rather than just patient outcomes, the new rankings aim to make hospitals "rethink what it means to be great." He explained, "What we're trying to do is create a new narrative and for all of us to think differently about hospital[s]—what they are doing and what they could do."

Civic leadership is especially important for hospitals because the health of people within their local communities "reflect[s] things outside the four walls of a hospital," Saini said. "If one patient is going back to a community without a lot of resources, where health equity is low, and another is going back to a wealthier community, their [long-term] health will be very different even if the quality of care in the hospital was identical. Hospitals have an obligation to improve the health of the outside community."

Leah Binder, president and CEO of the Leapfrog Group, praised the rankings, saying the decision to penalize hospitals within the rankings for performing a large number of low-quality procedures is "a breakthrough" in hospital ratings.

"We know inappropriate care is an extremely significant problem for the health care system," Binder said. "It's also a terrible tragedy for individual patients to go through an unnecessary procedure."

Sara Singer from the Stanford University School of Medicine also praised the rankings. "I love that they're measuring civic leadership," she said. "I also think they're right to evaluate overuse of low-value procedures: You want to be sure you aren't going to receive treatments you shouldn't be receiving."

However, Singer questioned whether all of the rankings' measures should be combined into one score. "I'm not sure civic leadership should influence where a patient chooses to get care as much as quality measures should, though I can see using it to decide where you might make a charitable contribution," she said.

But Saini said the rankings aren't meant to help patients decide where to seek care. Rather, the rankings should start a conversation among health care stakeholders regarding looking at the value of a hospital differently.

"It's also for community leaders—not for where they get their hip done—but for what kind of health care matters for them in their communities," Saini said.

In a statement, the American Hospital Association (AHA) said the rankings do not offer any "accurate and useful information" for consumers and instead provide "a hodgepodge of composite score, ranking, star ratings, and letter grades that will, at best, confuse consumers and likely mislead them."

Nancy Foster, VP for quality and patient safety policy at AHA, said the rankings use "confusing definitions and mak[e] sweeping conclusions about hospital performance based on an incomplete set of data sources."

Foster added that, for example, "most of the index's assessment of hospital quality and value is based on billing data for Medicare patients. Such data represent[s] only a portion of hospitals' patient population, and lack important clinical details needed for accurate performance calculation."

Saini acknowledged the limitations of the ranking system, but he said they stem from the lack of available information. "There is not enough good national data for us to get a 360-degree view of hospitals," he said, though he noted that the rankings will be continuously refined moving forward (Weintraub, USA Today, 7/7; Begley, STAT News, 7/7; Haefner, Becker's Hospital Review, 7/7; Castellucci, Modern Healthcare, 7/7; Frellick, Medscape, 7/7; Saini/Brownlee, Washington Monthly, July 2020).