The Lown Institute on Tuesday released its annual list of the most "socially responsible" hospitals in the United States based on equity, value, and outcomes.

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Methodology

For the rankings, the Lown Institute excluded non-acute care hospitals, federal hospitals, hospitals outside the 50 states and Washington, D.C., hospitals within the Kaiser Permanente health system, and specialty hospitals with more than 45% admissions for orthopedic or cardiac procedures, and more than 80% for surgical procedures or elective surgeries.

Hospitals that were closed as of October 2021 and those with volumes below 50 annual patient stays were also excluded, leaving 3,764 eligible hospitals, including 549 for-profits, 2,444 private nonprofits, and 771 public nonprofits.

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:

• Equity, which included the subcomponents of pay equity (how much a hospital's executives are paid compared with its frontline workers); community benefit; and inclusivity (described as "the degree to which a hospital's patient population reflects the demographics of its community area")
• Value, which included the subcomponents of "avoiding overuse" and cost efficiency
• Outcomes, which included the subcomponents of clinical outcomes, patient safety, and patient satisfaction

The Lown Institute assessed performance across these categories and subcomponents 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 inpatient, outpatient, and carrier claims data on CMS' Virtual Research Data Center, and more.

The top 20 U.S. hospitals

In total, the Lown Institute ranked 3,764 hospitals for this year's list. The top 20 were:

1. Adventist Health Howard Hospital* (Willits, CA)

2. Duke Regional Hospital* (Durham, NC)

3. Tristar Horizon Medical Center* (Dickson, TN)

4. Boston Medical Center* (Boston, MA)

5. Salinas Valley Memorial Hospital (Salinas, CA)

6. Legacy Mount Hood Medical Center* (Gresham, OR) 

7. Banner-University Medical Center South* (Tucson, AZ)

8. Saint Alphonsus Medical Center-Nampa (Nampa, ID)

9. Saint Alphonsus Medical Center-Ontario (Ontario, OR)  

10. Denver Health Medical Center (Denver, CO)

11. St. Rose Dominican Hospitals-Rose de Lima (Henderson, NV)

12. St. Mary-Corwin Hospital (Pueblo, CO)

13. Saint Joseph Berea (Berea, KY)

14. St. Charles Prineville* (Prineville, OR)  

15. MetroHealth System (Cleveland, OH)

16. Stoughton Hospital* (Stoughton, WI)

17. Sutter Solano Medical Center* (Vallejo, CA)

18. Providence Milwaukie Hospital* (Milwaukie, OR)

19. North Suburban Medical Center* (Thornton, CO)

20. Baystate Wing Hospital* (Palmer, MA)

*Denotes an Advisory Board member

Rankings have previously drawn criticism from AHA

Last year, following the release of the 2021 rankings, the American Hospital Association (AHA) said the Lown Institute's index draws "sweeping and arbitrary conclusions" and uses "old and incomplete data."

Specifically, AHA took issue with the rankings' inclusivity metric as it looks only at Medicare data, which AHA said is not representative of the communities cared for by hospitals.

"Hospitals treat the patients who come through their doors regardless of their ability to pay, and those who do enter the hospital may or may not match with the demographics of the Medicare population," AHA said. "Yet Lown penalizes hospitals whose patient mix does not match the local Medicare population."

AHA also took issue with the rankings' use of mortality as the only clinical outcome to measure cost efficiency.

"These and other shortcomings may explain why researchers themselves acknowledge the index won't help patients actually choose between hospitals," AHA said. ("America's Most Socially Responsible Hospitals" rankings, accessed 6/29; "America's Most Socially Responsible Hospitals" methodology, accessed 6/29; Gooch, Becker's Hospital Review, 6/28)